Role and practical aspects of antiarrhythmic therapy in acute and chronic settings in children.

Background and aim: Cardiac arrhythmias in children require early diagnosis and individualised treatment approaches that differ significantly from those used in adult medicine. This article reviews the role of antiarrhythmic drugs in acute and chronic clinical situations in children, focusing on practical use, safety and integration of non-pharmacological measures.

Results: Adenosine is the drug of choice for the acute treatment of supraventricular tachycardia. The aim of chronic drug prophylaxis is to achieve freedom from recurrence until the arrhythmia resolves spontaneously (more common in young children) or until elective catheter ablation is performed as a causal treatment for the arrhythmia. Several classes of antiarrhythmic drugs are used in long-term treatment. Amiodarone is usually reserved for complicated, treatment-resistant cases. When choosing a beta-blocker, the history of asthmatic-like symptoms in children should be taken into account and cardioselective beta-blockers should be chosen.

Discussion: Antiarrhythmic drugs are an essential part of the management of arrhythmias in children. Weight-adjusted dosing, close monitoring and age-appropriate use ensure safe and effective therapy. Multidisciplinary care and individualised strategies are essential for successful treatment.