Antiarrhythmic Medication in Neonates and Infants with Supraventricular Tachycardia

Diana Bruder,Christian Balmer,Roland Weber,Matthias Gass,Anna Cavigelli-Brunner

doi:10.1007/s00246-022-02853-9

Diana Bruder, Christian Balmer + Show 3 more

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https://doi.org/10.1007/s00246-022-02853-9

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Journal: Pediatric Cardiology	Publication Date: Mar 8, 2022
Citations: 7	License type: open-access

Affiliation: University Children's Hospital Zurich

Abstract

Supraventricular tachycardia (SVT) is the most common arrhythmia in neonates and infants, and pharmacological therapy is recommended to prevent recurrent episodes. This retrospective study aims to describe and analyze the practice patterns, effectiveness, and outcome of drug therapy for SVT in patients within the first year of life. Among the 67 patients analyzed, 48 presented with atrioventricular re-entrant tachycardia, 18 with focal atrial, and one with atrioventricular nodal re-entrant. Fetal tachycardia was reported in 27%. Antiarrhythmic treatment consisted of beta-receptor blocking agents in 42 patients, propafenone in 20, amiodarone in 20, and digoxin in 5. Arrhythmia control was achieved with single drug therapy in 70% of the patients, 21% needed dual therapy, and 6% triple. Propafenone was discontinued in 7 infants due to widening of the QRS complex. After 12 months (6–60), 75% of surviving patients were tachycardia-free and discontinued prophylactic treatment. Patients with fetal tachycardia had a significantly higher risk of persistent tachycardia (p: 0.007). Prophylactic antiarrhythmic medication for SVT in infancy is safe and well tolerated. Arrhythmia control is often achieved with single medication, and after cessation, most patients are free of arrhythmias. Infants with SVT and a history of fetal tachycardia are more prone to suffer from persistent SVT and relapses after cessation of prophylactic antiarrhythmic medication than infants with the first episode of SVT after birth.

Highlights

Supraventricular tachycardia (SVT) is the most common arrhythmia in children, occurring with an estimated incidence of 0.1–0.4% in the pediatric population [1–4]
The ECG during tachycardia was indicative for atrioventricular re-entrant tachycardia (AVRT) in 48 (72%), including 1 with permanent junctional reciprocating tachycardia (PJRT), atrioventricular nodal reentrant tachycardia (AVNRT) in 1 (1%), and Focal atrial tachycardia (FAT) in 18 (27%) patients, including 1 patient with multifocal atrial tachycardia
This study shows that prophylactic antiarrhythmic drug therapy for SVT in infancy used with our cohort is in the majority of cases safe and well tolerated

Summary

Introduction

Supraventricular tachycardia (SVT) is the most common arrhythmia in children, occurring with an estimated incidence of 0.1–0.4% in the pediatric population [1–4]. The first episode of an SVT occurs during the first year of life in 50–60%, predominantly in the first 3–4 months [4–7]. The most common paroxysmal SVT in the pediatric age group is atrioventricular re-entrant tachycardia (AVRT), which is mediated by an accessory pathway. This type of tachycardia accounts for 70–80% of tachycardias in infancy. The second most frequent tachycardia, with a much lower incidence in infants (5-17%), is atrioventricular nodal reentrant tachycardia (AVNRT). Focal atrial tachycardia (FAT) is diagnosed in 5 to 10% of infants with SVT [1–3, 8]

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