Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement

Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement

1. Josep Brugada1,*,
2. Nico Blom2,
3. Georgia Sarquella-Brugada3,
4. Carina Blomstrom-Lundqvist4,
5. John Deanfield5,
6. Jan Janousek6,
7. Dominic Abrams7,
8. Urs Bauersfeld8,†,
9. Ramon Brugada9,
10. Fabrizio Drago10,
11. Natasja de Groot11,
12. Juha-Matti Happonen12,
13. Joachim Hebe13,
14. Siew Yen Ho14,
15. Eloi Marijon15,
16. Thomas Paul16,
17. Jean-Pierre Pfammatter17 and
18. Eric Rosenthal18

+ Author Affiliations

1. ¹Paediatric Arrhythmia Unit, Cardiology Department, Hospital Sant Joan de Déu-Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
2. ²Department of Pediatric Cardiology, Leiden University Medical Center and Academical Medical Center Amsterdam, 2300 RC Leiden, The Netherlands
3. ³Paediatric Arrhythmia Unit, Cardiology Department, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
4. ⁴Department of Cardiology, Uppsala University, s-75236 Uppsala, Sweden
5. ⁵Cardiothoracic Unit, Great Ormond Street Hospital, Great Ormond Street, WC1N 3JH London, UK
6. ⁶Children's Heart Centre, University Hospital Motol, 15006 Prague, Czech Republic
7. ⁷Cardiac Electrophysiology Division, Department of Cardiology, Children's Hospital, Boston, 02115 MA, USA
8. ⁸Medizinische Fakultät, Kinderspital Zürich, 8032 Zürich, Switzerland
9. ⁹Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona-IdIBGi, 17003 Girona, Spain
10. ¹⁰Arrhythmia Unit, Pediatric Cardiology and Heart Surgery Department, Bambino Gesù Pediatric Hospital and Research Institute, Palidoro, 00055 Fiumicino, Italy
11. ¹¹Department of Cardiology, Erasmus MC, 3015 Rotterdam, The Netherlands
12. ¹²Department of Pediatric Cardiology, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, 00290 Helsinki, Finland
13. ¹³Center for Electrophysiology, 28277 Bremen, Germany
14. ¹⁴Cardiac Morphology Unit, Royal Brompton Hospital and Imperial College London, SW3 6NP, UK
15. ¹⁵Paris Cardiovascular Research Center, Inserm U970, European Georges Pompidou Hospital, 75908 Paris, France
16. ¹⁶Department of Pediatric Cardiology and Intensive Care Medicine, Childreńs University Hospital, Georg-August-University, 37099 Göttingen, Germany
17. ¹⁷Pedriatic cardiology, University of Bern, 3010 Bern, Switzerland
18. ¹⁸Evelina Children's Hospital, Guy's & St Thomas’ Hospital, SE1 7EH London, UK

1. ↵*Corresponding author: E-mail: Jbrugada@clinic.ub.es

1. Peer reviewers: Farre Jeronimo, Kriebel Thomas, Mavrakis Iraklis, Napolitano Carlo, Sanatani Shubhayan, Viskin Sami

Abstract

In children with structurally normal hearts, the mechanisms of arrhythmias are usually the same as in the adult patient. Some arrhythmias are particularly associated with young age and very rarely seen in adult patients. Arrhythmias in structural heart disease may be associated either with the underlying abnormality or result from surgical intervention. Chronic haemodynamic stress of congenital heart disease (CHD) might create an electrophysiological and anatomic substrate highly favourable for re-entrant arrhythmias.

As a general rule, prescription of antiarrhythmic drugs requires a clear diagnosis with electrocardiographic documentation of a given arrhythmia. Risk–benefit analysis of drug therapy should be considered when facing an arrhythmia in a child. Prophylactic antiarrhythmic drug therapy is given only to protect the child from recurrent supraventricular tachycardia during this time span until the disease will eventually cease spontaneously. In the last decades, radiofrequency catheter ablation is progressively used as curative therapy for tachyarrhythmias in children and patients with or without CHD. Even in young children, procedures can be performed with high success rates and low complication rates as shown by several retrospective and prospective paediatric multi-centre studies. Three-dimensional mapping and non-fluoroscopic navigation techniques and enhanced catheter technology have further improved safety and efficacy even in CHD patients with complex arrhythmias.

During last decades, cardiac devices (pacemakers and implantable cardiac defibrillator) have developed rapidly. The pacing generator size has diminished and the pacing leads have become progressively thinner. These developments have made application of cardiac pacing in children easier although no dedicated paediatric pacing systems exist.

Key words

• Paediatrics
• Arrhythmias
• Antiarrhythmic drugs
• Radiofrequency ablation
• Electrical devices

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