Beta-blockers in pediatric heart failure Current published experience highlights several impor- carvedilol efﬁcacy in children and select patients who would tant points: better beneﬁt from it. Selection of an homogeneous group – The heterogeneicity of anatomical and pathophysi- and longer follow-up would probably help to enhance the ological factors involved in the development of HF in power of such studies. – – – – children. A unique feature of pediatrics is the group of children with congenital heart disease resulting in ventricular dysfunction of a systemic right or single ventricle. Many factors play a role to maintain cardiac output in chronic heart disease with systemic ventricle dysfunction, in particular sinus node (Bullinga et al 2005). Moreover chronic hypoxemia and ischemia (as in adults) probably have different pathophysiological effects on myocardial function (Buchhorn et al 2003; Giardini et al 2003). The age of the patients that may inﬂuence myocardial compliance, or even pharmacokinetics (Läer et al 2002) and drug interference (Ratnapalan et al 2003). The timing of treatment initiation with beta-block- ers. Early onset might prevent ventricular remodeling, whereas late a onset strategy might help to assess potential spontaneous recovery of cardiac function (in the context of postoperative injury or myocarditis, or coronary artery anomaly). The length of follow-up after onset of beta-blocker treat- ment should be long enough to better assess efﬁcacy. The difference in HF symptoms between children and adults. Pediatric patients usually do not present with classic symptoms of HF; therefore, relying on clinical symptoms may be not sensitive enough to assess. Tolerability Beta-blocker agents have been widely and safely used in children to prevent acute hypoxemia or supraventricular tachycardia, or to treat systemic hypertension. Carvedilol is the gold standard for treatment of HF. It is a non-selective beta-blocker agent with α-adrenergic effect. Despite its impact on systemic resistance, it is usually well tolerated when administred through upgrading doses (Krum et al 2000). Discontinuation of angiotensin converting enzyme inhibitors or of beta-blockers because of low blood pressure is rarely required. Conclusion Although no evidence can be drawn from the literature, it is logical to conclude that beta-receptor antagonists may provide consistent improvement in myocardial function, clinical outcomes, and survival in the pediatric HF popula- tion. We suggest that further studies are needed to prove Therapeutics and Clinical Risk Management 2007:3(5) References Auslender M, Artman M. 2000. Overview of the management of pediatric heart failure. Progr Pediatr Cardiol, 11:231–41. Azeka E, Franchini Ramires JA, Bocchi EA. 2002. Delisting of infants and children from the heart transplantation waiting list after Carvedilol treatment. J Am Coll Cardiol, 40:2034–8. 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