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Listen "Safe and Effective Early Use of Betablockers after Pediatric Heart Transplantation"
Episode Synopsis
Safe and Effective Early Use of Betablockers after
Pediatric Heart Transplantation
https://doi.org/10.1016/j.healun.2023.02.1366
Purpose:
Beta-blockers (BBs) have been increasingly
incorporated into the management of heart transplant recipients, with data
supporting decreased mortality in adult recipients. However, very few studies
have evaluated the use of BBs in pediatric recipients, and early use after
pediatric heart transplantation (HTx) is still associated with hesitancy among
providers. We sought to evaluate the safety and effectiveness of early use of
BBs after pediatric HTx.
Methods:
We performed a single center retrospective review of
pediatric patients (< 18 years of age) who have undergone HTx (or heart
re-transplantation) from 1991 to 2022. Patients were included if they received
any oral BBs within the first 6 months after HTx. Patients who received only
intravenous BBs were excluded.
Results:
Out of 75 HTx performed, 22 patients (29.3%) were
identified, with 25 courses of BB therapy. Median age at HTx was 11.2 years (28
days - 17.9 years). The most common indication for HTx was cardiomyopathy in
17/22 cases (77.3%). BBs were most frequently started for stable atrial
tachyarrhythmias in 12 cases (48%), either as monotherapy or in combination
with other medications. Other indications included arterial hypertension or
afterload reduction, ventricular arrhythmias, and diastolic heart failure. In 2
patients, more than one course of BBs was given. BBs were started at a median
time after HTx of 21 days (5-180d). Metoprolol was the most frequently used
(12/25, 48%) and other agents included propranolol, carvedilol, atenolol and
sotalol. Median duration of therapy was 170 days (1-1444 d). Adverse effects
(symptomatic bradycardia) occurred in 2 patients; treatment had to be stopped
in 1 patient due to profound bradycardia, with full recovery after
discontinuation. There were no other associated complications. Early
discontinuation also occurred in 4 patients due to unsuccessful BB therapy
(16%). At median follow-up of 4.5 years after HTx (32d - 12.3 yrs), 7 patients
(31.8%) continued to receive BB therapy. There were 2 deaths (9.1%) during this
follow-up period, both unrelated to BB effects.
Pediatric Heart Transplantation
https://doi.org/10.1016/j.healun.2023.02.1366
Purpose:
Beta-blockers (BBs) have been increasingly
incorporated into the management of heart transplant recipients, with data
supporting decreased mortality in adult recipients. However, very few studies
have evaluated the use of BBs in pediatric recipients, and early use after
pediatric heart transplantation (HTx) is still associated with hesitancy among
providers. We sought to evaluate the safety and effectiveness of early use of
BBs after pediatric HTx.
Methods:
We performed a single center retrospective review of
pediatric patients (< 18 years of age) who have undergone HTx (or heart
re-transplantation) from 1991 to 2022. Patients were included if they received
any oral BBs within the first 6 months after HTx. Patients who received only
intravenous BBs were excluded.
Results:
Out of 75 HTx performed, 22 patients (29.3%) were
identified, with 25 courses of BB therapy. Median age at HTx was 11.2 years (28
days - 17.9 years). The most common indication for HTx was cardiomyopathy in
17/22 cases (77.3%). BBs were most frequently started for stable atrial
tachyarrhythmias in 12 cases (48%), either as monotherapy or in combination
with other medications. Other indications included arterial hypertension or
afterload reduction, ventricular arrhythmias, and diastolic heart failure. In 2
patients, more than one course of BBs was given. BBs were started at a median
time after HTx of 21 days (5-180d). Metoprolol was the most frequently used
(12/25, 48%) and other agents included propranolol, carvedilol, atenolol and
sotalol. Median duration of therapy was 170 days (1-1444 d). Adverse effects
(symptomatic bradycardia) occurred in 2 patients; treatment had to be stopped
in 1 patient due to profound bradycardia, with full recovery after
discontinuation. There were no other associated complications. Early
discontinuation also occurred in 4 patients due to unsuccessful BB therapy
(16%). At median follow-up of 4.5 years after HTx (32d - 12.3 yrs), 7 patients
(31.8%) continued to receive BB therapy. There were 2 deaths (9.1%) during this
follow-up period, both unrelated to BB effects.
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