Use of ivabradine in a critically ill pediatric patient with recalcitrant ectopic atrial tachycardia and complex congenital heart disease

Figures

• 

  Figure 1. Runs of atrial ectopy. Plethysmography pulsatility changes between sinus beats and ectopic atrial tachycardia are appreciated.

• 

  Figure 2. Echocardiogram demonstrating severe right atrial enlargement. A: Two-dimensional apical 4-chamber view demonstrating anatomy consistent with hypoplastic left heart syndrome. There is severe dilation of the right atrium. B: Apical 4-chamber view with color Doppler and severe tricuspid valve insufficiency owing to incomplete coaptation of valve leaflets. The severe tricuspid regurgitation led to severe right atrial dilatation, believed to be the nidus for incessant ectopic atrial tachycardia as well as heart failure. RA = right atrium; RV= right ventricle.

• 

  Figure 3. Timeline of antiarrhythmic regimens used in the care of our patient. ∗Not to scale. See case description for details of her antiarrhythmic medication administration.