Efficacy and Safety of Amiodarone and Propranolol in Pediatric Cardiology for Arrhythmia After Cardiac Surgery: A Retrospective Design Study

Objectives The study evaluated the efficacy of antiarrhythmic pharmacotherapies in managing tachyarrhythmia episodes in pediatric patients with congenital heart diseases post-tricuspid valve repair, assessing reductions in haemodynamic parameters and symptomatic variables, and observing side effects. Methods From January 2020 to January 2024, this study reviewed data from 300 patients, aged up to 18 years, who experienced arrhythmia following cardiac surgery and received treatment with amiodarone, propranolol, or both. The information included demographic and anthropometric measures, haemodynamic parameters, and antiarrhythmic drugs used to treat arrhythmias before and after tricuspid valve repair. The study employed two validated symptomatic assessment scales: the four "A" symptomatic (4ASX) score and the New York Heart Association (NYHA) classification I-IV. We categorised the outcomes into two groups: the unresponsive cohort (Cohort I) and the responsive cohort (Cohort II). The study determined the antiarrhythmic efficacy by observing that the responsiveness group exhibited higher distribution rates in the lower heart rate category and higher decrementing rates in the tracked haemodynamics categories. The negative occurrence of at least one composited side effect of interest identified the safety significance profile for these three adopted antiarrhythmic interventions. The study adopted the threshold of 0.05 as the level of statistical significance. Results This study found that 32.33% exhibited clinical unresponsiveness to antiarrhythmic agents, while 67.67% achieved desired responsiveness. 38% used amiodarone as the choice antiarrhythmic medication, while 32.3% used propranolol. The study found significant distribution rates concerning heart rates, with 56.2% of patients with a heart rate of <100 bpm being responsive, compared to 38.1% in the unresponsive cohort. Symptomatic improvement was noted after transcatheter atrial septal defect closure in the 300 patients undergoing this procedure to address complications related to tricuspid regurgitation. Most of the adopted haemodynamic indices showed statistical significance decrementing rates in the responsiveness cohort compared to the unresponsiveness cohort. Conclusion Using antiarrhythmic pharmacotherapies during tricuspid valve repair had statistically significant responsiveness statuses against procedural arrhythmia, positive outcomes in symptomatic and haemodynamic monitored parameters, and a statistically significant noninferior safety profile regardless of the antiarrhythmic agent used (amiodarone, propranolol, or a combination of both.