Pediatric Rheumatology Online Journal → August 2003 → Miscellaneous Clinical Studies and Case Reports → Abstract #192

BRADYARRHYTHMIAS ASSOCIATED WITH HIGH DOSE METHYLPREDNISOLONE

J. D. Akikusa,¹ E. D. Silverman,¹ B. M. Feldman,¹ R. M. Laxer,¹ R. Schneider.¹

¹Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada

High dose intravenous "pulse" methylprednisolone is an important therapeutic modality in the treatment of many autoimmune conditions in both children and adults. In many centres single pulses are administered as a "day unit" procedure.
Side effects of this therapy include hypertension, hyperglycaemia and, in children, behavioral changes. Cardiac rhythm disturbances, both tachyarrhythmias and bradyarrhythmias have been reported in adults. Less common are reports of such disturbances in children. We report our experience with 5 children who developed significant bradyarrhythmias during therapy with high dose (30mg/kg) intravenous pulse methylprednisolone. Patients were aged between 7 months and 13 years of age and were receiving treatment as inpatients for juvenile dermatomyositis (1), lupus (1), Wegener"s granulomatosis (1) and macrophage activation syndrome (2). Rhythm disturbances seen included sinus bradycardia and sinus exit block, with a reduction in resting heart rate of between 35 and 50 percent of baseline. In no case did the bradycardia develop during the actual infusion of the medication. All patients were asymptomatic and all rate disturbances resolved within 1-5 days of cessation of pulse therapy.
Clinicians need to be aware of this side effect and particularly its timing in relation to dosing when planning its use on an outpatient basis