A New Room

Unfortunately, I'm not talking about a new room at our house. Today, Malachi is being moved to Pediatric ICU. This afternoon he started having SVT. They tried the following to try to convert him out of that rhythm:
*vagal ice to the face maneuver which didn't work (it never does).
*an extra dose of atenolol which didn't work (it usually helps).
*an oral dose of procainamide (they couldn't get IV access).
*a couple doses of adenosine (after an IV) which didn't work.

Because his normal medication regimen of atenolol and digoxin (he also takes aspirin, sildenafil, and lasix for heart issues) isn't working, the cardiologist felt like it was time to switch him over to a new drug. The two drugs that they were thinking were flecainide and amiodarone. Because he is having such frequent drops in his heart rate, amiodarone was ruled out. We are left with flecainide. As like all drugs, flecainide comes with its risks--primarily that of new or worsened arrhythmias in patients with "normal" heart structure. Because Malachi does not have normal heart structure (he has two artificial shunts providing bloodflow to his lungs and his pulmonary artery and aorta have been combined to act as his new aorta), these risks are greatly increased.

Malachi is moving to a more critical unit as he is switched over to this medication because of the following:
"The relatively high frequency of proarrhythmic events in patients with sustained VT and serious underlying heart disease, and the need for careful titration and monitoring, requires that therapy of patients with sustained VT be started in the hospital." (drugs.com)

"In pediatric patients with structural heart disease, Flecainide has been associated with cardiac arrest and sudden death. Flecainide should be started in the hospital with rhythm monitoring. Any use of Flecainide in children should be directly supervised by a cardiologist skilled in the treatment of arrhythmias in children." (drugs.com)

Needless to say, I will be spending most of my evening at the hospital as they prepare to make the switchover. Pray that all goes well.