title: Adjunctive ivabradine in combination with amiodarone: A novel therapy for pediatric congenital junctional ectopic tachycardia.
abstract: Treatment of congenital junctional ectopic tachycardia (JET) is often challenging. In the majority of patients affected, a combination of ≥2 antiarrhythmic drugs is required for JET control.
  
  
  
  The purpose of this study was to assess the efficacy and safety of adjunctive ivabradine therapy for pediatric congenital JET.
  
  
  
  Since January 2015, 5 consecutive patients aged 10 days to 3.5 years (median 8 weeks) were treated with adjunctive ivabradine for congenital JET. All patients had previously undergone antiarrhythmic therapy with unsatisfactory control of JET. Ivabradine was administered orally at an initial dosage of 0.05-0.1 mg/kg/d divided into 2 single doses and was increased up to 0.28 mg/kg/d if necessary.
  
  
  
  In all 5 patients, ivabradine proved to be successful in controlling JET. Complete suppression of JET and conversion into sinus rhythm were achieved in 4 of 5 patients. The remaining patient had effective heart rate control with persistent slow JET. Mean heart rate was reduced by 31% compared to pre-ivabradine (P = .03) as assessed by 24-hour Holter monitoring. Echocardiography revealed improvement of left ventricular function in all 3 patients with previously impaired left ventricular function. No significant side effects of ivabradine were encountered during median follow-up of 135 days (range 37-203 days).
  
  
  
  In our group of patients with congenital JET, adjunctive treatment with ivabradine resulted in effective and safe rhythm/heart rate control and therefore may be recommended early in the course of this rare inborn tachyarrhythmia.
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany. Electronic address: jana.dieks@med.uni-goettingen.de.
authors.forename: Jana-Katharina
authors.initials: JK
authors.lastname: Dieks
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany.
authors.forename: Sophia
authors.initials: S
authors.lastname: Klehs
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany.
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Müller
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Paul
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Krause
mesh_terms: D000638:Amiodarone / Q000008:administration & dosage*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001552:Benzazepines / Q000008:administration & dosage*; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D005858:Germany; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000077550:Ivabradine; D008297:Male; D013613:Tachycardia, Ectopic Junctional / Q000151:congenital / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D001552:Benzazepines; D000077550:Ivabradine; D000638:Amiodarone
keywords: Arrhythmia; Children; Congenital junctional ectopic tachycardia; Ivabradine