[SCD-FORUM] 12E RE: A children with LQTS. Dr. Makarov

[SCD Symposium]

By our experience of the managment and follow up of children with  
congenital
LQTS, beta blockers (Propranolol, Atenolol, Nadolol) therapy in daily  
dose
1-2 mg/kg not significantly increase of bradycardia in this pts.  
Sometimes
combination of the regular doses of betablockers (1 mg/kg) and Na  
blockers
(we use carbamazepin 10 mg/kg/daily) may be useful. But in this case  
patient
had syncope, very long QTc (600 ms) and heart rate 55 bpm for 5 years  
old
children on rest ECG  is very low.  By my opinion children need in
antyarhythmic device in combination with drug therapy.
Dr. Leonid Makarov
Moscow Institute pediatry and children surgery
Moscow, Russia. Taldomskaya str. 2
leo at oss.ru

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee


>
> Dear Dr. Dubner,
>
> Thank you and your colleagues for this nice online symposium.
> Recently, a
> 5-year-old children with no evidence of structural heart disease
> referred to
> our center for evaluation of syncope. He also had history of  
> congenital
> deafness. One of the episodes of syncope occurred 48-hrs after
> betablocker
> withdrawal and second episodes on 10 mg propranolol tid. Surface ECG
> revealed a QTc=600 ms and heart rate of 55 bpm. We think that onset in
> childhood, congenital deafness and QTc=600 would place this patient at
> higher risk for cardiac events and therefore a candidate for ICD
> implantation. However, small body size and future risk of  
> inappropriate
> therapy with its devastating consequences are unfavorable aspects  
> of ICD
> implantation. Our limitimg factors for increase in dose of
> betablocker is
> low baseline hear rate. What is recommendation of scientific
> committee of
> SCD symposium regarding our patient?
>
> Thank you in advance for your recommendation.
>
> Regards,
>
> Majid Haghjoo,MD
> Department of Pacemaker and Electrophysiology
> Rajaie Cardiovascular Medical and Research Center
> Tel: +98 21 2392 2931
> Fax:+98 21 2204 8174
> Tehran, Iran

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