title: Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement.
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.
authors.affiliation: Paediatric Arrhythmia Unit, Cardiology Department, Hospital Sant Joan de Déu-Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain. Jbrugada@clinic.ub.es
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Nico
authors.initials: N
authors.lastname: Blom
authors.forename: Georgia
authors.initials: G
authors.lastname: Sarquella-Brugada
authors.forename: Carina
authors.initials: C
authors.lastname: Blomstrom-Lundqvist
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.forename: Jan
authors.initials: J
authors.lastname: Janousek
authors.forename: Dominic
authors.initials: D
authors.lastname: Abrams
authors.forename: Urs
authors.initials: U
authors.lastname: Bauersfeld
authors.forename: Ramon
authors.initials: R
authors.lastname: Brugada
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
authors.forename: Natasja
authors.initials: N
authors.lastname: de Groot
authors.forename: Juha-Matti
authors.initials: JM
authors.lastname: Happonen
authors.forename: Joachim
authors.initials: J
authors.lastname: Hebe
authors.forename: Siew
authors.initials: S
authors.lastname: Yen Ho
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.forename: Thomas
authors.initials: T
authors.lastname: Paul
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pfammatter
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenthal
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D002309:Cardiology / Q000592:standards*; D013504:Cardiovascular Surgical Procedures / Q000592:standards*; D002648:Child; D004554:Electric Countershock / Q000592:standards*; D006801:Humans; D010372:Pediatrics / Q000592:standards*
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Antiarrhythmic drugs; Arrhythmias; Electrical devices; Paediatrics; Radiofrequency ablation