digoxin and Heart-Defects--Congenital

Infants with single ventricle congenital heart disease are vulnerable to complications between stage 1 and stage 2 of palliation. Pharmaceutical treatment during this period is varied and often dependent on institutional practices as there is little evidence supporting a particular treatment path.. This review focuses on medical management of patients following stage I palliation. We performed a scoping review of the current literature regarding angiotensin converting enzyme inhibitors and digoxin treatment in the interstage period. In addition, we discuss other medication classes frequently used in these patients.. Due to significant heterogeneity of anatomy, rarity of disease, and other confounding factors, there is limited evidence to support most commonly used medications within the interstage period. Digoxin is associated with improved mortality within the interstage period and should be considered; however, no large randomized controlled trial exists supporting its use. Prevention of thrombotic complication with aspirin is also associated with improved outcomes and should be considered unless a contraindication exists. The addition of other prescriptions in this patient population should be considered only after an evaluation of the risks and benefits of each medication, recognizing the burden and risk of polypharmacy in this fragile patient population.

Topics: Digoxin; Heart Defects, Congenital; Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Infant; Norwood Procedures; Retrospective Studies; Risk Factors; Treatment Outcome

The management of heart failure in children is becoming a specialized discipline within pediatric cardiology. Unlike the treatment of heart failure in adults, for which an extensive body of literature supports current treatment regimens, management of heart failure in children is largely guided by extrapolation from adult studies and expert opinion. This review focuses on the current state-of-the-art with respect to the outpatient management of heart failure in children.

Topics: Adrenergic beta-Antagonists; Ambulatory Care; Angiotensin-Converting Enzyme Inhibitors; Cardiac Resynchronization Therapy; Cardiotonic Agents; Child; Death, Sudden, Cardiac; Defibrillators, Implantable; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Humans

Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Age Factors; Angiotensin-Converting Enzyme Inhibitors; Child; Child, Preschool; Clinical Trials as Topic; Digoxin; Diuretics; Ethics, Medical; Female; Heart Defects, Congenital; Heart Failure; Humans; Infant; Male; Patient Selection; Pediatrics

Topics: Anti-Arrhythmia Agents; Aortic Valve Stenosis; Digoxin; Echocardiography; Echocardiography, Doppler, Color; Female; Fetal Heart; Gestational Age; Heart Block; Heart Defects, Congenital; Humans; Pregnancy; Tachycardia; Ultrasonography, Prenatal

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiomyopathies; Child; Child, Preschool; Digoxin; Forecasting; Heart Defects, Congenital; Heart Failure; Humans; Infant

In recent years, thanks to a better understanding of the pathophysiology of congestive heart failure and progress made in the pharmacology of cardiovascular drugs, new therapeutics have been advocated in the treatment of congestive heart failure. Among them, converting enzyme inhibitors are the most useful. However, the classical association of digoxin-furosemide and general measures remains a very effective first-choice treatment in most cases. Only in particular situations, such as cardiomyopathy and decompensated atrio-ventricular insufficiency, should priority be given to converting enzyme inhibitors. Phosphodiesterase inhibitors are essentially used within the context of post-cardiac surgery intensive care. Beta-blockers which have been recently proposed for treatment of adult patients must not be used, as there is still no data available on their effectiveness and tolerance in pediatric patients.

Topics: Age Factors; Angiotensin-Converting Enzyme Inhibitors; Captopril; Child; Child, Preschool; Digoxin; Dihydralazine; Dopamine; Female; Furosemide; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Male

The place of digoxin in the pediatric cardiologist's armamentarium remains uncertain. As an antiarrhythmic, its use in the Wolff-Parkinson-White syndrome is obsolete, but it remains useful in the treatment of the chronic atrial fibrillation seen in some patients postoperatively and in children with dilated cardiomyopathy. The efficacy of digoxin in heart failure is unproven. There is some evidence of improvement in non invasive left ventricular contractile indices in neonates and infants, but it is unclear whether this is associated with sustained clinical improvement. There is even less evidence of its effectiveness in the older child. Whilst the measurement of any effect will undoubtedly be difficult, the time has come for double-blind, placebo-controlled trials in selected groups of patients. These should be designed not only to test the notion that digoxin does not improve ventricular function, but also to embrace the possibility that its administration may result in clinical improvement over and above that following diuretics alone. An absence of proof of efficacy must be distinguished from no efficacy--more data are needed.

Topics: Arrhythmias, Cardiac; Child; Child, Preschool; Digoxin; Heart Defects, Congenital; Heart Failure; Humans; Infant

The purpose of this report is to describe a case of nonimmune hydrops fetalis that resulted from an unusual congenital heart defect, premature closure of the ductus arteriosus. In this fetus, the ductal closure was not associated with other heart defects such as tetralogy of Fallot or truncus arteriosus, nor was it related to maternal use of nonsteroidal antiinflammatory agents. Despite adequate digitalization of the mother, the fetus died of congestive heart failure at 29 weeks of gestation. Autopsy confirmed stricture of the ductus in association with enlargement of the foramen ovale and marked dilation of the right atrium and main pulmonary artery.

Topics: Adult; Digoxin; Ductus Arteriosus; Female; Heart Defects, Congenital; Humans; Hydrops Fetalis; Pregnancy

Recently there has been a significant reappraisal of the role of PDA in the context of neonatal cardiopulmonary disease. This article reviews surgical intervention, pharmacologic treatment, and assessment of ductal patency in the neonate.

Topics: Alprostadil; Blood Circulation; Clinical Trials as Topic; Digoxin; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Defects, Congenital; Heart Function Tests; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Ligation; Persistent Fetal Circulation Syndrome; Prostaglandin Antagonists; Random Allocation; Respiratory Distress Syndrome, Newborn

Considerations for the use of the principal inotropic agents (digoxin and dopamine) in the newborn are discussed. The role of Prostaglandin-E in retaining the patency of the ductus arteriosus in the initial treatment of anomalous vessel formation is outlined. Conversely, chemotherapeutic possibilities for inhibiting prostaglandin production and thus encouraging closure of the ducts prior to surgical intervention are described.

Topics: Digoxin; Dopamine; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Defects, Congenital; Humans; Indomethacin; Infant, Newborn; Prostaglandins E

Topics: Cardiac Surgical Procedures; Cyanosis; Digoxin; Diuretics; Follow-Up Studies; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Postoperative Complications

Topics: Adolescent; Captopril; Cardiomyopathies; Child; Digoxin; Dobutamine; Dopamine; Echocardiography; Electrocardiography; Endocarditis, Bacterial; Furosemide; Heart; Heart Defects, Congenital; Heart Diseases; Heart Failure; Humans; Hydralazine; Isoproterenol; Nitroprusside; Physical Examination; Radionuclide Imaging; Rheumatic Heart Disease

Topics: Cyanosis; Diagnosis, Differential; Digoxin; Furosemide; Heart Defects, Congenital; Humans; Infant, Newborn

Topics: Age Factors; Arrhythmias, Cardiac; Child; Child, Preschool; Chlorothiazide; Diet, Sodium-Restricted; Digitalis Glycosides; Digoxin; Diuretics; Ethacrynic Acid; Furosemide; Heart Block; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Organomercury Compounds; Pacemaker, Artificial; Phenytoin; Procainamide; Propranolol; Quinidine; Tetralogy of Fallot; Transposition of Great Vessels

Topics: Acid-Base Equilibrium; Acidosis; Angiocardiography; Blood Gas Analysis; Blood Pressure; Bradycardia; Cardiac Catheterization; Cardiac Output; Child; Child, Preschool; Cineangiography; Cyanosis; Digoxin; Diuretics; Dyspnea; Electrocardiography; Heart Auscultation; Heart Block; Heart Defects, Congenital; Heart Failure; Heart Rate; Humans; Infant; Infant, Newborn; Oxygen Inhalation Therapy; Pulse; Referral and Consultation; Tachycardia; Vectorcardiography

Cardiac remodelling is now recognised as an important aspect of cardiovascular disease progression and is, therefore, emerging as a therapeutic target in cardiac failure due to different etiologies. Little is known about the influence of different therapies for cardiac failure on the remodelling seen in infants with congenital cardiac disease.. During follow-up of a prospective and randomized trial, we investigated therapeutic effects on neurohormonal activation, ventricular function, and myocardial gene expression. We compared the data from 8 infants with severe congestive heart failure due to left-to-right shunts, who received digoxin and diuretics alone, to 9 infants who received additional treatment with propranolol.. In these infants, beta-adrenergic blockade significantly reduced highly elevated levels of renin, from 284 +/- 319 microU/ml compared to 1061 +/- 769 microU/ml. Systolic ventricular function was normal in both groups, but diastolic ventricular function was improved in those receiving propranolol, indicated by significantly lower left atrial pressures, lower end-diastolic pressures, and less pronounced ventricular hypertrophy, the latter estimated by lower ratios of myocardial wall to ventricular cavity areas on average of 42%. Further hemodynamic parameters showed no significant differences between the groups, except for the lower heart rate in infants treated with propranolol. In those treated with digoxin and diuretics, there was a significant downregulation of beta2-receptor and angiotensin-2 receptor genes, and up-regulation of endothelin A receptor and connective tissue growth factor genes, that were partially prevented by additional treatment with propranolol.. Beta-blockade is a new therapeutic approach for congestive heart failure in infants with congenital cardiac disease, producing with significant benefits on neurohormonal activation, diastolic ventricular function, and cardiac remodelling.

Topics: Adrenergic beta-Antagonists; Digoxin; Diuretics; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Heart Defects, Congenital; Heart Failure; Heart Function Tests; Hemodynamics; Humans; Infant; Male; Probability; Prognosis; Propranolol; Prospective Studies; Reference Values; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Survival Rate; Treatment Outcome; Ventricular Remodeling

Analysis of heart rate variability (HRV) provides a noninvasive index of autonomic nervous system activity. HRV has shown to be reduced in congestive heart failure and in children with congenital heart disease (CHD). Beta-blockers improve HRV in adults with congestive heart failure, but this improvement remains to be demonstrated in children.. HRV was analysed in 14 infants with severe heart failure due to CHD who received a 'standard' therapy with digoxin and diuretics ('Digoxin/Diuretics' group) and in 9 of these patients with an additional propranolol therapy ('Propranolol' group) 17 days later on average and compared with HRV of 70 healthy infants ('Healthy Control').. Comparing the 'Digoxin/Diuretics' group versus 'Healthy Control', we found significantly reduced HRV in the time domain and the frequency domain, that could be abolished in the 'Propranolol' group. None of the HRV parameter were significantly related to age or any hemodynamic parameter but inversely related to ejection fractions within the normal range (pNN50: r= -0.58, p=0.004; rMSSD: r= -0.42; p=0.049). HRV measurements (SDNN, r= -0.48) and plasma norepinephrine levels (r=0.7) were significantly related to clinical symptoms of heart failure, measured by the Ross Score.. HRV represents a noninvasive parameter that is reduced in infants with congenital heart disease depending on the severity of heart failure but not on hemodynamic disturbances. Propranolol but not digoxin therapy effectively reduced the supposed autonomic imbalance in infants with severe heart failure due to CHD.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Heart Defects, Congenital; Heart Failure; Heart Rate; Hemodynamics; Humans; Infant; Neurotransmitter Agents; Propranolol

Neurohormonal activation in children with heart failure due to congenital heart disease leads to downregulation of myocardial beta-receptors that may influence the postoperative course after cardiothoracic surgery.. Myocardial biopsies of 26 children (aged 14+/-4 months) were obtained from the right atrium during cardiac surgery. Patients were allocated to either of two groups based on the duration of their intensive care unit stay: group 1 comprised those who stayed less than 7 days (n = 17), whereas group 2 comprised those who stayed more than 7 days, plus 3 infants who died during the early postoperative course (n = 9). For beta1- and beta2-mRNA quantitation, real-time polymerase chain reaction with fluorescence-labeled products was used.. Values for myocardial beta1-receptor gene expression were twice as high in group 1 children compared with group 2 (beta1-receptor 0.12+/-0.07 versus 0.06+/-0.03, p = 0.0016; beta2-receptor 0.12+/-0.07 versus 0.06+/-0.03, p = 0.0071). Beta-receptor gene expression in 16 children who received standard treatment for heart failure averaged lower than in the 10 children who received additional propranolol.. Beta-receptor downregulation due to congestive heart failure has an impact on the postoperative course in children with congenital disease and depends on heart failure therapy.

Topics: Biopsy; Child, Preschool; Digoxin; Diuretics; Down-Regulation; Drug Therapy, Combination; Female; Heart Defects, Congenital; Heart Failure; Hospital Mortality; Humans; Infant; Length of Stay; Male; Myocardium; Postoperative Complications; Propranolol; Prospective Studies; Receptors, Adrenergic, beta; Risk Factors

Infants with congenital heart disease and left-to-right shunts may develop significant clinical symptoms of congestive heart failure in spite of therapy with digoxin and diuretics. We investigated the effects of beta-blockade in infants with severe heart failure.. We performed a prospective, randomized, open monocenter trial in infants treated with digoxin and diuretics (n=10) in comparison to 10 infants receiving additional beta-blocker therapy. After 17 days on average beta-blocker treated infants (propranolol:1,6 mg/kg/day) improved significantly with respect to Ross heart failure score (3.3+/-2.3 vs. 8.3+/-1.9, P=0.002), lower renin levels (338+/-236 vs. 704+/-490 microU/l, P=0.008) and lower mean heart rates in Holter ECG (118+/-10 vs. 142+/-11 beats/min, P<0.001). While digoxin and diuretic treated infants had unchanged mean heart rate (149+/-8 vs. 148+/-10 beats/min), less decrease of symptoms (Ross Score: 8.5+/-1.7 vs. 6.8+/-2.3, P=0.02) but a significant increase of renin levels (139+/-102 vs. 938+/-607 microU/l, P=0.001).. Additional propranolol treatment but not digoxin and diuretics alone can effectively reduce clinical symptoms of heart failure in infants with congenital heart disease, who suffer from increased neurohormonal activation.

Topics: Adrenergic beta-Antagonists; Cardiotonic Agents; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Heart Rate; Heart Septal Defects; Hemodynamics; Hormones; Humans; Infant; Infant, Newborn; Propranolol; Prospective Studies; Severity of Illness Index; Statistics, Nonparametric

Recently there has been a significant reappraisal of the role of PDA in the context of neonatal cardiopulmonary disease. This article reviews surgical intervention, pharmacologic treatment, and assessment of ductal patency in the neonate.

Topics: Alprostadil; Blood Circulation; Clinical Trials as Topic; Digoxin; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Defects, Congenital; Heart Function Tests; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Ligation; Persistent Fetal Circulation Syndrome; Prostaglandin Antagonists; Random Allocation; Respiratory Distress Syndrome, Newborn

The efficacy of treatment with spironolactone for congestive heart failure secondary to congenital heart disease was studied in 21 infants under 1 year of age. All received digoxin and chlorothiazide. In addition, group A (n = 10) was given supplements of potassium and group B (n = 11) received spironolactone. Daily clinical observations of vital signs, weight, hepatomegaly, and vomiting were recorded. Paired t test analysis showed significant reduction in liver size and weight (P less than 0.01) and respiratory rate (P less than 0.05) in group B, and less significant decreases in group A. The incidence of vomiting was slightly lower in group B. We conclude that the addition of spironolactone hastens and enhances the response to standard treatment with digoxin and chlorothiazide in infants with congestive heart failure.

Topics: Chlorothiazide; Clinical Trials as Topic; Digoxin; Drug Therapy, Combination; Female; Heart Defects, Congenital; Heart Failure; Humans; Infant; Male; Potassium; Random Allocation; Spironolactone

To examine the association between digoxin use and cardiac function assessed by echocardiographic indices in infants with single-ventricle (SV) congenital heart disease (CHD) during the interstage period.. Retrospective cohort study.. Fifteen North American hospitals.. Infants discharged home following stage 1 palliation (S1P) and prior to stage 2 palliation (S2P). Infants with no post-S1P and pre-S2P echocardiograms were excluded.. None.. Of 373 eligible infants who met inclusion criteria, 140 (37.5%) were discharged home on digoxin. In multivariable linear and logistic regressions, we found that compared with infants discharged home without digoxin, those discharged with digoxin had a smaller increase in end-systolic volume (β = -8.17 [95% CI, -15.59 to -0.74]; p = 0.03) and area (β = -1.27 [-2.45 to -0.09]; p = 0.04), as well as a smaller decrease in ejection fraction (β = 3.38 [0.47-6.29]; p = 0.02) and fractional area change (β = 2.27 [0.14-4.41]; p = 0.04) during the interstage period.. Digoxin may partially mitigate the expected decrease in cardiac function during the interstage period through its positive inotropic effects. Prospective clinical trials are needed to establish the pharmacokinetics, safety, and efficacy of digoxin use in SV CHD.

Topics: Digoxin; Heart Defects, Congenital; Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Infant; Norwood Procedures; Palliative Care; Prospective Studies; Retrospective Studies; Treatment Outcome; Univentricular Heart

Digoxin has been associated with lower interstage mortality (ISM) following stage 1 palliation (S1P). Despite a substantial increase in digoxin use nationally, ISM has not declined. We aimed to determine the impact of digoxin on ISM in the current era. This study analyzed data from the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry. All patients who survived to hospital discharge following S1P were included. Comparisons were made between pre-specified eras (1: 2010-2015, 2: 2016-2019) based on digoxin use. ISM risk was estimated using the previously published NEONATE score (excluding digoxin). Multivariable Cox proportional hazard models assessed the impact of digoxin on ISM and freedom from unplanned readmission in era 2. A total of 1400 (46.8%) patients were included from era 1 and 1589 (53.2%) from era 2. Digoxin use (22.4% vs 61.7%, p < 0.001) and the proportion of high-risk patients (9.1% vs 20.3%, p < 0.001) increased across eras. There was no difference in predicted ISM risk between those who did vs did not receive digoxin in era 2 (p = 0.82). In era 2, digoxin use was independently associated with lower ISM (AHR 0.60, 95%CI 0.36 to 0.98, p = 0.043) and greater freedom from unplanned readmission (AHR 0.44, 95%CI 0.32 - 0.59, p < 0.001). In conclusion, digoxin is independently associated with lower ISM and greater freedom from interstage readmission. The lack of improvement in overall ISM in the current era may be secondary to a greater proportion of high-risk patients and/or disproportionately higher digoxin use in lower risk patients, who may not derive the same benefit.

Topics: Cardiotonic Agents; Digoxin; Female; Heart Defects, Congenital; Humans; Hypoplastic Left Heart Syndrome; Infant; Infant, Newborn; Male; Mortality; Norwood Procedures; Patient Readmission; Postoperative Care; Registries; Weight Gain

Interstage mortality (IM) remains significant after stage 1 palliation (S1P) for single-ventricle heart disease (SVD), with many deaths sudden and unexpected. We sought to determine whether digoxin use post-S1P is associated with reduced IM, utilizing the multicenter database of the National Pediatric Cardiology Quality Improvement Collaborative (NPCQIC).. From June 2008 to July 2013, 816 infants discharged after S1P from 50 surgical sites completed the interstage to stage II palliation, transplant, or IM. Arrhythmia during S1P hospitalization or discharge on antiarrhythmic medications were exclusions (n=270); 2 patients were lost to follow-up. Two analyses were performed: (1) propensity-score adjusted logistic regression with IM as outcome and (2) retrospective cohort analysis for patients discharged on digoxin versus not, matched for surgical site and other established IM risk factors. Of 544 study patients, 119 (21.9%) were discharged on digoxin. Logistic regression analysis with propensity score, site-size group, and digoxin use as predictor variables showed an increased risk of IM in those not discharged on digoxin (odds ratio, 8.6; lower confidence limit, 1.9; upper confidence limit, 38.3; P<0.01). The retrospective cohort analysis for 60 patients on digoxin (matched for site of care, type of S1P, post-S1P ECMO use, genetic syndrome, discharge feeding route, ventricular function, tricuspid regurgitation, and aortic arch gradient) showed 0% IM in the digoxin at discharge group and an estimated IM difference between the 2 groups of 9% (P=0.04).. Among SVD infants in the NPCQIC database discharged post-S1P with no history of arrhythmia, use of digoxin at discharge was associated with reduced IM.

Topics: Cardiac Surgical Procedures; Cardiovascular Agents; Digoxin; Female; Heart Defects, Congenital; Heart Ventricles; Humans; Infant; Infant Mortality; Infant, Newborn; Kaplan-Meier Estimate; Logistic Models; Male; Odds Ratio; Palliative Care; Patient Discharge; Propensity Score; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States

Mortality for infants with single ventricle congenital heart disease remains as high as 8% to 12% during the interstage period, the time between discharge after the Norwood procedure and before the stage II palliation. The objective of our study was to determine the association between digoxin use and interstage mortality in these infants.. We conducted a retrospective cohort study using the Pediatric Heart Network Single Ventricle Reconstruction Trial public use dataset, which includes data on infants with single right ventricle congenital heart disease randomized to receive either a Blalock-Taussig shunt or right ventricle-to-pulmonary artery shunt during the Norwood procedure at 15 institutions in North America from 2005 to 2008. Parametric survival models were used to compare the risk of interstage mortality between those discharged to home on digoxin versus those discharged to home not on digoxin, adjusting for center volume, ascending aorta diameter, shunt type, and socioeconomic status. Of the 330 infants eligible for this study, 102 (31%) were discharged home on digoxin. Interstage mortality for those not on digoxin was 12.3%, compared to 2.9% among those on digoxin, with an adjusted hazard ratio of 3.5 (95% CI, 1.1-11.7; P=0.04). The number needed to treat to prevent 1 death was 11 patients. There were no differences in complications between the 2 groups during the interstage period.. Digoxin use in infants with single ventricle congenital heart disease is associated with significantly reduced interstage mortality.

Topics: Blalock-Taussig Procedure; Cardiovascular Agents; Databases, Factual; Digoxin; Female; Heart Defects, Congenital; Heart Ventricles; Humans; Infant; Infant Mortality; Infant, Newborn; Male; Norwood Procedures; Patient Discharge; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Factors; Survival Analysis; Time Factors; Treatment Outcome

In Uganda, few children with congenital heart diseases (CHD) benefit from early corrective cardiac surgery. These children are at high risk of developing heart failure and electrolyte imbalances; factors which increase their risk of developing arrhythmias. This study aimed to determine the prevalence and factors associated with arrhythmias among children with congenital heart diseases receiving care at Mulago Hospital.. This was a cross-sectional study carried out from August 2013 to March 2014 at Mulago Hospital. Children were consecutively enrolled into the study. Standard 12-lead electrocardiograms (ECGs) were performed on 194 children with CHD (age range 10 days-15 years). Data was analysed using SPSS 16.0.. Out of 194 children studied, 53/194 (27.3 %, 95 % CI 21.0 - 33.6) children had arrhythmias. Of the CHD children, 44/194 (22.7 %, 95 % CI 16.8 - 28.6) had first degree AV block while 9/194 (4.6 %, 95 % CI 1.7 - 7.6) children had either ectopic atrial rhythm, premature atrial contractions, junctional rhythm, complete atrioventricular (AV) dissociation or premature ventricular contractions. Children using digoxin were more likely to have first degree AV block (OR 3.75, 95 % CI 1.60-8.86) while those aged 5 years and below were less likely to have first degree AV block (OR 0.16, 95 % CI 0.07-0.37).. Arrhythmias are common among children with CHD receiving care from Mulago Hospital. These are associated with digoxin use, child's age and electrolyte imbalances; factors which can easily be assessed, managed and where possible modified in these children during their care.

Topics: Adolescent; Age Factors; Arrhythmias, Cardiac; Cardiotonic Agents; Child; Child, Preschool; Cross-Sectional Studies; Digoxin; Electrocardiography; Female; Heart Defects, Congenital; Hospitals; Humans; Infant; Infant, Newborn; Male; Prevalence; Referral and Consultation; Risk Factors; Time Factors; Uganda; Water-Electrolyte Imbalance

Digoxin or propranolol are used as first-line enteral agents for treatment of infant supraventricular tachycardia. We used a large national database to determine whether enteral digoxin or propranolol was more efficacious as first-line infant supraventricular tachycardia therapy.. The Pediatric Health Information System database was queried over 10 years for infants with supraventricular tachycardia initiated on enteral digoxin or propranolol monotherapy. Patients were excluded for Wolff-Parkinson-White, intravenous antiarrhythmics (other than adenosine), or death. Success was considered as discharge on the initiated monotherapy. Risk factors for successful monotherapy and risk factors for readmission for supraventricular tachycardia for patients discharged on monotherapy were determined.. A total of 374 patients (59.6% male) met the study criteria. Median length of stay was 7 days (interquartile range of 3-16 days). Patients had CHD (n=199, 53.2%) and underwent cardiac surgery (n=123, 32.9%), ICU admission (n=238, 63.6%), mechanical ventilation (n=146, 39.0%), and extracorporeal membrane oxygenation (n=3, 0.8%). Pharmacotherapy initiation was at median 37 days of life (interquartile range of 12-127 days) and 47.3% were initiated on digoxin. Success was similar between digoxin (73.1%) and propranolol (73.5%). Initial therapy with digoxin was not associated with success (odds ratio 1.01, 95% CI 0.64-1.61, p=0.93). Multivariable analysis demonstrated hospital length of stay (odds ratio 0.98, 95% CI 0.98-1.00) and involvement of a paediatric cardiologist (odds ratio 0.46, 95% CI 0.29-0.75) associated with monotherapy failure, and male gender (odds ratio 1.66, 95% CI 1.03-2.67) associated with monotherapy success. No variables were significant for readmission on multivariable analysis.. Digoxin or propranolol may be equally efficacious for inpatient treatment of infant supraventricular tachycardia.

Topics: Anti-Arrhythmia Agents; Databases as Topic; Digoxin; Female; Heart Defects, Congenital; Hospitalization; Humans; Infant; Infant, Newborn; Male; Multivariate Analysis; Propranolol; Retrospective Studies; Risk Factors; Sex Factors; Tachycardia, Supraventricular; Treatment Outcome

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Echocardiography; Female; Fetal Diseases; Flecainide; Heart Atria; Heart Defects, Congenital; Humans; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

This study aimed to evaluate the effectiveness of digoxin in children with heart failure secondary to left-to-right shunt lesions and normal left ventricular systolic function. The study registered 37 such patients (ages 10 days to 24 months, groups 1 and 2) and used 20 healthy children as a control group (group 3). Left ventricular systolic function, as assessed by conventional echocardiography, was normal in all the subjects. Congestive heart failure was diagnosed by clinical evaluation and modified Ross scoring. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations and complete blood counts were assessed in all the children. Group 1 was treated with digoxin, enalapril, and furosemide and group 2 with enalapril and furosemide. Approximately 1 month after starting treatment, the patients were reevaluated by physical and echocardiographic examinations, modified Ross scoring, plasma NT-proBNP concentrations, and complete blood counts. The pre- and posttreatment Ross scores of group 1 (p = 0.377) and group 2 (p = 0.616) did not differ significantly. The NT-proBNP values in both groups decreased after treatment (p = 0.0001). The pre- and posttreatment NT-proBNP values did not differ significantly in group 1 (p = 0.094)) and group 2 (p = 0.372). The pretreatment NT-proBNP values in groups 1 and 2 (p = 0.0001) were significantly higher than in the control group (p = 0.003). A smaller difference was observed between posttreatment NT-proBNP values in group 1 and the control group (p = 0.045). We found no significant difference between the posttreatment NT-proBNP values of group 2 and those of the control group (p = 0.271). The study showed that both treatments currently used to treat heart failure secondary to congenital heart disease with left-to-right shunts and preserved left ventricular systolic function are effective and do not differ significantly. Thus, digoxin does not provide any extra benefit in the treatment of such patients.

Topics: Biomarkers; Child, Preschool; Digoxin; Echocardiography; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Failure; Heart Ventricles; Humans; Infant; Infant, Newborn; Male; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Retrospective Studies; Systole; Treatment Outcome; Ventricular Function, Left

Paediatric cardiomyopathy and heart failure are distinct but frequently associated conditions, which have a high mortality. Traditional medical therapy has evolved to incorporate newer classes of heart failure drugs, although the evidence to support efficacy in children is limited. This perspective article discusses the rationale, benefits and limitations of the various classes of drug therapy used in paediatric heart failure due to cardiomyopathy or congenital heart disease. Controversies in management and challenges for future development are highlighted.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiomyopathies; Cardiotonic Agents; Child; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Humans; Hydrazones; Natriuretic Peptide, Brain; Pyridazines; Simendan

The purpose of this study was to report the efficacy of intravenous amiodarone alone or in combination with digoxin in neonates and small infants with life-threatening supraventricular tachyarrhythmia (SVT).. We retrospectively analyzed 9 neonates and small infants with life-threatening or resistant SVT who were treated with intravenous amiodarone alone or in combination with digoxin.. This report consists of 8 patients with reentrant SVT and 1 with atrial flutter. On admission, 7 patients had a congestive heart failure and 3 of whom had cardiovascular collapse. Intravenous rapid bolus of adenosine caused a sustained sinus rhythm in 4 patients. These patients were given digoxin initially, but recurrence of persistent tachyarrhythmia necessitated the use of intravenous amiodarone in all these patients. Amiodarone was given initially to the other 4 patients in whom adenosine caused only temporary conversion to the sinus rhythm. It was effective in 2 patients. In the other 2, digoxin was added to therapy for tachycardia control. Amiodarone alone or in combination with digoxin effectively controlled reentrant SVT in all patients. This combined treatment caused ventricular rate control in patient with atrial flutter, and conversion to the stable sinus rhythm was achieved at approximately 8 months.. Intravenous amiodarone alone or in combination with digoxin was found to be safe and effective in controlling refractory and life-threatening SVT in neonates and small infants.

Topics: Adenosine; Amiodarone; Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Drug Evaluation; Drug Therapy, Combination; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Failure; Heart Neoplasms; Heart Rate; Humans; Hypotension; Infant; Infant, Newborn; Infusions, Intravenous; Injections, Intravenous; Male; Retrospective Studies; Rhabdomyoma; Shock, Cardiogenic; Tachycardia, Supraventricular; Thyrotropin; Treatment Outcome

To determine the digoxin population pharmacokinetic parameters and influence of various factors on pharmacokinetic parameters in Thai pediatric patients with heart disease.. The present study was an analytical cross-sectional study design and population pharmacokinetic modeling study. The data of 130 patients and 264 samples with an age range of 0.1-15.7-years-old were collected during routine care. Blood samples were drawn at various times after administration. All patients received digoxin administration with a dose ranged of 1.7-13.6 microg/kg/day at Queen Sirikit Heart Center; Khon Kaen University, Thailand. Population pharmacokinetic modeling was developed from digoxin data by using NONMEM program (Version V) according to one-compartment of subroutine ADVAN2 TRANS2 model.. Weight, age, height and the presence of congestive heart failure (CHF) were significant covariates on CL. Weight and the presence of CHF were significant covariates on Vd. The final population model of CL and Vd in pediatric patients were as follows: CL/F (L/h) for infant (0-1 year) = 0.322 * WT (kg); CL/F (L/h) for children (> 1 year) = (0.138 * WT(kg) + 0.0319 * HT (cm) * 0.765CHF; and Vd/F (L) for all ages = 9.27 * WT (kg) * 1.75CHF. The interindividual variability of CL/F, Vd/F and intraindividual variability with proportional error model were 31.48, 35.56, and 41.7%, respectively. In the validation data set (57 samples), predictive performance in terms of bias (ME) and precision (RMSE) were -0.049 ng/mL (95% CI: -0.118-0.020) and 0.269 ng/mL (95% CI: 0.216-0.312), respectively.. This simple final population model of Vd and CL can be used in clinical practice for estimating appropriate dosage regimen of loading dose and maintenance dose, respectively. Current weight, height, and presence of CHF should be taken into account when designing dosage regimen for individualized pediatric patients.

Topics: Anti-Arrhythmia Agents; Child; Child, Preschool; Cross-Sectional Studies; Digoxin; Female; Heart Defects, Congenital; Humans; Male; Models, Statistical; Thailand

Congenital diverticulum of the left ventricle is a malformation, often associated with midline thoraco-abdominal defects. Here we describe a case of isolated congenital left ventricular diverticulum that presented with an abnormal four-chamber view and fetal dysrhythmia on ultrasonography. Maternal digoxin therapy was started due to significant ventricular ectopy. Restoration of fetal sinus rhythm was achieved within 48 h. Serial fetal echocardiograms were performed every week, followed by a normal vaginal delivery at term. The child is surviving at 1 year of age.

Topics: Adult; Arrhythmias, Cardiac; Diagnosis, Differential; Digoxin; Disease Management; Diverticulum; Female; Fetal Diseases; Heart Defects, Congenital; Heart Ventricles; Humans; Infant, Newborn; Pregnancy; Ultrasonography, Prenatal

Topics: Adult; Anti-Arrhythmia Agents; Cardiomegaly; Digoxin; Fatal Outcome; Female; Heart Defects, Congenital; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Ultrasonography, Prenatal

Supraventricular tachycardia (SVT) is the second most frequent form of arrhythmia in pediatrics after extrasystole.. 1. To determine the clinical characteristics and treatment of SVT in infants and children. 2. To determine treatment response and the drugs used.. A retrospective review of 61 cases of SVT requiring PICU admission (1999-2004) was performed. PICU admission was due to persistent SVT after vagal maneuvers.. There were 61 patients and 39 were boys (63.9%). The mean age was 2.1 years (SD +/- 3.1). Twelve patients had congenital heart disease (19.7%); three (4.9%) were admitted after heart surgery, and the remaining patients had no antecedents (60.7%). The mean cardiac frequency was 238 beats/min (SD +/- 42.86). Heart failure (HF) was observed in 14 patients (23%). Statistically significant differences were found between the presence of HF and time since onset (p < 0.01) and younger age (p < 0.01). The most frequent diagnosis was SVT due to re-entry in 28 patients (45.9%). Medical treatment was required in 46 patients (75.4%) and response was achieved in 35 (57.4%). At crisis the first drug used was adenosine triphosphate (ATP) in 35 patients (61.4%) with good response in 21 (36.8%). As maintenance therapy digoxin was used in 29 patients (50.9%) without relapses in 22 (78.6%). Radiofrequency ablation was required in 17 patients (27.9%), and there were three relapses (17.6%). The ages of patients who underwent ablation ranged from 3.5 days to 13 years.. 1. HF was observed mainly in infants. 2. Most of the patients had good response to ATP therapy. 3. Radiofrequency ablation was mainly required in patients aged more than 1 year.

Topics: Adenosine Triphosphate; Adolescent; Age Factors; Anti-Arrhythmia Agents; Cardiotonic Agents; Catheter Ablation; Child; Child, Preschool; Data Interpretation, Statistical; Digoxin; Female; Heart Defects, Congenital; Heart Failure; Heart Rate; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Sex Factors; Tachycardia, Supraventricular; Treatment Outcome

Digitalis intoxication is usually accidental in children. We report the case of a young infant with congenital heart disease in whom the coadministration of digoxin and josamycin led to a 50% increase in the digoxin concentration, generating sinoatrial block and cardiac failure. Clinical and electrocardiographic symptoms very quickly resolved following immunotherapy with antidigitalis Fab fragments. Digoxin concentrations must be carefully monitored in patients concomitantly receiving macrolides to ensure that the digoxin dose can be readjusted if necessary.

Topics: Anti-Bacterial Agents; Cardiotonic Agents; Child, Preschool; Digoxin; Drug Interactions; Heart Defects, Congenital; Humans; Josamycin; Male; Whooping Cough

The aim was to delineate the significance and natural history of fetal arrhythmias and provide information about their management. A cohort of 114 infants with fetal arrhythmias detected during prenatal ultrasound (US) screening were studied. All subjects underwent echocardiography and were treated as clinically indicated. Postnatal outcome was obtained in 100% of infants until 1 year of age. The incidence of fetal arrhythmias was 0.3%. Among the 87 fetuses with atrial extrasystoles, 2.3% developed supraventricular tachycardia (SVT) in utero. Of the 10 SVT cases, only five required antiarrhythmic therapy in utero with digoxin and propafenone, which successfully restored sinus rhythm in 100% of fetuses, both nonhydropic and hydropic. Sinus bradycardia was associated with structural anomalies in 5 of 6 patients and only 2 of 4 fetuses with atrioventricular block survived. It is concluded that prognosis is good for most fetal tachyarrhythmias, whereas it is less favorable for bradyarrhythmias.

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cohort Studies; Digoxin; Fetal Diseases; Fetal Therapies; Heart Defects, Congenital; Humans; Prognosis; Tachycardia, Ectopic Atrial; Ultrasonography, Prenatal

To compare the dental health of a group of children with complex congenital heart disease with that of age and gender matched healthy controls.. Case-control study.. Faculty of Medicine and Odontology/Pediatric cardiology and Pedodontics, Umeå University, Sweden.. All the cases and their controls lived in the county of Västerbotten in northern Sweden. Each group comprised 41 children with a mean age of 6.5 years. Data were collected from medical and dental records while all bitewing radiographs were read separately by one of the authors.. Children with congenital heart disease had significantly more caries in their primary teeth than the control group. The mean dmfs-value was 5.2 +/- 7.0 in the cardiac group compared to 2.2 +/- 3.5 in the control group (P < 0.05). Twenty-six of the children had all four 6-year-molars, and their mean DMFS-values were 0.9 +/- 1.9 in the cardiac group compared to 0.3 +/- 0.6 in the control group (P > 0.05). The children with congenital heart disease had received more caries prevention based on the use of fluorides than the control group. There was a significant correlation between the number of fluoride varnish treatments and the dmfs value of the child (r = 0.411, P < 0.01). Fifty-two per cent of the children in the cardiac group had been prescribed fluoride tablets on one or more occasions compared to 17% in the control group (P < 0.01). Number of months on digoxin medication and the dmfs-value had a significant correlation (r = 0.368, P < 0.05). Ten of the children had been on digoxin medication between 6 and 87 months; this subgroup had a mean dmfs-value of 10.1 +/- 8.5.. Swedish children with complex congenital heart disease have poorer dental health than healthy age and gender matched controls in spite of intensive preventive efforts. In many cases, intervention had been given when caries were present. A closer cooperation between paediatric cardiology and paediatric dentistry is needed.

Topics: Cardiotonic Agents; Case-Control Studies; Child; Child, Preschool; Dental Caries; Digoxin; DMF Index; Female; Fluorides, Topical; Heart Defects, Congenital; Humans; Male; Sweden

To review the diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia.. Retrospective review of published reports: 11 papers about fetal tachyarrhythmia published between 1991 and 2002 were selected for review.. All selected studies were analysed for the type of arrhythmia, degree of atrioventricular block in atrial flutter, occurrence of hydrops fetalis, gestational age at diagnosis, first and second line drug treatment, associated cardiac and extracardiac malformations, and mortality of the fetuses.. Atrial flutter accounted for 26.2% of all cases of fetal tachyarrhythmias, and supraventricular tachycardia for 73.2%. Hydrops fetalis was reported in 38.6% and 40.5% of fetuses with atrial flutter and supraventricular tachycardia, respectively (NS). Hydropic fetuses with atrial flutter had higher ventricular rates (median 240 beats/min, range 240-300) than non-hydropic fetuses (220 beats/min, range 200-310) (p = 0.02), whereas the atrial rates were not significantly different (median 450 beats/min, range 370-500). Digoxin treatment resulted in a higher conversion rate in non-hydropic fetuses with fetal tachyarrhythmias than in hydropic fetuses (p < 0.001). The overall mortality of atrial flutter was similar to that of supraventricular tachycardia, at 8.0% v 8.9% (p = 0.7).. The prevalence of hydrops fetalis did not differ in fetal atrial flutter and supraventricular tachycardia with 1:1 conduction. There was no difference between the response rate to digoxin in fetus with atrial flutter or supraventricular tachycardia. Mortality was similar in the two types of tachyarrhythmia.

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Fetal Diseases; Heart Block; Heart Defects, Congenital; Humans; Hydrops Fetalis; Postnatal Care; Prenatal Care; Prenatal Diagnosis; Prognosis; Tachycardia, Supraventricular

Approximately 60% of children with supraventricular tachycardia (SVT) develop their initial episode by 1 year of age. Despite resolution in most of these patients by 1 year, approximately 30% of the SVT will recur. We performed a retrospective review of all patients <1 year of age with SVT between January 1984 and December 2000. Recurrence was defined as documented SVT at >1 year of age. Patients were divided into: (1) a first line (FL) group (controlled with digoxin and/or propranolol) and (2) a second line (SL) group (requiring additional antiarrhythmics). The groups were divided based on the presence of preexcitation. The FL group included 116 patients, 20 of whom (17%) had Wolff-Parkinson-White (WPW) syndrome. The SL group included 34 patients, 21 of whom (62%) had WPW (p <0.001). Recurrence of SVT occurred in 32 patients (28%) in the FL group and in 23 patients (68%) in the SL group (p <0.001). SVT recurred in 36 of 41 patients (88%) with WPW compared with 19 of 109 patients (17%) without WPW syndrome (p <0.001). Logistic regression analysis demonstrated that the presence of WPW syndrome was associated with a 29-fold higher odds of SVT recurrence (p <0.001), and that patients with WPW syndrome were more likely to require additional antiarrhythmic therapy (p <0.001). Thus, patients with WPW syndrome who had SVT at <1 year of age have 29-fold higher odds of recurrence at >1 year of age versus those patients with preexcitation. These patients are also more likely to require additional antiarrhythmic therapy to control SVT. Furthermore, children with WPW syndrome who are refractory to treatment with digoxin and/or propranolol are at increased risk of SVT recurrence.

Topics: Age of Onset; Anti-Arrhythmia Agents; Digoxin; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Pre-Excitation Syndromes; Predictive Value of Tests; Propranolol; Recurrence; Retrospective Studies; Risk Factors; Sex Factors; Tachycardia, Supraventricular

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Child; Cranial Nerve Neoplasms; Digoxin; Down Syndrome; Ductus Arteriosus, Patent; Facial Nerve; Facial Paralysis; Female; Heart Defects, Congenital; Heart Septal Defects, Atrial; Humans; Hypothyroidism; Infant, Newborn; Male; Neurilemmoma; Transposition of Great Vessels

Infants with congenital heart disease (CHD) and heart failure have elevated plasma norepinephrine levels (NE) as a sign for sympathetic activation. We analysed ECGs of 64 infants with CHD and found normal heart rates on average in four groups split up according to their NE. Mean heart rate in Holter ECGs was significantly reduced in infants with low NE (below 350 ng/l) but normal in the other groups (NE < 350 ng/l: 121 +/- 10/min; NE = 350-700 ng/l: 139 +/- 11/min; NE = 700-1300 ng/l: 142 +/- 13/min; NE > 1300 ng/l: 135 +/- 12/min). An analysis of heart rate variability in a subgroup of 25 infants showed significantly reduced values in patients with elevated NE in comparison to 70 healthy infants. Significantly reduced frequency domain measures in infants with elevated NE but also normal NE are evidence for a high diagnostic sensitivity of an analysis of heart rate variability for autonomic imbalance with sympathetic activation and parasympathetic withdrawal in infants with CHD.

Topics: Age Factors; Cardiotonic Agents; Data Interpretation, Statistical; Digoxin; Diuretics; Electrocardiography; Electrocardiography, Ambulatory; Epinephrine; Heart Defects, Congenital; Heart Rate; Hemodynamics; Humans; Infant; Infant, Newborn; Norepinephrine; Propranolol; Vasodilator Agents

Uhl's anomaly was first reported by Uhl in 1952 and is characterized by congenital partial or complete absence of right ventricular myocardium. It is a very rare anomaly with unknown aetiology. Associations with other congenital heart diseases, familial occurrency, sudden death and arrhythmia with Uhl's anomaly have been reported. Pathologic findings vary with the patient's age and severity of the right ventricular disorder. In infancy, it may occur with severe right-sided heart failure as well as asymptomatic cardiomegaly. Despite its rarity, Uhl's anomaly may be considered in patients with right ventricular failure due to dilated cardiomyopathy of the right ventricle. We report the case of six-year-old boy presenting with striking ascites due to severe right heart failure of Uhl's anomaly.

Topics: Cardiotonic Agents; Child; Diagnosis, Differential; Digoxin; Diuretics; Drug Therapy, Combination; Echocardiography; Heart Atria; Heart Defects, Congenital; Heart Failure; Humans; Male; Radiography; Ventricular Dysfunction, Right

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Cardiomyopathy, Dilated; Cardiotonic Agents; Coronary Disease; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Hemodynamics; Humans; Hypertension; Myocardial Ischemia; Phosphodiesterase Inhibitors; Vasodilator Agents

Re-entrant supraventricular tachycardia is the most common cardiac arrhythmia in infancy. Pharmacological prevention of recurrencies is a standard recommendation for infants less than 1 year of age. In view of the often benign spontaneous clinical course of the disease, the risk-benefit analysis of any antiarrhythmic agent given is important. It was the aim of this retrospective study, to assess the value of oral long-term digoxin given to paediatric patients with supraventricular tachycardia with onset in the first 4 months of life. Twenty-six newborns and infants fulfilled the inclusion criteria. Median age at first presentation of the patients was 7 days. Eight patients (31%) had structural heart disease, 9 patients had a pre-excitation syndrome, and the other 17 children had a concealed accessory atrioventricular pathway. Long-term prophylaxis with oral digoxin was considered successful in 17 children (65%). In 2 patients therapy with digoxin was considered partially effective and in 7 patients (27%) failure of digoxin to improve symptoms led to the introduction of other anti-arrhythmic agents. Serum digoxin levels were no different in the patients with successful therapy as compared to those with treatment failure. No side-effects due to digoxin were noted in all the patients treated. After a mean followup of 54 months (12-130 months), 19 children (73%) were free of recurrencies and on no medication, 5 children were free of recurrencies but had anti-arrhythmic therapy. Only 2 patients, both on anti-arrhythmic therapy, were still suffering from tachycardia.. Digoxin remains an effective treatment option in infants with supraventricular tachycardia and it helped to avoid the long-term use of other anti-arrhythmic drugs with potentially more serious side-effects (pro-arrhythmia) in a considerable proportion of infants treated.

Topics: Anti-Arrhythmia Agents; Digoxin; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Recurrence; Retrospective Studies; Tachycardia, Atrioventricular Nodal Reentry; Treatment Outcome; Wolff-Parkinson-White Syndrome

Atrioventricular nodal reentry is a commonly recognized mechanism of supraventricular tachycardia (SVT) in adults, but is only rarely documented in the first year of life. The aim of this study was to elucidate characteristics, management, and outcome in infants with atrioventricular nodal reentrant tachycardia (AVNRT). Electrophysiologic studies performed between January 1988 and June 1996 were reviewed. Fifteen infants with AVNRT at 58 +/- 27 days (mean +/- SEM) were identified. Five had AVNRT detected following palliation of structural cardiac anomalies, including 4 with critical obstructions to left ventricular outflow. Typical AVNRT (ventriculoatrial interval 49 +/- 5 ms) was observed in 14 of 15 patients and atypical AVNRT (ventriculoatrial interval 191 +/- 22 ms) in 4 of 15. All patients received long-term therapy, beginning with digoxin in 13. Eight had symptomatic recurrences on digoxin and 6 of these were given beta blockers, with satisfactory control in 4. Three patients were controlled with class III agents, and 2 underwent slow pathway radiofrequency modification at ages 4.1 and 6.7 years, respectively. AVNRT was still inducible in 6 of 6 asymptomatic patients who underwent follow-up atrial stimulation studies after discontinuation of medical therapy. All 15 patients were alive with either absent or well-controlled AVNRT at age 45 +/- 7 months. We conclude that the course and outcome of AVNRT diagnosed in the first year of life are generally benign, but that a minority of patients have symptoms persisting beyond infancy. Digoxin is of questionable benefit in long-term control. AVNRT often remains inducible in asymptomatic patients, although the significance of this finding remains to be determined by long-term follow-up.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Catheter Ablation; Digoxin; Electrocardiography; Follow-Up Studies; Heart Defects, Congenital; Humans; Infant; Retrospective Studies; Tachycardia, Atrioventricular Nodal Reentry

To assess the efficacy and safety of current pharmacologic therapy for supraventricular tachycardia (SVT) in infants, we reviewed 112 infants treated between July 1985 and March 1993. The SVT mechanism was determined by esophageal electrophysiologic study and involved an accessory pathway in 86, atrioventricular (AV) node reentry in 10, atrial muscle reentry in 11, and an ectopic atrial tachycardia in 5 patients. Of six infants not treated, none had clinical recurrences of SVT. Of the 106 patients treated, 70% remained free of tachycardia while receiving digoxin, propranolol, or both. Class I antiarrhythmic agents were necessary for 13 patients, and class III agents were required for another 13 infants. Verapamil was used in one infant with AV node reentry tachycardia. Nine infants with complex clinical presentations were believed to have failed medical management and underwent radiofrequency ablation. Five patients died, four of complications related to structural heart disease and one shortly after radiofrequency ablation was performed. No deaths appeared to be related to antiarrhythmic medications. No drug-related side effects requiring medication change occurred, and no proarrhythmia was observed. Thus medical therapy appears to be effective and safe in infants with SVT. Radiofrequency ablation should be reserved for rare infants who fail aggressive medical regimens or when the situation is complicated by ventricular dysfunction, severe symptoms, or complex congenital heart disease.

Topics: Anti-Arrhythmia Agents; Catheter Ablation; Digoxin; Electrocardiography; Esophagus; Female; Follow-Up Studies; Heart Block; Heart Conduction System; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Propranolol; Recurrence; Retrospective Studies; Risk Factors; Survival Rate; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Ectopic Atrial; Tachycardia, Supraventricular; Verapamil

Endogenous digoxin-like immunoreactive substances (DLIS) show crossreactions with different immunoassays used for digoxin drug monitoring. In 61 blood samples of 47 eutrophic healthy newborns with jaundice, digoxin serum concentrations were measured during examination of serum bilirubin using a digoxin polarisation immunoassay. Although there was no digoxin therapy in any case, we found positive serum digoxin immunoreactivity (> or = 0.2 ng/ml) in 86% of serum samples. The mean DLIS-concentration was 0.43 +/- 0.19 ng/ml with a maximum of 0.9 ng/ml. We found a significant indirect correlation (rs = -0.34; p = 0.05) between age and serum DLIS concentration. A case report demonstrates the possibility of DLIS interference on digoxin drug monitoring.

Topics: Blood Proteins; Cardenolides; Digoxin; Dose-Response Relationship, Drug; Drug Monitoring; Heart Defects, Congenital; Heart Failure; Humans; Infant, Newborn; Male; Medigoxin; Saponins

Topics: Adolescent; Adult; Atrial Flutter; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Heart Atria; Heart Defects, Congenital; Humans; Infant; Male; Middle Aged; Procainamide; Quinidine; Tachycardia

Experience with three prenatally diagnosed pregnancies complicated by an acardiac twin reveals that ultrasonography and echocardiography are helpful in detecting early signs of in-utero congestive heart failure in the normal twin. The use of Doppler blood flow analysis to determine direction of blood flow, post-mortem placental and fetal angiography, and umbilical cord blood gas determination provided proof that retrograde arterial perfusion occurs in the acardiac fetus. In a fourth pregnancy, an experimental approach to occlude the acardiac twin's umbilical cord was attempted, but was unsuccessful.

Topics: Adult; Digoxin; Echocardiography; Female; Heart Defects, Congenital; Heart Failure; Humans; Maternal-Fetal Exchange; Polyhydramnios; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Prenatal Diagnosis; Twins, Monozygotic

Topics: Adolescent; Arrhythmias, Cardiac; Child; Child, Preschool; Creatinine; Digoxin; Drug Interactions; Drug Therapy, Combination; Heart Defects, Congenital; Humans; Infant; Propafenone

Seventy consecutive patients hospitalized before 1 year of age for reentrant paroxysmal atrial tachycardia (PAT) were studied according to the age of onset of arrhythmia making 3 distinctive groups: group I: 10 patients in whom onset of the arrhythmia occurred during foetal life; group II: 39 infants whose arrhythmia appeared during the first month of life and group III consisting of 21 patients in whom tachycardia began between 1 and 12 months of age. The characteristics and the consequences of the arrhythmia as well as the patients' course and the different treatments used were analysed. Foetal tachycardias were characterized by a slower heart rate. Episodes were most often short and repetitive as opposed to post-natal tachycardias which were often prolonged but somewhat unfrequent. Before the age of 3 months the occurrence of heart failure was more frequent. Independently of the age of onset, 43% of patients presented Wolff-Parkinson-White syndrome (WPW), which disappeared spontaneously in 1 out of 3 cases. The existence of WPW syndrome was correlated with late relapses.

Topics: Age Factors; Digoxin; Female; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Male; Pregnancy; Prenatal Diagnosis; Tachycardia, Paroxysmal; Time Factors; Wolff-Parkinson-White Syndrome

To find reliable indicators of digoxin clearance (CLdig) in the neonatal period, we investigated the linear correlation of CLdig and the reciprocal of CLdig (1/CLdig) with serum beta 2-microglobulin (S beta 2-MG), serum creatinine, blood urea nitrogen, age, and weight on 25 occasions in 21 neonates with congenital heart disease. The S beta 2-MG value showed a significantly closer correlation to 1/CLdig (r = 0.84, p less than 0.0001) than to the other values. The regression equation was (1/CLdig) = 0.15 X (s beta 2-MG) + 0.08. Creatinine and blood urea nitrogen values correlated less closely with 1/CLdig (r = 0.67 and 0.71, respectively). Age and weight had no significant linear correlation with CLdig and 1/CLdig. Determination of s beta 2-MG values allowed an estimate of CLdig by means of the regression equation between s beta 2-MG and 1/CLdig, and permitted a prediction of the required maintenance dose of digoxin. We conclude that s beta 2-MG is a good indicator of CLdig in neonates, and that the determination of s beta 2-MG values may facilitate the advance individualization of digoxin therapy in the neonatal period.

Topics: beta 2-Microglobulin; Blood Urea Nitrogen; Creatinine; Digoxin; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Prospective Studies; Retrospective Studies

It has been postulated that one or more plasma digitalis-like compounds may play an important role in body fluid regulation and in essential hypertension, although very little is known about their possible role in general haemodynamics. We therefore measured plasma inhibition of human kidney Na+,K+-ATPase and plasma cross-reactivity with digoxin antibodies in 11 normotensive cardiopathic subjects admitted to our clinic for heart catheterization. Possible correlations with haemodynamic parameters were studied. Plasma digoxin-like activity correlated directly with left atrial pressure and with pulmonary circulation data. The ability of the plasma to inhibit Na+,K+-ATPase showed an inverse correlation with cardiac output and cardiac index. No correlations were found with any of the other parameters measured, notably systemic resistance, blood pressure and natriuresis. These findings suggest the presence of more than one substance sharing chemical properties with digitalis: (1) a substance cross-reacting with digoxin antibodies and dependent on pulmonary vascular congestion; and (2) a substance capable of inhibiting the Na+-K+ pump and present in large amounts in heart diseases with a reduced cardiac index.

Topics: Adult; Aged; Blood Proteins; Cardenolides; Cardiac Catheterization; Coronary Disease; Digoxin; Heart Defects, Congenital; Hemodynamics; Humans; Middle Aged; Radioimmunoassay; Saponins; Sodium-Potassium-Exchanging ATPase

Topics: Child, Preschool; Digoxin; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Medigoxin

In 44 cases with nonimmunologic hydrops fetalis (NIHF), perinatal management was performed based on our protocol. Twenty-one cases were treated by albumin and/or packed red blood cell (PRC) injection into the fetal abdominal cavity, and 8 cases were treated by transplacental digitalization. Among the cases treated by albumin and/or PRC injection, 5 of 7 cases without pleural effusion recovered in utero, and all 5 cases are alive at the time of writing. However, of 14 cases with pleural effusion, none recovered in utero, and only 1 case is alive. Of 8 cases treated by transplacental digitalization, 2 cases recovered in utero, and 1 case is alive. All fetuses with congenital heart anomaly died. This evidence indicates that albumin and/or PRC injection into the fetal abdominal cavity is an effective procedure for in utero treatment of NIHF without pleural effusion, but suggests that in NIHF resulting from either congenital heart anomaly and/or heart failure, the survival rate may not be increased by transplacental digitalization.

Topics: Blood Transfusion, Intrauterine; Digoxin; Erythrocyte Transfusion; Female; Heart Defects, Congenital; Humans; Hydrops Fetalis; Lung; Pleural Effusion; Pregnancy; Pregnancy Outcome; Serum Albumin

In 11 of 15 profoundly sick, digitalized infants and children, elevation in serum digoxin concentration could be detected long after cessation of therapy. This phenomenon concurred with a rapid deterioration of renal function. Because death of a digitalized child may be attributed to the glycoside itself, it is important to recognize that elevation in serum concentration to a potentially toxic level is a common pathophysiologic pattern.

Topics: Child; Child, Preschool; Digoxin; Female; Heart Defects, Congenital; Hemolytic-Uremic Syndrome; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Prospective Studies

Topics: Adolescent; Adult; Child; Digoxin; Erythrocytes; Female; Heart Defects, Congenital; Humans; Male; Middle Aged; Myocardium; Radioimmunoassay

The sodium and potassium concentrations of the red blood cells and plasma were investigated in 93 children with cardiac disease, most of them with congenital heart defect, and in 48 healthy children of the same age. The red blood cell sodium and potassium concentrations were constant within a narrow range in normal subjects, but varied profoundly in pathological conditions. Digitalis treatment caused RBC Na+ and plasma K+ levels to increase and the RBC K+ level to decrease by blocking the Na+-K+ pump. The highest RBC Na+ concentration was observed in critically ill patients with congestive heart failure treated with digoxin. An augmented RBC sodium value was found in heart malformations with left to right shunt and in congestive cardiomyopathy that was not treated, whereas in patients with right to left shunt lower RBC sodium, higher RBC potassium and plasma potassium values were registered without any treatment. In cases of hyperkinetic circulation without any congenital heart defect the value of RBC sodium was definitely low. A low sodium and a high potassium level of the RBC were found after total correcting heart surgery. It is concluded that measurement of changes in sodium and potassium concentrations of the red blood cells is not a reliable method for assessment of the efficacy of digitalis treatment. The results point to the accompanying phenomena at a cellular level in heart disease.

Topics: Child; Digoxin; Erythrocytes; Female; Heart Defects, Congenital; Heart Failure; Humans; Male; Potassium; Sodium

Topics: Child; Child, Preschool; Chloral Hydrate; Digoxin; Female; Heart Defects, Congenital; Humans; Infant; Isoproterenol; Male; Postoperative Complications; Propranolol; Tachycardia; Verapamil

Congestive heart failure in children is unusual as a presenting problem, and the nonspecific nature of the signs and symptoms in the pediatric population makes recognition difficult. Congenital heart disease is most common in the infant whereas older children most commonly develop congestive heart failure due to cardiomyopathy, myocarditis, electrolyte abnormalities, dysrhythmias, and, more rarely, endocarditis, and rheumatic carditis. Management focuses upon stabilization of the airway and ventilation while improving circulatory function. This is achieved by the use of inotropic agents, combined with attention to the volume and pressure overload, pulmonary problems, dysrhythmias, and ongoing follow-up.

Topics: Cardiotonic Agents; Digoxin; Diuretics; Heart Defects, Congenital; Heart Diseases; Heart Failure; Humans; Infant; Infant, Newborn; Pulmonary Edema; Respiration, Artificial

Owing to its positive inotropic action, digitalis is indicated in congestive heart failure; because of its effect on AV conduction it can also be used in arrhythmias. However the nature of the dysrhythmia and the underlying causes of congestive heart failure and arrhythmia need to be further differentiated. Any underlying disease (e.g. renal failure) must be treated primarily. Also, the value of inotropic agents in obstructive lesions needs to be considered. In cardiac arrhythmias digitalis can elicit potentially dangerous arrhythmias owing to AV block. Shortening of the refractory period of "bypass tracts" and by changing automaticity in autonomic focus atrial tachycardia. The possibility of interactions with such commonly used antiarrhythmic drugs as quinidine and amiodarone must be considered. All patients receiving digitalis should be carefully followed and monitored using physical examination, ECG, echocardiographic assessments and digitalis blood level determinations.

Topics: Arrhythmias, Cardiac; Child, Preschool; Digitalis Glycosides; Digoxin; Dose-Response Relationship, Drug; Drug Interactions; Electrocardiography; Heart Defects, Congenital; Heart Failure; Hemodynamics; Humans; Infant; Infant, Newborn

In a cooperative, retrospective, study 120 children are reviewed with preexcitation pattern. 80 patients had tachycardias; 54 children were under 1 year, 49 under 3 months of age at their first attack. In 50% the preexcitation pattern disappeared in the first year of life, allthough intermittent preexcitation could be seen in some patients. In 12 patients a circusmovement tachycardia was proved on the surface ecg; in the group of 63 children with a tachycardia of unknown origin probably more may be caused by this mechanism. A beneficial effect of digoxin in childhood is noticed, with good response in 45 cases. A possible explanation for the difference in effect of digoxin during childhood and in adolescence is discussed.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Digoxin; Electrocardiography; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Retrospective Studies; Tachycardia; Wolff-Parkinson-White Syndrome

The addition of amiodarone to digoxin therapy in nine children caused a sharp increase in digoxin serum concentrations (68% to 800%) in the presence of preserved serum creatinine and BUN concentrations. Digoxin half-life was prolonged. Digoxin accumulation could be attributed in part to the decrease in the renal clearance of digoxin resulting from inhibited tubular secretion of the drug and to the reduction in the distribution volume of digoxin caused by amiodarone. Creatinine clearance was not affected by amiodarone. This interaction appears to be more acute in children than in adults, presumably because of the more important role of the renal tubular secretion of digoxin in children. Whenever digoxin and amiodarone therapy are combined, the digoxin serum concentration should be monitored carefully, with appropriate reduction of the digoxin dose.

Topics: Adolescent; Amiodarone; Benzofurans; Cardiomyopathy, Dilated; Child; Child, Preschool; Creatinine; Digoxin; Drug Interactions; Heart Defects, Congenital; Heart Diseases; Humans; Infant; Male; Prospective Studies

The effects of digoxin on systolic and diastolic time intervals were studied in 25 children and infants the majority of whom had congenital heart disease by M mode echocardiography. The recordings were performed before and after the administration of digoxin. Serum digoxin levels were measured to confirm therapeutic dosage. After digoxin, the right and left ventricular pre-ejection periods, the duration of the corrected electromechanical systole and the Weissler indices decreased, and the isovolumic relaxation periods increased. The ventricular ejection times were unchanged except for the corrected right ventricular ejection time which was only slightly decreased. Our results concerning left ventricular systolic time intervals are in agreement with other studies in children. As no other studies of the effects of digoxin on the right ventricular systolic time intervals, or of the right and left isovolumic relaxation time are available, confirmatory studies are required. The decrease in the right and left pre-ejection periods, electromechanical systole and the Weissler indices, is interpreted as being related to the positive inotropic effect of digoxin whilst the increase in isovolumic relaxation reflects only a decrease in preload. This study allows a better understanding of the effects of digoxin on the different phases of the cardiac cycle and a better appreciation of its action potential.

Topics: Diastole; Digoxin; Echocardiography; Female; Heart Defects, Congenital; Humans; Infant; Male; Myocardial Contraction; Stroke Volume; Systole; Time Factors

Topics: Alprostadil; Cardiac Output; Child, Preschool; Digoxin; Furosemide; Heart Defects, Congenital; Heart Failure; Humans; Hypoxia; Infant; Postoperative Care; Prostaglandins E; Tetralogy of Fallot

Ten cases of chaotic atrial tachycardia (CAT) in childhood are reported. Patients' ages ranged from 1 day to 18 years (average, 3.5 years) at the time of diagnosis. The patients were divided into groups according to the following criteria: (1) no cardiac disease (n = 5), (2) congenital heart disease (n = 4), and (3) acquired heart disease (n = 1). Nine of the children were treated with digoxin; however, it appears there was no beneficial effect. In fact, the single death in our study group may have been attributable to digitalis intoxication. No children have had recurrence of the arrhythmia after discontinuation of the drug. The duration of the tachyarrhythmia was extremely variable; however, CAT was well tolerated and was self-limiting in our patients.

Topics: Adolescent; Arrhythmias, Cardiac; Child; Child, Preschool; Chronic Disease; Digoxin; Electrocardiography; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Propranolol; Quinidine; Rheumatic Heart Disease; Tachycardia

One hundred and twenty-two patients with cardiac disease were compared with 250 controls with respect to the duration of pregnancy and labour, birth weight percentile and Apgar score. The babies of the patients with cardiac disease were light-for-dates (18% below the 10th percentile); the mothers, if multiparous, delivered at an earlier gestational age. The patients with cardiac disease did not have shorter labours than the control group. Digoxin administration and the severity of heart disease had no significant effect on these variables.

Topics: Apgar Score; Birth Weight; Digoxin; Female; Heart Defects, Congenital; Heart Diseases; Humans; Infant, Low Birth Weight; Infant, Newborn; Labor, Obstetric; Parity; Pregnancy; Pregnancy Complications, Cardiovascular; Rheumatic Heart Disease

Topics: Digoxin; Glycosides; Heart Defects, Congenital; Humans; Infant; Radioimmunoassay

Six examples of intrauterine supraventricular tachycardia together with 31 previously reported cases are described and analyzed. Among the 37 infants, structural heart disease was present in only four (11%), three of whom died. Males comprised 68% of the group without identifiable heart disease or pre-excitation. Congestive heart failure was evident in 62% of the infants at birth or shortly thereafter; ascites was the predominant finding in three (8%). Neither the duration of SVT nor heart rate was predictive of the clinical status at birth. Infants without underlying heart disease or conduction abnormalities had a benign course after the neonatal period. Thirty-eight percent of the babies converted to sinus rhythm during or shortly after delivery without medication, and most of the others converted after digitalization. The failure of maternal digitalization to convert SVT to sinus rhythm in two of our infants was perhaps related to subtherapeutic maternal and fetal digoxin levels. Newborn infants presenting with unexplained ascites or congestive heart failure should have an ECG to determine whether pre-excitation is present, and their cardiac rhythm should be monitored for several days.

Topics: Ascites; Cardiomegaly; Digoxin; Female; Fetal Diseases; Heart Defects, Congenital; Heart Failure; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia

Topics: Calcium; Digoxin; Electrolytes; Heart Defects, Congenital; Humans; Infant, Newborn; Magnesium; Potassium; Saliva; Sodium

A case of multiple neonatal haemangiomatosis is reported. The disease entity is rare and probably always combined with haemangiomas of internal organs. When visceral involvement provokes clinical symptoms (cardiac, cerebral, gastrointestinal), the spontaneous course often proves fatal. The prognosis seems to improve substantially if treatment with systemic corticosteroids is instituted. The patient reported, who had concomitant cardiac and gastrointestinal symptoms, recovered completely following corticosteroid treatment. It is concluded that steroid treatment is indicated without hazards in complicated cases of multiple neonatal haemangiomatosis.

Topics: Angiomatosis; Digoxin; Female; Heart Defects, Congenital; Hemangioma; Humans; Infant; Prednisone; Skin; Skin Neoplasms

Digoxin serum levels in 41 children with clinical and/or ECG symptoms of digitoxicity were determined by radioimmunoassay and compared to the normal values. 54% of the cases showed a good relationship between clinical and/or ECG signs of toxicity and digoxin levels; on the contrary, 29% of patients exhibited only clinical and/or ECG signs of toxicity with normal digoxin levels and 17% of patients had high digoxin levels without signs of toxicity. The significance and possible causes of this relative discrepancy are discussed.

Topics: Adult; Arrhythmias, Cardiac; Cardiomyopathies; Child; Child, Preschool; Digitalis Glycosides; Digoxin; Heart Defects, Congenital; Heart Failure; Humans; Infant; Radioimmunoassay

The renal clearance of digoxin and creatinine were measured in eleven infants, aged one to five months, with congenital heart disease and heart failure. The renal clearances of digoxin were low at one month of age (50 ml/min/1.73 m2) but increased progressively until the adult range was attained at about five months of age (130-150 ml/min/1.73 m2). At any given age, however, the renal clearance of digoxin was almost twice as great as the simultaneously determined creatinine clearance (mean ratio 1.73). This stands in marked contract to older subjects where creatinine and digoxin clearances are usually similar. These data explain (in part) the larger digoxin dosage requirement of infants.

Topics: Aging; Creatinine; Digoxin; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Kidney; Kinetics; Metabolic Clearance Rate

Diagnostic separation of infants with signs of cardiac failure (hypoglycemia, sepsis, myocarditis, hypoxemia) but no congenital cardiocirculatory malformation from those with a large left to right shunt is crucial in newborn management. Echocardiographic studies of 218 infants and children allowed group separation and distinction from normal by the assessment of mean velocity of circumferential fiber shortening (Vcf) and the ratio of left atrial to aortic root diameter at end-systole (LA/Ao). In normal premature and full-term infants, Vcf (1.51 +/- 0.04 [mean +/- standard error]) was significantly lower than in infants with a large shunt (2.12 +/- 0.08, P less than 0.01) and higher than in infants with nonstructural heart disease (1.18 +/- 0.06, P less than 0.001). LA/Ao ratios were comparable in the groups with a large shunt and nonstructural heart disease (1.14 +/- 0.1 and 1.26 +/- 0.2, respectively) and were significantly higher in both groups than in normal subjects (0.77 +/- 0.01, P less than 0.001). Similar echocardiographic distinctions could be made when 10 older children (aged 2 to 10 years) with cardiomyopathy were compared with 45 normal older children. Serial determination of these variables was of major assistance in patient management.

Topics: Cardiomyopathies; Child; Child, Preschool; Diagnosis, Differential; Digoxin; Ductus Arteriosus, Patent; Echocardiography; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Myocardial Contraction; Myocarditis

Serum magnesium estimation was done in 19 children who had heart failure of varied etiology. Five of nine toxic patients and three of 10 nontoxic ones had magnesium deficiency (serum magnesium less than 1.5 mEq. per liter). Mean serum magnesium level was significantly lowered (P less than 0.01) in 19 children and it was further lowered in nine toxic patients (P less than 0.001) as well as in eight hypomagnesemic patients (P less than 0.001) than in healthy control subjects. Mean serum digoxin level in toxic patients was significantly higher than in nontoxic ones (P less than 0.05). In three cases magnesium sulfate was successfully used for the management of cardiac arrhythmias.

Topics: Adolescent; Arrhythmias, Cardiac; Child; Child, Preschool; Digoxin; Heart Defects, Congenital; Heart Failure; Humans; Magnesium; Magnesium Deficiency; Magnesium Sulfate; Rheumatic Heart Disease

The distribution of digoxin in the myocardium, skeletal muscle, erythrocytes, and plasma (or serum) was studied in 19 infants. There was a linear relationship between myocardium and serum concentrations and no saturation was observed over the serum concentration range of 0.5-8.6 ng/ml. Myocardium uptake of digoxin was nearly twice as great in infants as in adults at any given serum concentration. Erythrocyte: plasma concentration ratios of digoxin were one-third smaller during digitalization than during maintenance digoxin therapy. The latter ratios were also three times greater in infants than found previously in adults. Their findings are consistent with a greater apparent volume of distribution of digoxin in infants and may partly explain the unusually large therapeutic doses needed in infants.

Topics: Digoxin; Erythrocytes; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Iodine Radioisotopes; Kinetics; Muscles; Myocardium

Sodium and potassium levels in plasma and leucocytes and the sodium efflux rate constants of leucocytes were measured in patients with congenital heart disease not on treatment, patients with valvular heart disease being treated with digoxin and conventional diuretics, and patients with valvular heart disease receiving digoxin and either conventional diuretics or triamterene or both. The group being treated with digoxin and conventional diuretics showed low cellular potassium levels, low sodium efflux rate constants, and a rise in cellular sodium levels. Patients given triamterene showed a rise in potassium levels in plasma and cells and in the sodium efflux rate constant.

Topics: Digoxin; Diuretics; Heart Defects, Congenital; Heart Valve Diseases; Humans; Leukocytes; Potassium; Sodium; Triamterene

Topics: Blood Gas Analysis; Cardiac Catheterization; Cyanosis; Digoxin; Electrocardiography; Female; Fetal Heart; Heart Auscultation; Heart Defects, Congenital; Hematocrit; Hemodynamics; Humans; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Oxygen; Oxygen Inhalation Therapy; Physical Examination; Pregnancy; Primary Health Care; Pulse

Topics: Adolescent; Child; Child, Preschool; Digoxin; Drug Evaluation; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Rheumatic Fever

The paper deals with the problems of intensive therapy in cardiac surgery of early childhood. Proceeding from their experience in the treatment of 1036 children aged under 3 years the authors give recommendations as to the measures of intensive therapy both prior to surgery, and in the early postoperative period. The principal differences of pre- and postoperative intensive therapy are determined.

Topics: Age Factors; Blood Transfusion; Child Health Services; Child, Preschool; Critical Care; Digoxin; Diuretics; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Intensive Care Units; Moscow; Oxygen Inhalation Therapy; Postoperative Care; Preoperative Care; Respiration, Artificial; Resuscitation

In 20 children needing treatment for symptomatic sick sinus syndrome, the average age at presentation was 7.1 years and ranged from 9 months to 18 years. Symptoms were never precise but, in retrospect, 5 children had syncope, 7 had a rapid heart action, 6 had dyspnoea or tachypnoea, 2 had nonspecific chest pains, 2 had pale spells, and 1 had a sudden hemiplegia. Symptoms followed cardiac surgery in 15 cases and were related to unoperated congenital heart disease in 2 and to myocarditis in 2. The aetiology was unknown in 1 case. The type of cardiac surgery resulting in the development of the sick sinus syndrome was predominantly related to atrial suturing. Both tachy- and bradydysrhythmias were found, including wandering atrial pacemaker (9 cases), junctional rhythm (19 cases), supraventricular tachycardia (9 cases), atrial flutter (11 cases), and atrial fibrillation (2 cases). Both atrial (8 cases) and ventricular (7 cases) premature beats were seen. All patients were given trials of drug therapy but difficulties were encountered. Cardioversion was used for tachyarrhythmias in 11 cases without serious problems. Six children had permanent cardiac pacemakers inserted with good results. Recognition of the sick sinus syndrome in childhood is important and treatment must be regulated by the severity of symptoms.

Topics: Adolescent; Arrhythmia, Sinus; Arrhythmias, Cardiac; Bradycardia; Cardiac Catheterization; Child; Child, Preschool; Digoxin; Dyspnea; Female; Heart Block; Heart Defects, Congenital; Heart Rate; Hemiplegia; Humans; Infant; Male; Myocarditis; Pacemaker, Artificial; Pallor; Syncope

Topics: Child; Child, Preschool; Digoxin; Drug Evaluation; Heart Defects, Congenital; Heart Failure; Humans; Infant; Pneumonia; Sepsis; Tachycardia, Paroxysmal

Topics: Child; Child, Preschool; Digoxin; Female; Follow-Up Studies; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Kidney; Male; Radioimmunoassay

Topics: Aorta; Aortic Arch Syndromes; Aortic Valve; Autopsy; Birth Weight; Chlorothiazide; Digoxin; Ductus Arteriosus, Patent; Electrocardiography; Heart Auscultation; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Male; Mitral Valve; Oxygen; Pulmonary Artery; Pulse

Topics: Administration, Oral; Adolescent; Arrhythmias, Cardiac; Child; Child, Preschool; Digoxin; Drug Evaluation; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Myocarditis; Pregnancy

Topics: Adult; Aged; Body Surface Area; Body Weight; Digoxin; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Middle Aged; Potassium; Radioimmunoassay; Time Factors; Urea

Topics: Digoxin; Heart Defects, Congenital; Heart Failure

Topics: Acidosis; Body Temperature; Cardiac Catheterization; Child; Cholesterol; Digoxin; Electrocardiography; Follow-Up Studies; Heart Auscultation; Heart Defects, Congenital; Humans; Hypertension; Infant; Pulse

Topics: Adipose Tissue; Arrhythmias, Cardiac; Child; Child, Preschool; Creatinine; Digoxin; Extracorporeal Circulation; Heart Defects, Congenital; Humans; Hypokalemia; Muscles; Myocardium; Postoperative Complications; Radioimmunoassay

Topics: Blood Pressure; Carbon Dioxide; Cardiac Catheterization; Cardiac Output; Cryosurgery; Digoxin; Epinephrine; Female; Furosemide; Halothane; Heart; Heart Arrest, Induced; Heart Defects, Congenital; Hemodynamics; Hemoglobins; Humans; Hydrogen-Ion Concentration; Infant; Infant, Newborn; Isoproterenol; Jaundice; Male; Myocardium; Oxygen; Oxygen Consumption; Postoperative Care; Postoperative Complications; Pulmonary Veins; Regression Analysis

Topics: Angiocardiography; Cardiac Catheterization; Cardiomegaly; Digoxin; Electrocardiography; Extracorporeal Circulation; Female; Furosemide; Heart Auscultation; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Male; Oxygen Inhalation Therapy; Pulmonary Valve Stenosis; Pulmonary Veins; Respiratory Insufficiency

Topics: Acidosis; Alkalosis; Anti-Bacterial Agents; Blood Transfusion; Body Temperature; Digoxin; Diuretics; Drainage; Glucose; Heart Arrest; Heart Defects, Congenital; Humans; Hypoglycemia; Hypoproteinemia; Infant, Newborn; Intubation, Intratracheal; Isoproterenol; Parenteral Nutrition; Positive-Pressure Respiration; Postoperative Care; Serum Albumin; Thrombocytopenia; Water-Electrolyte Balance

Topics: Adult; Body Weight; Colorimetry; Digitalis Glycosides; Digitoxin; Digoxin; Fluorometry; Gastric Juice; Heart Defects, Congenital; Humans; Infant, Newborn; Kidney; Liver; Lung; Male; Methods; Myocardium

Topics: Administration, Oral; Adolescent; Adult; Age Factors; Aortic Valve Stenosis; Child; Child, Preschool; Digitalis Glycosides; Digoxin; Heart Defects, Congenital; Heart Septal Defects; Humans; Infant; Injections, Intramuscular; Poisoning; Radioimmunoassay; Tritium

Topics: Acidosis; Angiocardiography; Cardiac Catheterization; Cineangiography; Diet Therapy; Digoxin; Diuretics; Electrocardiography; Heart Auscultation; Heart Defects, Congenital; Heart Diseases; Heart Failure; Humans; Infant, Newborn; Infant, Newborn, Diseases; Isoproterenol; Radiography, Thoracic; Respiration, Artificial

Topics: Anemia; Anti-Bacterial Agents; Cardiomyopathies; Diet, Sodium-Restricted; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Myocarditis; Palliative Care; Respiratory Tract Infections; Rest; Tachycardia, Paroxysmal

Topics: Adult; Aged; Digoxin; Female; Fetus; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Maternal-Fetal Exchange; Middle Aged; Pregnancy; Pregnancy Complications, Cardiovascular; Radioimmunoassay; Rheumatic Heart Disease; Umbilical Cord

Topics: Aortic Coarctation; Aortic Valve Stenosis; Child, Preschool; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Pulmonary Valve Stenosis; Transposition of Great Vessels

Topics: Child; Child, Preschool; Digoxin; Heart Defects, Congenital; Humans; Infant; Infant, Newborn

Topics: Adolescent; Age Factors; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Heart Defects, Congenital; Heart Ventricles; Humans; Infant; Infant, Newborn; Infections; Male; Methods; Myocarditis; Quinidine; Sulfates; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Cardiac Volume; Computers; Digoxin; Heart; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Phonocardiography

Topics: Age Factors; Child, Preschool; Digoxin; Feces; Female; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Male; Time Factors; Tritium

Topics: Acidosis, Respiratory; Age Factors; Arrhythmias, Cardiac; Cardiac Catheterization; Cardiomegaly; Cyanosis; Diagnosis, Differential; Digoxin; Dyspnea; Electrocardiography; Ethacrynic Acid; Heart Defects, Congenital; Heart Failure; Hemodynamics; Hepatomegaly; Humans; Infant; Infant Care; Infant, Newborn; Lung Diseases; Monitoring, Physiologic; Oxygen; Parenteral Nutrition; Radiography

Topics: Digoxin; Heart Defects, Congenital; Heart Failure; Humans; Infant

Topics: Anti-Bacterial Agents; Anticoagulants; Aortic Coarctation; Bradycardia; Chlorothiazide; Diet, Sodium-Restricted; Digitalis Glycosides; Digitoxin; Digoxin; Drug Tolerance; Electrocardiography; Endocardial Fibroelastosis; Furosemide; Heart Block; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Lanatosides; Myocarditis; Organomercury Compounds; Oxygen Inhalation Therapy; Potassium Chloride; Pulmonary Edema; Tachycardia; Tachycardia, Paroxysmal; Transposition of Great Vessels

Topics: Digoxin; Feces; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Kidney; Liver; Male; Myocardium; Tritium

Topics: Child, Preschool; Digoxin; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Coronary Disease; Digoxin; Female; Heart Defects, Congenital; Heart Diseases; Heart Valve Diseases; Humans; Male; Middle Aged; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia, Paroxysmal

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Child; Child, Preschool; Digoxin; Heart Defects, Congenital; Heart Diseases; Heart Septal Defects, Atrial; Humans; Lanatosides; Middle Aged; Postoperative Complications; Preoperative Care; Retrospective Studies; Tachycardia

Topics: Cardiac Catheterization; Cyanosis; Diagnosis, Differential; Digoxin; Electrocardiography; Heart Defects, Congenital; Humans; Infant; Infant Care; Infant Mortality; Infant, Newborn; Interprofessional Relations; Physician-Patient Relations

Topics: Adolescent; Arrhythmias, Cardiac; Child; Digoxin; Heart Defects, Congenital; Humans; Hypokalemia; Infant; Infant, Newborn; Rheumatic Heart Disease; Toxicology

Topics: Blood Pressure; Child; Digitalis Glycosides; Digitoxin; Digoxin; Diuretics; Drug Therapy; Fluid Therapy; Heart Auscultation; Heart Defects, Congenital; Heart Failure; Humans; Infant; Lanatosides; Liver Circulation; Morphine; Oxygen Inhalation Therapy; Parenteral Nutrition; Posture; Respiratory Tract Infections; Rest; Shock; Sodium; Water-Electrolyte Balance

Topics: Anxiety; Cardiac Surgical Procedures; Child; Digoxin; Drug Therapy; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant Mortality; Infant, Newborn; Morbidity; Parent-Child Relations; Thoracic Surgery

Topics: Child; Chlorothiazide; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Humans; Morphine; Organomercury Compounds; Oxygen Inhalation Therapy; Pediatrics