A hemodynamic complication of verapamil therapy in a neonate.

The effectiveness and lack of undesirable side-effects has made Verapamil the drug of choice in the treatment of paroxysmal supraventricular tachycardia in infants without underlying heart disease. The case described demonstrates the occasional severe negative inotropic effect of the drug, independent of its influence on heart rate and conduction. Severe heart failure and shock ensued after a therapeutic dose of i.v. Verapamil in a newborn suffering from atrial flutter with no associated heart disease. Although the arrhythmia was promptly converted to sinus rhythm, the baby required two hours of cardiopulmonary resuscitation and inotropic support. Follow-up during the first year of life revealed a normal healthy baby. Attention to the hemodynamic status in addition to continuous ECG monitoring is mandatory during i.v. Verapamil administration also in patients without underlying heart disease.