R E V I E W Beta-adrenergic receptor antagonists and chronic heart failure in children Sylvie Di Filippo Department of Pediatric Cardiology, Hopital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France Correspondence: Sylvie Di Filippo Department of Pediatric Cardiology, Hopital Cardiovasculaire et Pneumologique Louis Pradel, 28 Avenue Doyen Lepine, 69677, Lyon, France Tel + 33 4 72 35 73 89 Fax + 33 4 72 35 70 49 Email sylvie.di-ﬁlippo@chu-lyon.fr; sylvie.di.ﬁlippo@wanadoo.fr Abstract: Chronic congestive heart failure (HF) occurs in infants and children as a result of systemic ventricle incompetence. Neurohormonal activation is thought to be the main consequence of cardiac pump failure and cause of further worsening. Several large multicenter randomized trials have demonstrated that beta-adrenergic blocking agents can improve ventricular ejection fraction, symptoms, and survival in adults with chronic congestive HF. Current literature about pediatric HF is very scarce. The only large, multicenter, randomized, placebo-controlled pediatric trial failed to demonstrate any beneﬁcial effect of beta-blockers in infants and children with chronic HF. Other small-size reports showed signiﬁcant improvement in ejection fraction and/or clinical outcomes. The HF pediatric population is characterized by wide heterogeneicity regarding causes, underlying cardiac disease, drug pharmacokinetics, and interactions, which may account for divergences. Further large-scale studies are needed to elucidate the optimal use (indications and dosages) of beta-blockers in the management of HF in children, with particular attention to the underlying cardiac disease. Keywords: heart failure, children, beta-blockers, carvedilol Introduction Chronic congestive heart failure (HF) is an ongoing problem in pediatric patients with cardiac disease, characterized by a high risk for morbidity and mortality. The physiopathological mechanisms of HF have been widely explored in adults (Lowes et al 1999; Francis 2001; Buchhorn et al 2003). Numerous trials have demonstrated the beneﬁcial impact of newer agents on prognosis and survival in the adult HF population (Lechat et al 1998). Only scarce literature is available regarding both mechanisms and treatment of HF in the pediatric population. Most of the practice in the management of HF in children is drawn from adult experience. In particular, the advantage of beta-adrenergic receptor antagonists in the pediatric HF population is still a matter of discussion. The aims of this review are to give an overview of the mechanisms and causes of HF in children, and to assess current knowledge about efﬁcacy and tolerability of beta-receptor antagonist agents in the treatment of pediatric HF. This review will focus on chronic HF due to systemic ventricle systolic dysfunction. Congestive HF Deﬁnition Congestive HF is deﬁned as inadequate oxygen delivery by the heart or the circulatory system to meet the demands of the body. It occurs when the compensatory mecha- nisms of the body are overcome (Francis 2001). There is a tremendous heterogeneicity regarding the age, the mechanisms, the causes, and the manifestations of HF in children (O’Laughlin 1999; Kay et al 2001). Therapeutics and Clinical Risk Management 2007:3(5) 847–854 © 2007 Dove Medical Press Limited. All rights reserved 847