Stimulant Medication Use in Congenital Heart Disease

Children with congenital heart disease (CHD) are at risk for neurodevelopmental problems including attention-deficit hyperactivity disorder.[Vetter: 2008] [Bass: 2004] [Kirshbom: 2005] While there have been reports of sudden cardiac death (SCD) in children without CHD using psychostimulant medications, this risk is no greater than that for SCD in the general population.[Perrin: 2008] There are no clinical studies suggesting that children with most forms of CHD are at risk for SCD while taking stimulant medications. According to the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing, it is reasonable to consider treatment of ADHD in patients with corrected or uncorrected CHD that is stable unless the patient's pediatric cardiologist has specific concerns. The following conditions are associated with an increased risk of SCD and while they do not contraindicate the use of stimulants, these medications must be used with caution and close monitoring:[Keane: 2006]
  • Heart condition associated with SCD (prolonged QT syndrome, short-QT syndrome, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Brugada syndome, coronary anomaly, Wolff-Parkinson-White syndrome, Marfan syndrome)
  • History of an arrhythmia requiring cardiopulmonary resuscitation, direct current cardioversion or defibrillation, or overdrive pacing
  • Previous aborted SCD
  • Other clinically significant arrhythmia not treated or controlled
  • QTc on ECG >0.46 seconds
  • Heart rate or blood pressure >2 SD above means for age
If any of the above conditions or arrhythmias are diagnosed during treatment, consideration should be given to discontinuation of the stimulant medication until further testing and treatment can be achieved. If arrhythmias are treated and controlled, on approval of a pediatric cardiologist, the patient may be restarted on medication.


Author: Catherine Jolma, MD - 7/2010

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