title: Successful treatment of pallid breath-holding spells with fluoxetine.
abstract: Pallid breath-holding (PBH) is a childhood condition that presents with recurrent syncope. Although typically benign, severe cases can lead to asystole and anoxic seizures. Previous studies have advocated pacemaker placement to abbreviate symptoms. This was a retrospective study of patients treated with fluoxetine for PBH spells. Clinical response, side effects and avoidance of pacemaker implantation were reviewed in six patients (12-60 months) treated with fluoxetine for PBH. Patients were referred because of concern of arrhythmia and failed medical treatment strategies. Two patients had previously implanted loop recorders, 5 patients had documented episodes of asystole, and 2 patients had generalized seizures. Fluoxetine resulted in alleviation of syncope in 5 of 6 patients. Time to symptomatic improvement symptoms ranged from 2 days to 1 month (median, 2 weeks). Median duration of treatment with fluoxetine was 12 months (12-24 months). One patient demonstrated no improvement and had a pacemaker implanted. There were no reported side effects to fluoxetine. Fluoxetine can be used to treat childhood PBH spells and may obviate the need for permanent pacing in a significant subset of this population. Considering its safe side-effect profile it is a worthwhile first-line agent to treat this disorder.
authors.affiliation: Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Walsh
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Knilans
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Anderson
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Czosek
mesh_terms: D001049:Apnea / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D010138:Pacemaker, Artificial; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013575:Syncope / Q000209:etiology
chemical_list: D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors