Antithymocyte Globuline Therapy and Bradycardia in Children
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In antithymocyte globulin (ATG) treated patients occasionally bradycardia has been noticed. Therefore, we retrospectively analyzed the occurrence of bradycardia in ATG-treated children. Using medical records between 2007 and 2012 we identified children undergoing a combined therapy with ATG and glucocorticoids (ATG group, n = 22). The incidence of bradycardia was compared to that registered in children treated with glucocorticoids alone (glucocorticoid alone group, n = 21). Heart rates (HR) were registered before and on days 0–3, 4–7 and 8–14 after the ATG or steroid administration. The rate of bradycardic episodes was higher during ATG therapy than in the steroid alone group, while severe bradycardia occurred only in the ATG group (97 versus 32, p = 0.0037, and 13 versus 0, p = 0.0029, respectively). There was an interaction between the time and treatment group on HR (p = 0.046). Heart rates in ATG and steroid alone groups differed significantly on day 0–3 and day 4–7 (p = 0.046, p = 0.006, respectively). Within the ATG group HR was lower on days 4–7 compared to the days before and the days 8–14 values (p < 0.001, 95%CI: 0.020–0.074). These findings indicate that transient asymptomatic bradycardia is probably more common with ATG therapy than previously reported. HR should be closely monitored during and after ATG therapy.
KeywordsAntithymocyte globulin ATG Bradycardia Children
All authors have contributed substantially in the conception and design of the study. They all participated actively in the writing and approving of the manuscript.
Compliance with Ethical Standards
Conflict of Interest
The authors report no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
- 1.George B, Mathews V, Viswabandya A, Lakshmi KM, Srivastava A, Chandy M (2010) Allogeneic hematopoietic stem cell transplantation is superior to immunosuppressive therapy in Indian children with aplastic anemia--a single-center analysis of 100 patients. Pediatr Hematol Oncol 27(2):122–131CrossRefGoogle Scholar
- 7.Godown J, Deal AM, Riley K, Bailliard F, Blatt J (2011) Worsening bradycardia following antithymocyte globulin treatment of severe aplastic anemia. J Pediatr Pharmacol Ther 16(3):218–221Google Scholar
- 10.Al Shibli A, Al Attrach I, Hamdan MA (2012) Bradycardia following oral corticosteroid use: case report and literature review. Arab Journal of Nephrology and Transplantation 5(1):47–49Google Scholar
- 12.Michaelson ME (1972) MA;. Congenital complete heart block: an international study of the natural history. In: Clinics C (ed) Brest AE, MA. FA Davis, Philadelphia, p 85Google Scholar
- 13.Kugler J (1990) Sinus node dysfunction. In: Gilette PG, Jr AG (eds) Pediatric arrhythmias: electrophysiology and pacing. WB Saunders, Philadelphia, p 250Google Scholar
- 18.Rein AJ, Mevorach D, Perles Z, Gavri S, Nadjari M, Nir A et al (2009) Early diagnosis and treatment of atrioventricular block in the fetus exposed to maternal anti-SSA/Ro-SSB/la antibodies: a prospective, observational, fetal kinetocardiogram-based study. Circulation 119(14):1867–1872CrossRefGoogle Scholar
- 22.Costedoat-Chalumeau N, Amoura Z, Villain E, Cohen L, Piette JC (2005) Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Research & Therapy 7(2):69–73CrossRefGoogle Scholar
- 24.Daly KP, Chandler SF, Almond CS, Singh TP, Mah H, Milford E, Matte GS, Bastardi HJ, Mayer JE, Fynn-Thompson F, Blume ED (2013) Antibody depletion for the treatment of crossmatch-positive pediatric heart transplant recipients. Pediatr Transplant 17(7):661–669Google Scholar