Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-28T00:13:19.887Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Polanczyk, G, Rohde, LA. Epidemiology of attention-deficit/hyperactivity disorder across the lifespan. Curr Opin Psychiatry 2007; 20: 386–392.CrossRefGoogle ScholarPubMed
2. Schlander, M, Trott, GE, Schwarz, O. The health economics of attention deficit hyperactivity disorder in Germany. Part 1: Health care utilization and cost of illness. Nervenarzt 2010; 81: 289–300.Google Scholar
3. Faraone, SV, Spencer, T, Aleardi, M, et al. Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J Clin Psychopharmacol 2004; 24: 24–29.Google Scholar
4. Schubert, I, Koster, I, Lehmkuhl, G. The changing prevalence of attention-deficit/hyperactivity disorder and methylphenidate prescriptions: a study of data from a random sample of insurees of the AOK Health Insurance Company in the German State of Hesse, 2000–2007. Dtsch Arztebl Int 2010; 107: 615–621.Google ScholarPubMed
5. Cooper, WO, Habel, LA, Sox, CM, et al. ADHD drugs and serious cardiovascular events in children and young adults. N Engl J Med 2011; 365: 1896–1904.CrossRefGoogle ScholarPubMed
6. Habel, LA, Cooper, WO, Sox, CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults. JAMA 2011; 306: 2673–2683.CrossRefGoogle Scholar
7. Leslie, LK, Alexander, ME, Trikalinos, TA, et al. Reexamining the emperor's new clothes: ambiguities in current cardiac screening recommendations for youth with attention deficit hyperactivity disorder. Circ Cardiovasc Qual Outcomes 2008; 1: 134–137.Google Scholar
8. Buchhorn, R, Conzelmann, A, Willaschek, C, et al. Heart rate variability and methylphenidate in children with ADHD. Atten Defic Hyperact Disord 2012; 4: 85–91.CrossRefGoogle ScholarPubMed
9. La Rovere, MT, Bigger, JT Jr, Marcus, FI, et al. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (autonomic tone and reflexes after myocardial infarction) investigators. Lancet 1998; 351: 478–484.Google Scholar
10. Vaseghi, M, Shivkumar, K. The role of the autonomic nervous system in sudden cardiac death. Prog Cardiovasc Dis 2008; 50: 404–419.Google Scholar
11. Buchhorn, R, Muller, C, Willaschek, C, et al. How to predict the impact of methylphenidate on cardiovascular risk in children with attention deficit disorder: methylphenidate improves autonomic dysfunction in children with ADHD. ISRN Pharmacol 2012; 2012: 170935.Google Scholar
12. Roggen, A, Pavlovic, M, Pfammatter, JP. Frequency of spontaneous ventricular tachycardia in a pediatric population. Am J Cardiol 2008; 101: 852–854.CrossRefGoogle Scholar
13. Wang, S, Zhu, W, Hamilton, RM, et al. Diagnosis-specific characteristics of ventricular tachycardia in children with structurally normal hearts. Heart Rhythm 2010; 7: 1725–1731.Google Scholar
14. MacLellan-Tobert, SG, Porter, CJ. Accelerated idioventricular rhythm: a benign arrhythmia in childhood. Pediatrics 1995; 96: 122–125.Google Scholar
15. Riera, AR, Barros, RB, de Sousa, FD, et al. Accelerated idioventricular rhythm: history and chronology of the main discoveries. Indian Pacing Electrophysiol J 2010; 10: 40–48.Google Scholar
16. Kinoshita, S, Ogawa, S, Mitsuoka, T. Reverse effects of exercise on the sinus and parasystolic cycle lengths. J Electrocardiol 1996; 29: 131–137.CrossRefGoogle ScholarPubMed
17. Kinoshita, S, Mitsuoka, T. Effect of standing on ventricular parasystole: shortening of the parasystolic cycle length. Heart 1997; 77: 133–137.Google Scholar
18. Lanza, GA, Lucente, M, Rebuzzi, AG, et al. Ventricular parasystole: a chronobiologic study. Pacing Clin Electrophysiol 1986; 9: 860–867.Google Scholar
19. Prasad, S, Furr, AJ, Zhang, S, et al. Baseline values from the electrocardiograms of children and adolescents with ADHD. Child Adolesc Psychiatry Ment Health 2007; 1: 11.Google Scholar
20. Fazio, G, Novo, G, Sutera, L, et al. Sympathetic tone and ventricular tachycardia. J Cardiovasc Med (Hagerstown) 2008; 9: 963–966.Google Scholar
21. Rosen, MR, Hoffman, BF. The vagus and the ventricles. Circ Res 1978; 42: 1.Google Scholar
22. Wilens, TE, Prince, JB, Spencer, TJ, et al. Stimulants and sudden death: what is a physician to do? Pediatrics 2006; 118: 1215–1219.Google Scholar
23. Batra, AS, Alexander, ME, Silka, MJ. Attention-deficit/hyperactivity disorder, stimulant therapy, and the patient with congenital heart disease: evidence and reason. Pediatr Cardiol 2012; 33: 394–401.Google Scholar