Role of Theophylline in Management of Bradycardia Secondary to High Cervical Spinal Cord Injury in a Seven-Year-Old Child: Case Report and a Review of Literature

High-level cervical spinal cord injury (SCI) frequently leads to the development of severe sinus bradycardia and asystole. Conventionally, owing to their chronotropic effects, medical management has largely relied on the use of atropine and/or infusion of pressors such as epinephrine or dopamine as the first-line treatment. However, for severe symptomatic events refractory to medical therapy, cardiac pacemaker implantation may be required. In light of the limited data, found in the adult literature, use of methylxanthines such as theophylline has been suggested for the treatment of bradycardia or asystole in the setting of cervical SCI, but to our knowledge, this treatment approach has not been reported in very young children. We present a case of medical management of bradycardia-asystole episodes in a seven-year-old child who sustained cervical SCI after a motor vehicle accident (MVA). His clinical course was complicated by frequent episodes of symptomatic sinus bradycardia progressing to asystole. Episodes were responsive to atropine, but his events were recurrent and feared to be life-threatening if unobserved, and so pacemaker implantation was being considered. In the hope of averting the need for pacemaker implantation, he was started on enteral theophylline, with blood level monitoring and had remained in normal sinus rhythm without recurrence of severe bradycardic or asystole events for a latent period of 74 days. Subsequently, however, he underwent pacemaker placement.