Pediatric ectopic atrial tachycardia: Successful management with beta blocker and Ivabradine in a 7-year-old girl - A case report

Abstract

Ectopic atrial tachycardia (EAT) is a supraventricular tachycardia commonly found in younger children, which can lead to tachycardia-induced cardiomyopathy. While radiofrequency ablation is often recommended for older children, limited studies exist on the use of Ivabradine, a medication that lowers heart rate, in children with EAT.

A 7-year-old girl presented with exertional palpitations and dizziness upon sudden changes in posture. Physical examination, 12-lead ECG, and 2D-ECHO were unremarkable. A 24-hour Holter monitor revealed atrial high-rate episodes with distinct P waves, abnormal axis, longer RP interval, and QRS alternans, confirming a diagnosis of EAT. The patient was treated with Metoprolol initially, resulting in partial symptom relief. However, repeat Holter monitoring showed persistent ectopic atrial rhythm episodes. Based on literature review, Ivabradine was added to the treatment regimen after one week. With the addition of Ivabradine, heart rate reduction was observed, accompanied by alternating periods of restored sinus rhythm and ectopic atrial rhythm. Although ectopic atrial rhythm episodes persisted, the patient's symptoms improved compared to earlier. This case report provides additional evidence for the successful use of Ivabradine as an adjunctive therapy, along with beta blockers, in the management of resistant atrial ectopic tachycardia in children. While research on its use in younger children is scarce, this case highlights the potential effectiveness of Ivabradine in treating EAT, warranting further clinical studies to evaluate its safety and efficacy compared to standard treatment protocols for pediatric ectopic atrial tachycardia.