Cardiac arrhythmias: the role of pharmacologic intervention

The growing menu of drugs used to treat arrhythmias in children enhances the importance of antiarrhythmic selection based on the application of underlying electrophysiologic and pharmacokinetic principles, as well as a reduction of the side effect to benefit ratio. No attempt has been made in this report to discuss the diagnosis of arrhythmias in children, nor is the list of agents we discuss all-encompassing. Rather, the major thrust has been to promote an understanding of the important relationship between anatomic considerations, basic electrophysiology, and developmental pharmacology in directing therapy. We wish to emphasize that many of the studies quoted in this report are investigational, and that not all of the applications listed in the text and tables are approved for use in pediatric patients in the United States. Nevertheless, the information may serve as a guideline to developing management strategies for the individual child with an arrhythmia. Given the number of new antiarrhythmic agents under development, it would be no surprise if, in a few years, a paper such as this one discussed several new drugs we have not mentioned. We hope that the principles we have outlined will serve as a framework for incorporating these new agents into clinical practice as they become available.