Stimulant-Drug Therapy for Attention-Deficit Disorder (With or Without Hyperactivity) and Sudden Cardiac Death

PEDIATRICS ◽  
2007 ◽  
Vol 119 (1) ◽  
pp. 154-155 ◽  
Author(s):  
M. Knight
Keyword(s):  
Drug Therapy ◽  
Sudden Cardiac Death ◽  
Attention Deficit ◽  
Attention Deficit Disorder ◽  
Cardiac Death ◽  
Stimulant Drug

scholarly journals How to Predict the Impact of Methylphenidate on Cardiovascular Risk in Children with Attention Deficit Disorder: Methylphenidate Improves Autonomic Dysfunction in Children with ADHD

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Reiner Buchhorn ◽  
Christian Müller ◽  
Christian Willaschek ◽  
Kambiz Norozi
Keyword(s):  
Sudden Cardiac Death ◽  
Attention Deficit ◽  
Attention Deficit Disorder ◽  
Cardiac Death ◽  
Control Group ◽  
Healthy Children ◽  
Children With Adhd ◽  
Heart Defect ◽  
Adhd Children ◽  
The Impact

Background. Although stimulants have long been touted as treatments for attention deficit disorder with or without hyperactivity (ADHD), in recent years, increasing concerns have been raised about the cardiovascular safety of these medications. We aimed to prove if measurements of autonomic function with time domain analysis of heart rate variability (HRV) in 24-hour Holter ECG are useful to predict the risk of sudden cardiac death in ADHD children and adolescents. Methods. We analysed HRV obtained from children with the diagnosis of ADHD prior to (N=12) or during medical therapy (N=19) with methylphenidate (MPH), aged 10.8±2.0 years (mean ± SD), who were referred to our outpatient Paediatric Cardiology Clinic to rule out heart defect. As a control group, we compared the HRV data of 19 age-matched healthy children without heart defect. Results. Average HRV parameters from 24-hour ECG in the ADHD children prior to MPH showed significant lower values compared to healthy children with respect to rMSSD (26±4 ms versus 44±10 ms, P≤0.0001) and pNN50 (6.5±2.7% versus 21.5±9.0%, P≤0.0001). These values improved in MPH-treated children with ADHD (RMSSD: 36±8 ms; pNN50: 14.2±6.9%). Conclusion. Children who suffer from ADHD show significant changes in HRV that predominantly reflects diminished vagal tone, a well-known risk factor of sudden cardiac death in adults. In our pilot study, MPH treatment improved HRV.

scholarly journals Implantable cardioverter defibrillator - powerful weapon in primary and secondary prevention of sudden cardiac death

2019 ◽  
Vol 76 (10) ◽  
pp. 1007-1013
Author(s):  
Tomislav Kostic ◽  
Dragana Stanojevic ◽  
Ognjen Gudelj ◽  
Dragan Milic ◽  
Svetozar Putnik ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Sudden Cardiac Death ◽  
Medical Therapy ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Cardiac Insufficiency ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction

Bacgraund/Aim. Sudden cardiac death (SCD) is one of the biggest problems of the contemporary medicine. Large studies showed that anti-arrhythmics, including amiodarone, are not effective in prevention of SCD in the patients with cardiac diseases who were on drug treatment. Those patients who received implantable cardioverter defibrillators (ICD) had better survival. The aim of this paper was to determine whether the patients receiving the ICD in the primary and secondary SCD prevention have longer survival than the patients treated exclusively with drug therapy. Methods. We included 1,260 patients with cardiac insufficiency and reduced left ventricular ejection fraction (LVEF < 35%) who were at high risk for malignant ventricular arrhythmias and SCD. Five hundred forty patients received ICD therapy. The cardiac resynchronization therapy ? CRT/ICD group (n = 270) comprised the patients with cardiac insufficiency and CRT/ICD pacemaker at an optimal medical therapy. In the control group (n = 450), there were the patients with cardiac insufficiency (NYHA functional class 3?4, LVEF ? 35%, QRS duration ? 130 ms), at optimum drug therapy. Results. In the ICD group, there was a statistically significant increase in end-systolic volume (ESV) from 92.68 mL to 99.05 mL. In the group of patients with cardiac insufficiency who were on drug therapy, there was a significant decrease in LVEF (33.15% vs. 30.2%; p = 0.017), 6-minute walk distance (6 MWT distance) (216.55 m vs. 203.27 m, p = 0.003). In the same group, there was an increase in the values of ESV (90.19 mL vs. 95.41 mL; p = 0.011). An increase in the mortality rate in the group of patients with drug therapy compared to the CRT/ICD and ICD groups was statistically significant (p < 0.05). Conclusions. An ICD pacemaker implantation significantly reduces mortality compared to medical therapy only. In addition, the patients who have CRT in addition to ICD pacemaker, have a significantly better quality of life and increase in LVEF.

Antidysrhythmic Agents

1992 ◽  
Vol 3 (2) ◽  
pp. 483-493
Author(s):  
Frances Stier
Keyword(s):  
Patient Outcome ◽  
Drug Therapy ◽  
Sudden Cardiac Death ◽  
Mortality Rate ◽  
Cardiac Death ◽  
Adverse Reactions ◽  
Profound Impact ◽  
Cardiac Arrhythmia Suppression Trial ◽  
Ventricular Dysrhythmias ◽  
Versus Risk

Antidysrhythmic therapy is used to suppress supraventricular and ventricular dysrhythmias, thus relieving symptoms and reducing the risk of sudden cardiac death. The Cardiac Arrhythmia Suppression Trial (CAST) found an increased mortality rate in a group of patients treated with two antidysrhythmic agents. This result has had a profound impact on the prescribing and monitoring of antidysrhythmic therapy. Prodysrhythmia is a frequent and serious complication of antidysrhythmics and is unpredictable. Assessment of benefit versus risk of drug therapy for each patient is recommended. The nurse’s knowledge of antidysrhythmic pharmacology, including symptoms that indicate adverse reactions, and prodysrhythmia influences the patient outcome

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