Efficacy of Propafenone for Treating Idiopathic Premature Ventricular Contractions in Children

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Background. Premature ventricular contractions (PVCs) are a common heart rhythm disorder in children, often following a benign course. However, in rare cases, antiarrhythmic therapy is required for managing this arrhythmia. Limited data is available regarding the effectiveness of such therapy specifically in children. Objective. To evaluate the efficacy and safety of propafenone administration in children with idiopathic PVCs. Methods. The study enrolled 33 children aged 11.1 ± 4.8 years (29 days — 17 years) with idiopathic PVCs. Propafenone dose was titrated from initial (5–7 mg/kg/day) to effective (no more than 15 mg/kg/day) dose under clinical and electrocardiographic control to monitor for proarrhythmias and other side effects. An increase in PQ interval duration and a widening of the QRS complex no more than 25% compared to baseline was considered acceptable. Results. The incidence of PVCs before propafenone administration was 36.3 ± 10.1 (22.0–60.6) thousands/day or 33.2 ± 8.4% (20.5–50.0). Complex forms of PVCs were observed in 25 (75.8%) children: 25 (75.8%) had frequent paired PVCs, 6 (18.2%) had polymorphic PVCs, 20 (60.6%) had short runs of ventricular tachycardia (VT), and 19 (27.6%) had a combination of various forms of PVCs. The starting dose of propafenone was 5.6 ± 2.2 mg/kg/day with subsequent increases to 10 ± 0.8 mg/kg/day. Propafenone was employed as the initial therapy in 23 (69.7%) children and as a second line therapy in 10 (30.3%) children, following the ineffectiveness or adverse effects of beta-adrenoblockers. The duration of propafenone therapy was 95.8 ± 62.8 days. Propafenone was effective in 25 (75.8%) children. The average reduction in the number of PVCs during therapy was 71.7 ± 32.6% (13.0–100.0) during therapy. One (3%) child developed proarrhythmia — sustained VT and 1 (3%) child had gastrointestinal side effects. Conclusion. Propafenone is an effective antiarrhythmic drug in children with idiopathic PVCs, including patients with poor response to beta-adrenoblockers. Arrhythmogenic and extracardiac side effects are possible during propafenone therapy, which require clinical and electrocardiographic observation in the process of selecting an effective dose of the drug.

Full Text

Restricted Access

About the authors

Ksenija B. Alekseeva

Children’s City Multidisciplinary Clinical Specialized Center of High Medical Technologies

Author for correspondence.
Email: alekseeva_kb@mail.ru
ORCID iD: 0000-0002-3763-1709
SPIN-code: 6798-2420
Russian Federation, Saint Petersburg

Tatiana К. Kruchina

Children’s City Multidisciplinary Clinical Specialized Center of High Medical Technologies; Saint Petersburg State Pediatric Medical University

Email: kruchina@gmail.com
ORCID iD: 0000-0002-6865-0136
SPIN-code: 3791-3196

MD, PhD, Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Mohiniso Sh. Maljarova

Children’s City Multidisciplinary Clinical Specialized Center of High Medical Technologies

Email: mavlyanova@mail.ru
ORCID iD: 0000-0003-3901-0698
SPIN-code: 9596-1852

MD, PhD

Russian Federation, Saint Petersburg

Gennadij A. Novik

Saint Petersburg State Pediatric Medical University

Email: ga_novik@mail.ru
ORCID iD: 0000-0002-7571-5460
SPIN-code: 6289-0209

MD, PhD, Professor

Russian Federation, Saint Petersburg

References

  1. Трешкур Т.В., Тулинцева Т.Э., Татаринова А.А., и др. Желудочковые аритмии и холтеровское мониторирование — принципы формирования заключения по результатам исследования // Вестник аритмологии. — 2018. — № 93. — С. 53–63. [Treshkur TV, Tulintseva TE, Tatarinova AA, et al. Ventricular arrhythmias and holter monitoring: guideline on creating reports. Journal of Arrhythmology. 2018;93:53–63. (In Russ.)] doi: https://doi.org/10.25760/VA-2018-93-53-63
  2. Макаров Л.М. Холтеровское мониторирование. — 4-е изд. — М.: Медпрактика-М, 2017. — 504 с. [Makarov LM. Holterovskoe monitorirovanie. 4rd ed. Moscow: Medpraktika-M; 2017. 504 s. (In Russ.)]
  3. Кручина Т.К., Васичкина Е.С., Алексеева К.Б., и др. Желудочковая экстрасистолия у детей: классификация, принципы наблюдения и лечения // Лечащий врач. — 2018. — № 1. — С. 35–37. [Kruchina TK, Vasichkina ES, Alekseeva KB, et al. Premature ventricular contractions in children: classification, principles of observation and treatment. Lechashchij Vrach, 2018;1:35–37. (In Russ.)]
  4. Елисеева О.В., Школьникова М.А., Березницкая В.В., и др. Алгоритм топической электрокардиографической диагностики желудочковых аритмий у детей // Российский вестник перинатологии и педиатрии. — 2017. — Т. 62. — № 1. — С. 60–68. [Eliseeva OV, Shkolnikova MA, Bereznickaja VV, et al. An algorithm for topical electrocardiographic diagnosis of ventricular arrhythmias in children. Rossiyskiy Vestnik Perinatologii i Pediatrii = Russian Bulletin of Perinatology and Pediatrics.. 2017;62(1):60–68. (In Russ.)] doi: https://doi.org/10.21508/1027-4065-2017-62-1-60-68
  5. Лебедев Д.С., Михайлов Е.Н., Неминущий Н.М., и др. Желудочковые нарушения ритма. Желудочковые тахикардии и внезапная сердечная смерть. Клинические рекомендации 2020 // Российский кардиологический журнал. — 2021. — Т. 26. — № 7. — С. 4600. [Lebedev DS, Mikhailov EN, Neminuschiy NM, et al. Ventricular arrhythmias. Ventricular tachycardias and sudden cardiac death. 2020 Clinical guidelines. Russian Journal of Cardiology. 2021;26(7):4600. (In Russ.)] doi: https://doi.org/10.15829/1560-4071-2021-4600
  6. Баранов А.А., Васичкина Е.С., Ильдарова Р.А., и др. Желудочковая экстрасистолия у детей // Педиатрическая фармакология. — 2018. — Т. 15. — № 6. — С. 435–446. [Baranov AA, Vasichkina ES, Ildarova RA, et al. Premature Ventricular Contraction in Children. Pediatricheskaya farmakologiya = Pediatric Pharmacology. 2018;15(6):435–446. (In Russ.)] doi: https://doi.org/10.15690/pf.v15i6.1981
  7. Михайлов И.Б. Клиническая фармакология — основа рациональной фармакотерапии: Руководство для врачей. — СПб.: Фолиант, 2013. [Mihajlov IB. Klinicheskaya farmakologiya — osnova racional’noj farmakoterapii: Rukovodstvo dlya vrachej. Saint Petersburg: Foliant; 2013. (In Russ.)]
  8. Часнык В.Г., Кручина Т.К., Адрианов А.В., и др. Аритмии сердца у детей: основные принципы диагностики, наблюдения и лечения. — СПб.: Изд-во Санкт-Петерб. гос. педиатр. мед. ун-та, 2014. [Chasnyk VG, Kruchina TK, Adrianov AV, i dr. Aritmii serdca u detej: osnovnye principy diagnostiki, nablyudeniya i lecheniya. Saint Petersburg: Izd-vo Sankt-Peterb. gos. pediatr. med. un-ta, 2014. (In Russ.)]
  9. Свинцова Л.И., Джаффарова О.Ю., Плотникова И.В. Прогнозирование эффективности антиаритмической терапии у детей // Российский кардиологический журнал. — 2019. — Т. 24. — № 7. — С. 75–82. [Svincova LI, Dzhaffarova OY, Plotnikova IV. Predicting the effectiveness of antiarrhythmic therapy in children. Russian Journal of Cardiology. 2019;24(7):75–82. (In Russ.)] doi: https://doi.org/10.15829/1560-4071-2019-7-75-82
  10. Кручина Т.К., Ковальчук Т.С., Васичкина Е.С., и др. Опыт применения пропафенона у новорожденных и детей раннего возраста с нарушениями ритма сердца // Российский кардиологический журнал. — 2020. — Т. 25. — № 7. — С. 3462. [Kruchina TK, Kovalchuk TS, Vasichkina ES, et al. Experience of using propafenone in newborns and young children with arrhythmias. Russian Journal of Cardiology. 2020;25(7):3462. (In Russ.)] doi: https://doi.org/10.15829/1560-4071-2020-3462
  11. Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. ESC Scientific Document Group. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997–4126. doi: https://doi.org/10.1093/eurheartj/ehac262
  12. Sadron Blaye-Felice M, Hamon D, Sacher F, et al. Premature ventricular contraction-induced cardiomyopathy: Related clinical and electrophysiologic parameters. Heart Rhythm. 2016;13(1):103–110. doi: https://doi.org/10.1016/j.hrthm.2015.08.025
  13. Brugada J, Blom N, Sarquella-Brugada G, et al. Pharmхacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working group joint consensus statement. Europace. 2013;15(9):1337–1382. doi: https://doi.org/10.1093/europace/eut082
  14. Janousek J, Paul T. Safety of oral propafenone in the treatment of arrhythmias in infants and children (European retrospective multicenter study). Working Group on Pediatric Arrhythmias and Electrophysiology of the Association of European Pediatric Cardiologists. Am J Cardiol. 1998;81(9):1121–1124. doi: https://doi.org/10.1016/s0002-9149(98)00142-8
  15. Bruder D, Weber R, Gass M, et al. Antiarrhythmic Medication in Neonates and Infants with Supraventricular Tachycardia. Pediatr Cardiol. 2022;43(6):1311–1318. doi: https://doi.org/10.1007/s00246-022-02853-9
  16. Kim HK, Kim SS, Ki YJ, et al. Ventricular Tachycardia in Association with Propafenone Overdose. Acta Cardiol Sin. 2021;37(1):100–103. doi: https://doi.org/10.6515/ACS.202101_37(1).20200914A
  17. Femenia F, Palazzolo J, Arce M, et al. Proarrhythmia Induced by Propafenone: What is the Mechanism? Indian Pacing Electrophysiol J. 2010;10(6):278–280.
  18. Chu YQ, Wang C, Li X-M, et al. Propafenone-Induced QRS Widening in a Child with Arrhythmogenic Right Ventricular Cardiomyopathy: A Case Report and Literatures Review. Front Pediatr. 2020;8:481330. doi: https://doi.org/10.3389/fped.2020.481330
  19. Алексеева К.Б., Кручина Т.К., Малярова М.Ш., и др. Эффективность бета-адреноблокаторов в терапии идиопатической желудочковой экстрасистолии у детей // Российский кардиологический журнал. — 2022. — Т. 27. — № 7. — С. 158–164. [Alekseeva KB, Kruchina TK, Maliarova MS. Effectiveness of beta-blockers in the treatment of idiopathic premature ventricular contractions in children. Russian Journal of Cardiology. 2022;27(7):158–164. (In Russ.)] doi: https://doi.org/10.15829/1560-4071-2022-5117
  20. Дощицин В.Л., Крамынина О.А., Чернова Е.В., и др. Влияние терапии антиаритмическими препаратами на качество жизни больных с экстрасистолией // Российский кардиологический журнал. — 2008. — Т. 5. — № 13. — С. 46–52. [Doshchicin VL, Kramynina OA, Chernova EV, et al. Antiarrhythmic therapy effects on quality of life among patients with extrasystoles. Russian Journal of Cardiology. 2008;5(13):46–52. (In Russ.)]
  21. Hwang J, Oh Y-S, Park H-S, et al. Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study. J Clin Med. 2023;12(8):2887. doi: https://doi.org/10.3390/jcm12082887

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig.1. ECG fragment of boy A., 16 years old. Determination of the epicardial localization of the PVC (pseudodelta wave > 49 ms according to the M. Sadron Blaye-Felice algorithm [12])

Download (123KB)
Indexing metadata
3. Fig.2. ECG fragments of girl S., 15 years old: A - before the prescription of propafenone, ventricular trigeminy (QRS (VES) 110 ms); B - 1 day after the appointment of propafenone: 1 tablet. (150 mg) 3 times a day (7 mg/kg/day), sustained VT with heart rate 120 beats/min (QRS (VES) 140 ms)

Download (408KB)
Indexing metadata

Copyright (c) 2023 "Paediatrician" Publishers LLC



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies