Arrhythmia Induction in Children
In this chapter we will demonstrate that medication administration in children for arrhythmia induction has specific characteristics. Basic principles such as pharmacology and mechanism of action are mostly the same as in adults, and the biggest difference is in dosing. It goes without saying that there are not many studies performed in children as in adults and many of dosing schemes are based on the particular experience of different electrophysiology centers. The current practice for selecting the pediatric dose for the drugs used in electrophysiology does not guarantee a safe and effective dose for children. Reducing the dose used in adults by formulas using age, body weight, or any other demographic variable without any prior evidence of how these factors contribute to the drug’s plasma concentration may lead to unreliable pediatric dose estimates. However, this practice is universally used in electrophysiology for medication that induces arrhythmias in children as in adults. Although it is relatively easy and simple to use empirical doses for these drugs, growth and development of the child can result in unpredictable dose-effect pharmacokinetic changes. Recent advances in qualitative and quantitative pharmacokinetic analysis will allow electrophysiologists to determine the most appropriate dose for the child that needs ablation. Until then, we should use the doses published by pediatric electrophysiology teams in various articles dealing with pediatric catheter ablation. These doses will be listed in the following paragraphs.
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