Pediatr Cardiol 19:445–449, 1998
Pediatric
Original Articles
Amiodarone Used Alone or in Combination with Propranolol: A Very
Effective Therapy for Tachyarrhythmias in Infants and Children
F. Drago,1 A. Mazza,2 P. Guccione,1 A. Mafrici,1 G. Di Liso,1 P. Ragonese1
1
Pediatric Cardiology Department, Bambino Gesù Hospital, Piazza Sant’Onofrio 4, 00165 Rome, Italy
2
Department of Cardiology, Santo Spirito Hospital, Lungotevere in Sassia 1, Rome, Italy
Abstract. The aim of the study was to evaluate the ef-
ficacy of amiodarone used alone or in combination with
propranolol in infants and children affected by life-
threatening or drug-resistant tachyarrhythmias. The
study included 27 children (median age 3 months), af-
fected by life-threatening and/or drug-resistant supraven-
tricular or ventricular tachyarrhythmias. The loading
dose of amiodarone was 10–20 mg/kg/day and the main-
tenance dose ranged between 3 and 20 mg/kg/day. When
amiodarone was ineffective, propranolol was added at a
dosage of 2–4 mg/kg/day. The study population was di-
vided into two groups: group A was composed of pa-
tients <1 year and group B of patients >1 year. The
effectiveness of the therapy was assessed by clinical
evaluation, Holter monitoring, exercise testing, and, in
patients with reentry tachycardias, electrophysiological
testing. Amiodarone used alone was effective or partially
effective in 4/14 (28%) patients in group A and in 11/13
(85%) patients in group B (p < 0.006). Among amioda-
rone-resistant patients, the combined therapy with pro-
pranolol was effective in 8/10 patients in group A and
2/2 patients in group B. Therefore, amiodarone used
alone or in combination with propranolol was effective
in 25/27 (93%) patients. During the follow-up (20.5 ± 13
months) there were no arrhythmic effects but side effects
were noted in 5/27 (18.5%) patients. Amiodarone seems
to be an effective drug in the control of the life-
threatening and/or drug-resistant supraventricular and
ventricular tachyarrhythmias in children. The addition of
propranolol can significantly enhance the success rate of
this class III drug, especially in the treatment of reentry
tachycardias due to accessory pathways.
Key words: Supraventricular tachycardia — Ventricular
tachycardia — Amiodarone — Propranolol
Amiodarone, a class III antiarrhythmic agent, is often
used with success in the treatment of children with re-
Correspondence to: F. Drago
Cardiology
© Springer-Verlag New York Inc. 1998
sistant and life-threatening supraventricular and ven-
tricular arrhythmias, either intravenously [9, 15, 16, 18,
23] or by oral administration [2, 5, 6, 8, 10, 11, 14, 21,
24–26]. However, it seems to be poorly effective in in-
fants with reentrant supraventricular tachycardia [22]
and its arrhythmic effects are not negligible [2, 8, 10–13,
21, 24–26]. Very good results are reported in the treat-
ment of adults with malignant arrhythmias when a ␤-
blocker agent is added to amiodarone [1].
The aim of our study was to evaluate the effective-
ness of amiodarone used alone in infants and children
affected by life-threatening or drug-resistant tachyar-
rhythmias, if age was related to amiodarone therapy fail-
ure, and if propranolol, a nonselective ␤-blocker agent,
could improve the success rate of amiodarone.
Materials and Methods
Patient Population
Twenty-seven pediatric patients affected by life-threatening or drug-
resistant sustained supraventricular or ventricular tachyarrhyth-
mias were enrolled in the study. There were 21 males and 6 females.
The median age was 3 months (range 15 days to 15 years). Twenty
had supraventricular arrhythmias, and 7 had ventricular arrhyth-
mias. Eleven patients had the arrhythmia when amiodarone was started
and the others received the drug while in sinus rhythm to prevent
arrhythmia recurrences. Eleven patients had a heart disease (postop-
erative congenital heart disease in 6, dilated cardiomyopathy in 2,
nonobstructive hypertrophic cardiomyopathy in 1, myocarditis in 1,
and arrhythmogenic right ventricular dysplasia in 1). Sixteen had failed
one to four drug regimen before starting amiodarone, which was the
first antiarrhythmic drug used with the other 11 patients. The study
population was divided in two groups: group A was composed of
patients younger than 1 year and group B of patients older than 1 year.
Clinical features of the study population are shown in Table 1.
Study Protocol
The protocol for drug administration and evaluation of therapy effec-
tiveness was different in the two groups.
446 Pediatric Cardiology Vol. 19, No. 6, 1998

Table 1. Clinical features, therapy, and side effects of the study population

Patient Age Sex Heart Surgery Arrhythmia Symptoms Previous Therapy Efficacy Side
disease performed drugs effects

Group A (<1 year)

1 90 d f 0 0 AFL 0 P AMIO Complete 0
2 30 d f 0 0 AFL Heart fail 0 AMIO Complete Hyperthyr
3 30 d m 0 0 AFL 0 0 AMIO Complete 0
4 40 d m 0 0 AET Heart fail P AMIO+PR Complete 0
5 25 d m 0 0 AVRT-WPW Heart fail P, F, F + PR AMIO+PR Complete 0
6 60 d m 0 0 AVRT-WPW 0 P, F, F + PR AMIO+PR Complete 0
7 40 d m 0 0 AVRT-WPW Heart fail P, F, F + PR AMIO+PR Complete 0
8 20 d m 0 0 AVRT-CAP Heart fail P, F, F + PR AMIO+PR Complete 0
9 60 d m 0 0 AVRT-WPW Heart fail PIND, P AMIO+PR Complete 0
10 30 d m 0 0 AVRT-CAP Heart fail F AMIO Complete 0
11 15 d m 0 0 AVRT-CAP Heart fail 0 AMIO+PR Complete 0
12 30 d m 0 0 AVRT-WPW Heart fail F, P AMIO+PR Ineffective 0
13 25 d f 0 0 AVRT-WPW Heart fail P, F AMIO+PR Ineffective 0
14 20 d m 0 0 INC VT Heart fail 0 AMIO+PR Complete 0

Group B (>1 year)

1 12 y m TGA+IVSD Mustard IART Palp-Asth 0 AMIO Partial 0
2 13 y m UVH Fontan IART Palp 0 AMIO Complete 0
3 12 y f TAT Fontan IART Palp P, F AMIO Partial 0
4 15 y m UVH Fontan IART 0 0 AMIO Partial 0
5 2y m AVSD Repair IART-SSS Heart fail 0 AMIO Complete 0
6 3y m UVH Fontan AVRT-WPW Heart fail 0 AMIO Complete Hypothyr
7 3y f 0 0 AVRT-CAP Heart fail P, F, F + PR, S AMIO Complete 0
8 13 y m DCMP 0 POLY VT 0 P, MEX AMIO Complete Thyr, He
9 14 y m DCMP 0 MONO VT Syncope 0 AMIO+PR Complete Skin discol
10 12 y m HCMP 0 POLY VT 0 P AMIO Complete 0
11 8y m MYOC 0 MONO VT Palp-Asth P, S AMIO+PR Complete Corneal de
12 3y f 0 0 MONO VT Heart fail 0 AMIO Complete 0
13 13 y m ARVD 0 MONO VT Dizziness P AMIO Complete Hypothyr

AET, atrial ectopic tachycardia; AFL, common type atrial flutter; AMIO, amiodarone; ARVD, arrhythmogenic right ventricular dysplasia;
Asth, asthenia; AVRT, atrioventricular reciprocating tachycardia; AVSD, atrioventricular septal defect; CAP, concealed anomalous pathway;
d, day(s); DCMP, dilated cardiomyopathy; de, deposits; discol, discoloration; f, female; F, Flecainide; fail, failure; HCMP, hypertrophic cardio-
myopathy; He, hepatitis; Hyperthyr, hyperthyroidism; Hypothyr, hypothyroidism; IART, intra-atrial reentry tachycardia; INC, incessant; IVSD,
intraventricular septal defect; m, male; MEX, mexiletine; MONO, monomorphic; MYOC, myocarditis; P, propafenone; Palp, palpitations; PIND,
pindolol; POLY, polymorphic; PR, propranolol; S, sotalol; SSS, sick sinus syndrome; TAT, tricuspid atresia; TGA, transposition of the great
arteries; Thyr, thyroiditis; UVH, univentricular heart; VT, ventricular tachycardia; WPW, Wolff–Parkinson–White; y, years.

Group A. Patients <1 year (mean age 36 ± 20 days; range 15–90)
received a loading dose of 10 mg/kg/day for 7 days. If this loading dose
was ineffective, amiodarone was increased to 20 mg/kg/day for another
7 days. The maintenance dose was the same as the loading dose in
absolute value but, obviously, it decreased in relative value in relation
to the increase of the body weight of the infant. Propranolol was added
to amiodarone when the latter was ineffective. The initial quantity was
2 mg/kg/day in three doses and, if ineffective, the dosage was gradually
increased up to 4 mg/kg/day.
All the patients were hospitalized with continuous electrocardio-
graphic monitoring during the period of drug administration. If clinical
recurrences did not occur, in patients with reciprocating supraventricu-
lar tachycardia, the effectiveness of the therapy was also evaluated by
transesophageal atrial pacing. The latter was performed at the end of
the loading period of amiodarone or, when amiodarone was used in
combination with propranolol, after five half-lives of propranolol in
every step of increasing dosage of this drug.
In paroxysmal supraventricular tachycardia, the therapy was con-
sidered effective if no clinical recurrences occurred and if sustained
arrhythmia was not inducible at transesophageal atrial pacing. In
chronic tachyarrhythmias, the therapy was judged to be effective if
pharmacological cardioversion was obtained and no recurrences oc-
curred clinically or during Holter monitoring. The therapy was consid-
ered ineffective when a complete disappearance of the clinical recur-
rences was not reached or sustained arrhythmias were still inducible.
Group B. Patients >1 year (mean age 9.4 ± 4.9 years; range 2–15)
received a loading dose of 10/mg/kg/day for 7 days and a maintenance
dose of 3–5 mg/kg/day. Propranolol was added with the same criteria
used for patients <1 year.
The effectiveness of the therapy was evaluated on the basis of
clinical recurrences and by the use of Holter monitoring and exercise
testing. Transesophageal atrial pacing and endocavitary electrophysi-
ologic study in patients with inducible monomorphic sustained ven-
tricular tachycardia were also used at the end of the loading dose of
amiodarone or after five half-lives of propranolol at every step of
increasing dosage.
Drago et al.: Amiodarone Plus Propranolol in Tachyarrhythmias
The therapy was considered effective if there were no clinical
recurrences, no arrhythmias during Holter monitoring and exercise test-
ing, and no inducibility at electrophysiologic study. The therapy was
judged partially effective if the arrhythmia persisted but the ventricular
rate slowed and the symptoms disappeared.
Transesophageal atrial pacing was performed in a quiet room, in
the fasting and sedated state (50–70 mg/kg chloral hydrate in patients
of group A and isoflurane in patients of group B). Atrial stimulation
was accomplished with a programable stimulator using a pulse width of
9.9 ms and a stimulus amplitude slightly in excess of that resulting in
consistent atrial capture (8–20 mA). The stimulation protocol consisted
of single, double, and triple extrastimuli after a drivetrain of one or
more cycle lengths (450 and 350 msec) to the point of atrial or atrio-
ventricular node refractoriness and rapid atrial pacing to the point of
atrioventricular Wenckebach phenomenon.
Endocavitary electrophysiologic study was performed in the fast-
ing and sedated state. The stimulation protocol consisted of up to three
extrastimuli delivered during sinus rhythm and after a drive-train of
two or more cycle lengths (600, 450, and 350 msec).
Follow-Up
The average follow-up duration was 20.5 ± 13 (range 7–76) months.
Serial evaluations were performed every 3–6 months, including a
physical examination, a 12-lead electrocardiogram, Holter monitoring,
complete serum analysis with dosage of thyroid hormones (TSH, T3,
T4, FT3, FT4), chest x-ray, treadmill exercise testing in cooperative
patients, and transesophageal atrial pacing in patients <1 year.
Statistical Methods
Continuous data are expressed as median and range or as mean ±
standard deviation. Proportional data are expressed as a percentage
[95% confidence limit (CL)]. Chi-square and Fisher’s exact test were
performed to compare the success rates and side effects of amiodarone
alone or in combination with propranolol in patients of the two groups
(in relation to the type of arrhythmia) and between the patients of the
two groups. A p value < 0.05 was considered significant.
To investigate if age was related to amiodarone therapy failure,
we calculated the crude relative risk (RR).
Results
Results in detail are shown in Table 1. Amiodarone
used alone was effective or partially effective in 15/27
patients (56%; CL 35–75%). Among amiodarone-
resistant patients, the combined therapy with amiodarone
plus propranolol was effective in 10/12 patients (83%;
CL 52–98%). Therefore, amiodarone alone or in combi-
nation with propranolol was effective or partially effec-
tive in 25/27 patients (93%; CL 76–99%).
Amiodarone alone was effective or partially effec-
tive in 8/9 patients affected by atrial tachyarrhythmias
(89%; CL 52–100%), whereas in the remaining patient it
was effective only in combination with propranolol.
In the 11 patients affected by atrioventricular reentry
tachycardia, amiodarone alone was effective in 3 (27%;
447
CL 6–61%). Among the others, 3 had clinical recur-
rences and in 5 tachycardia was still inducible at trans-
esophageal atrial pacing either by single extrastimulus or
by continuous atrial pacing. Tachycardia cycle length
was 22 ± 4% longer than that before the antiarrhythmic
treatment. Among these 8 amiodarone-resistant patients,
amiodarone in combination with propranolol was effec-
tive in 6 (75%; CL 35–97%), whereas in 2 patients tachy-
cardia was still inducible at transesophageal atrial pac-
ing. Among the 7 patients affected by ventricular tachy-
cardia, amiodarone alone was effective in 4 (57%; CL
18–90%) and in combination with propranolol it was
effective in the remaining 3 (100%; CL 29–100%).
The difference in amiodarone effectiveness for these
three particular types of arrhythmias was statistically sig-
nificant (p ⳱ 0.02). In particular, the effectiveness of
amiodarone in atrial tachyarrhythmias was significantly
different from that in atrioventricular reciprocating
tachycardia (p ⳱ 0.009).
In group A, amiodarone alone was effective in 3/3
patients with atrial flutter and in 1/9 (11%) with supra-
ventricular tachycardia due to an accessory pathway (p
⳱ 0.01). In group B, amiodarone alone was effective in
4/7 (57%; CL 18–90%) and partially effective in 3/7
(43%; CL 10–82%) patients with supraventricular ar-
rhythmias and in 4/6 (67%; CL 22–96%) patients with
ventricular arrhythmias (p ⳱ NS). All 3 patients in
whom amiodarone was partially effective had postopera-
tive intraatrial reentry tachycardia. In 2 patients the ar-
rhythmia was clinically better tolerated because the atrio-
ventricular conduction ratio changed from 2:1 to 3:1. In
the third patient the arrhythmia was stopped by amioda-
rone and, during the follow-up, the patient had only in-
frequent and very brief recurrences with slower ventricu-
lar rate (90 beats/min). Amiodarone alone was effective
in 4/14 (29%; CL 8–58%) patients of group A and ef-
fective or partially effective in 11/13 (85%; CL 55–98%)
patients of group B (p ⳱ 0.006). Among amiodarone-
resistant patients, the combined therapy was effective in
8/10 (80%; CL 44–97%) of group A and 2/2 (100%; CL
16–100%) of Group B (p ⳱ NS). The RR of amiodarone
therapy failure in patients <1 year versus patients >1 year
was 4.64 (CL 1.24–17.3).
Side Effects
During the follow-up, 2 patients had hypothyroidism
with an increase of TSH (7 and 8.1 ␮U/ml) and a de-
crease of FT3 (1.8 and 1.3 pg/ml) after 1 year. One
patient had a mild hyperthyroidism with only an increase
of T3 (2.58 ng/ml). One had thyroiditis and hepatitis, 1
had corneal deposits, and 1 had blue skin discoloration.
In all of them amiodarone was stopped. No patients had
arrhythmic effects during the follow-up. Side effects
were noted in 6/27 (22%; CL 9–42%) patients. The
448
prevalence of side effects in children <1 or >1 year
showed a p ⳱ 0.06.
Discussion
Amiodarone has been largely used in the treatment of
children with life-threatening or drug-resistant arrhyth-
mias. Coumel and Fidelle [6] reported a complete control
of the arrhythmias in 60% of their patients and a partial
control in 30%. Bucknall et al. [5] observed a complete
effectiveness of amiodarone used alone in 63% of pa-
tients, increasing up to 93% when used in combination
with other antiarrhythmic drugs. Guccione and cowork-
ers [11] reported a success rate of amiodarone in children
with life-threatening disrhythmias of 84%. However,
Shuler et al. [22] observed a very low success rate of
amiodarone in neonates, with reciprocating supraven-
tricular tachycardia obtaining a successful treatment only
in 3 of 10 neonates.
In our study, amiodarone used alone was effective or
partially effective in 56% of patients. According to
Shuler et al.’s [22] data, this low success rate is probably
due to the very unsatisfactory success rate in infants with
reciprocating supraventricular tachycardia, who are the
most numerous subgroup of our study population. In
fact, the failure of amiodarone in these particular patients
is probably due to the very resistant nature of these
tachycardias and to the use of the transesophageal atrial
pacing to test the drug effectiveness. Also, when using
only a clinical evaluation to test the effectiveness of an
antiarrhythmic drug, the lack of recurrences may be in-
cidental or due to the suppression of the trigger factors
and not directly related to the effectiveness of the drug.
Even though Benson et al. [3] reported that the induc-
ibility of supraventricular reentrant tachycardia in infants
persisted, whether or not spontaneous supraventricular
tachycardia was observed, the transesophageal atrial pac-
ing is a method with very high specificity for testing the
effectiveness of an antiarrhythmic therapy [4, 19]. How-
ever, a limitation of this study was that in our infants the
effectiveness of amiodarone could also have been limited
by the dosage that we administered, which may have
been too low.
There are several theoretical reasons to explain the
enhancement of the antiarrhythmic effectiveness of
amiodarone when a ␤-blocking agent is added: (1) the
effect on the delayed rectifier potassium current iK is
maximized, slowing the heart rate and preserving the
class III antiarrhythmic properties during periods of el-
evated sympathetic tone [7, 20]; (2) arrhythmias due to
trigger activity or a reentrant mechanism may be induced
by a sudden increase in the sinus rate or by frequent
supraventricular or ventricular premature beats caused
by an elevated sympathetic tone; or (3) amiodarone can
prolong the QT interval and may cause the appearance of
Pediatric Cardiology Vol. 19, No. 6, 1998
malignant ventricular arrhythmias due to afterdepolariza-
tions or reentrant circuits. Propranolol can counteract the
␤-adrenergic stimulation which facilitates the formation
of afterdepolarizations as well as the dispersion of ven-
tricular refractoriness [17].
Regarding the amiodarone success rate in relation to
the type of arrhythmia, our data show that, in pediatric
patients, the atrial arrhythmias which do not have the
atrioventricular node in their reentry circuit are more
successfully treated by amiodarone than the arrhythmias
due to an anomalous pathway.
The significant relative risk of amiodarone therapy
failure for patients <1 year of age versus patients >1 year
of age found in this study could also suggest that the
effectiveness of the drug has to do also with the age of
the patients. This may be due to the different metabolism
of amiodarone in infants [6, 14] or, as already indicated
as a limitation of our study, to the dosage which was
administered to our patients <1 year old.
Propranolol combined with amiodarone was effec-
tive in 10 of 12 amiodarone-resistant patients. It is ex-
tremely difficult to establish whether the effectiveness of
this treatment is due to the combined effects of the two
drugs or to propranolol alone, but this limitation could
not be avoided in such a pharmacological trial of life-
threatening arrhythmias. Despite this, it seems that our
data strongly demonstrate that in case of failure of amio-
darone alone, addition of propranolol would be required
and helpful.
The difference in the rate of side effects was not
statistically significant between patients <1 year old and
patients >1 year old. However, the trend toward fewer
side effects in children <1 year old seems to confirm the
results of other authors [11, 14] and the hypothesis of an
accelerated metabolism of amiodarone in infants.
In conclusion, amiodarone seems to be a very effec-
tive drug in the control of the drug-resistant atrial and
ventricular tachyarrhythmias, especially in children >1
year old. The addition of propranolol can significantly
enhance the well-known low success rate in the treat-
ment of atrioventricular reciprocating tachycardias in
children <1 year old.
References
1. Bashir Y, Paul VE, Griffith MJ, et al (1992) A prospective study
of the efficacy and safety of adjuvant metoprolol and xamoterol in
combination with amiodarone for resistant ventricular tachycardia
associated with impaired left ventricular function. Am Heart J
124:1233–1240
2. Bauersfeld U, Gow RM, Hamilton RM, Izukawa T (1995) Treat-
ment of atrial ectopic tachycardia in infants <6 months old. Am
Heart J 129:1145–1148
3. Benson DW Jr, Dunnigan A, Benditt DG (1987) Follow-up evalu-
ation of infant paroxysmal atrial tachycardia: transesophageal
study. Circulation 75:542–549
Drago et al.: Amiodarone Plus Propranolol in Tachyarrhythmias 449

4. Benson DW, Dunnigan A, Benditt DG, et al (1985) Prediction of
digoxin treatment failure in infants with supraventricular tachycar-
dia: role of transesophageal pacing. Pediatrics 75:288–293
5. Bucknall CA, Keeton BR, Curry PVL, et al (1986) Intravenous and
oral amiodarone for arrhythmias in children. Br Heart J 56:278–
284
6. Coumel P, Fidelle J (1980) Amiodarone in the treatment of cardiac
arrhythmias in children: one hundred thirty-five cases. Am Heart J
100:1063–1069
7. Duchatelle-Gourdon I, Hartzell HC, Lagrutta AA (1989) Modula-
tion of the delayed rectifier K current in frog cardiomyocytes by
beta-adrenergic agents and magnesium. J Physiol 415:251–274
8. Fidelle J, Do Ngoc, Attuel P, Coumel P (1985) L’Amiodarone dans
le traitment des troubles du rythme cardiaque chez l’enfant: a
propos de 135 cas. Arch Mal Couer 24:14–21
9. Figa FH, Gow RM, Hamilton RM, Freedom RM (1994) Clinical
efficacy and safety of intravenous amiodarone in infants and chil-
dren. Am J Cardiol 15:573–577
10. Garson A Jr, Gillette PC, McVey P, et al (1984) Amiodarone
treatment of critical arrhythmias in children and young adults. J
Am Coll Cardiol 3:749–755
11. Guccione P, Paul T, Garson A Jr (1990) Long-term follow-up of
amiodarone therapy in the young: continued efficacy, unimpaired
growth, moderate side effects. J Am Coll Cardiol 15:1118–1124
12. Herre JM, Ross BA (1990) Amiodarone in children: borrowing
from the future? J Am Coll Cardiol 15:1125–1126
13. Hesslein PS (1983) Amiodarone therapy in children: a cautionary
comment. Pediatrics 72:817–818
14. Paul T, Guccione P (1994) New antiarrhythmic drugs in pediatric
use: amiodarone. Pediatr Cardiol 15:132–138
15. Perry JC, Knilans TK, et al (1993) Intravenous amiodarone for
life-threatening arrhythmias in children and young adults. J Am
Coll Cardiol 22:95–98
16. Pongiglione G, Strasburger JF, Deal BJ, Benson DW Jr (1991) Use
of amiodarone for short-term and adjuvant therapy in young pa-
tients. Am J Cardiol 68:603–608
17. Priori SG, Corr PB (1990) Mechanism underlying early and de-
layed afterdepolarizations induced by catecholamines. Am J Phys-
iol 258:H1796–H1805
18. Raja P, Hawker RE, Chaikitpinyo A, et al (1994) Amiodarone
management of junctional ectopic tachycardia after cardiac surgery
in children. Br Heart J 72:261–265
19. Rhodes LA, Walsh EP, Saul JP (1994) Programmed atrial stimu-
lation via the esophagus for management of supraventricular ar-
rhythmias in infants and children. Am J Cardiol 74:353–356
20. Sanguinetti MC, Jurkiewicz NK, Scott A, Siegl PK (1991) Isopro-
terenol antagonizes prolongation of refractory period by the class
III antiarrhythmic agent E-4031 in guinea pig myocites. Mecha-
nism of action. Circ Res 68:77–84
21. Shahar E, Barzilay Z, Frand M, Feigl A (1983) Amiodarone in
control of sustained tachyarrhythmias in children with Wolff–
Parkinson–White syndrome. Pediatrics 72:813–816
22. Shuler CO, Case CL, Gillette PC (1993) Efficacy and safety of
amiodarone in infants. Am Heart J 125:1430–1432
23. Soult JA, Munoz M, Lopez JD, et al (1995) Efficacy and safety of
intravenous amiodarone for short-term treatment of paroxysmal
supraventricular tachycardia in children. Pediatric Cardiol 16:16–
19
24. Vignati G, Danzi GB, Austoni P, et al (1985) La terapia con
amiodarone in età pediatrica: efficacia ed effetti collaterali. G Ital
Cardiol 15:786–794
25. Villain E, Vetter VL, Garcia JM, et al (1990) Evolving concepts in
the management of congenital junctional ectopic tachycardia. A
multicenter study. Circulation 81:1544–1549
26. Zeevi B, Berant M, Sclarovsky S, Blieden LC (1986) Treatment of
multifocal atrial tachycardia with amiodarone in a child with con-
genital heart disease. Am J Cardiol 57:344–345

A Guide to Pediatric Cardiovascular Physical Examination

By Colin L. Phoon; Lippincott-Raven Publishers, Philadelphia

In this 142 page manual, Dr. Phoon reviews history and pediatric cardiovascular physical examination. The
author indicates in a preface that this book is intended for cardiac specialists, generalists, and students alike. The
emphasis is on evaluation in an outpatient setting.
The manual contains six chapters and two appendices. Chapters 1–3 are concerned with physical exami-
nation, Chapter 4 outlines innocent heart murmurs, and Chapter 5 details physical findings in specific cardiac
lesions. Chapter 6 presents 100 cases with questions and comments. This manual is helpful for students and
residents to sharpen their skills in history and physical examination in the child with suspected or known cardiac
lesion.

Ra-id Abdulla
Associate Editor