title: Impact of early and standardized treatment with amiodarone on therapeutic success and outcome in pediatric patients with postoperative tachyarrhythmia.
abstract: OBJECTIVE
  Effects of timing of inception of amiodarone antiarrhythmic treatment after corrective surgery for congenital heart defects are not yet well defined.
  
  
  METHODS
  In a 10-year prospective observational study, 71 of 2651 patients (2885 procedures, 2106 bypass procedures) received amiodarone for newly detected postoperative atrial (n = 70) or ventricular (n = 7) tachyarrhythmia: early treatment (initiation within 60 minutes of arrhythmia detection) and late treatment (after that). From an interim analysis, a treatment protocol was established (32 patients). Inotropic requirements were monitored, as were heart rate, blood pressure, central venous pressure, and sedation requirements.
  
  
  RESULTS
  With early treatment (n = 29), delay before start of amiodarone was 40.7 +/- 21.9 minutes, versus 227.7 +/- 228.1 minutes (P < .001) with late treatment (n = 42). There were significant benefits of early treatment for times to rate (155.9 +/- 299.8 vs 407.6 +/- 376.9 minutes, (P < .001) and rhythm control (400.4 +/- 845 vs 1038.5 +/- 1158.4 minutes, P < .001), reduction in dose needed for rate control (28.2 +/- 45.2 vs 66.5 +/- 137.5 mg, P < .025), and significant reduction in pediatric cardiac intensive care unit stay (3.32 +/- 1.9 vs 5.26 +/- 4.27 days, P < .01). There were continuous improvements in heart rate, blood pressure, and filling pressures without additional inotropic requirements or side effects.
  
  
  CONCLUSIONS
  Early treatment of postoperative tachyarrhythmia with amiodarone according to a standardized treatment protocol is safe and has beneficial effects on arrhythmia control and pediatric cardiac intensive care unit stay.
authors.affiliation: Department of Paediatric Cardiac Intensive Care, The Prince Charles Hospital, Brisbane, Australia. nikhaas@hdz-nrw.de
authors.forename: Nikolaus A
authors.initials: NA
authors.lastname: Haas
authors.forename: Christoph K
authors.initials: CK
authors.lastname: Camphausen
mesh_terms: D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002496:Central Venous Pressure / Q000187:drug effects; D003422:Critical Care; D006330:Heart Defects, Congenital / Q000601:surgery*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D011183:Postoperative Complications; D011446:Prospective Studies; D013610:Tachycardia / Q000188:drug therapy*
chemical_list: D000889:Anti-Arrhythmia Agents; D006993:Hypnotics and Sedatives; D000638:Amiodarone