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Ventricular arrhythmias in children with attention deficit disorder – a symptom of autonomic imbalance?

Published online by Cambridge University Press:  12 February 2013

Reiner Buchhorn  and
Willaschek Christian
Reiner Buchhorn*
Affiliation:
Department of Paediatrics, Caritas Krankenhaus, Bad Mergentheim, Germany
Willaschek Christian
Affiliation:
Department of Paediatrics, Caritas Krankenhaus, Bad Mergentheim, Germany
*
Correspondence to: Prof. Dr. Reiner Buchhorn, Department of Paediatrics, Caritas Krankenhaus, Klinik für Kinder- und Jugendmedizin, Uhlandstr. 7, 97980 Bad Mergentheim, Germany. Tel: +49-7931-582301; Fax: +49-7931-582390; E-mail: reiner.buchhorn@ckbm.de
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Abstract

Objectives

Potential side effects of stimulants for attention deficit disorder are in the focus of scientific discussions, intensified by the higher number of prescriptions. Children with known arrhythmias or other severe cardiac problems should not receive stimulants because of their sympathomimetic effects.

Methods

This is a retrospective analysis of 24-hour Holter electrocardiograms from 100 consecutive children with attention deficit disorder from January, 2006 to April, 2012.

Results

In all, nine children had significant ventricular arrhythmia (mean age 11.4 ± 3.1 years, 77% male, 77% received methylphenidate). All these children had ventricular parasystole – four of them with an accelerated idioventricular rhythm. A significant circadian rhythm of premature ventricular contractions in seven children and the effect of standing and exercise clearly indicate the influence of the autonomic nervous system. In these children, hourly analysis of circadian rhythm within a 24-hour period showed a highly significant correlation between premature ventricular contractions and the vagal tone indicated by the heart rate variability parameter RMSSD (r = −0.83; p < 0.001). Ventricular arrhythmia was unaffected in seven children who received methylphenidate before diagnosis and decreased during metoprolol treatment in two children.

Conclusion

By Holter electrocardiogram analysis, we observed a remarkably high incidence of ventricular parasystole and accelerated idioventricular rhythm in nine of 100 children with attention deficit disorder, which depends on autonomic imbalance and not on stimulant treatment.

Keywords

Parasystoleaccelerated idioventricular rhythmmethylphenidateautonomic nervous system
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 1 , February 2014 , pp. 120 - 125
Copyright
Copyright © Cambridge University Press 2013 

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