Beta-adrenergic blockers in the treatment of pediatric heart failure.

Beta-adrenergic blocking agents for the treatment of chronic congestive heart failure in adults have gained wide acceptance. Although the exact mechanism of their effect is still not entirely clear, the preponderance of data support the hypothesis that the primary mechanism of action of beta-blocking agents in chronic heart failure is to prevent and reverse adrenergically-mediated intrinsic myocardial dysfunction and remodeling. Large, multicenter trials in adults with chronic congestive heart failure have definitively shown that beta-blockers improve left ventricular ejection fraction, symptoms, and survival when compared to placebo. Although experience with beta-blockers in children is limited, anecdotal evidence suggests that children with chronic congestive heart failure may also benefit from this therapy. Large trials in children are currently in the planning stages in order to attempt to determine the indications, dosages, and optimal use of beta-blockers in children with chronic congestive heart failure.