We treated 13 children aged 0.2 years to 15.7 years (median 7.1 years) with
flecainide acetate for refractory symptomatic
supraventricular tachycardia. Six children had direct atrioventricular accessory pathways, of whom four had overt
Wolff-Parkinson-White syndrome on the 12 lead electrocardiogram, while in the other two the accessory pathway was concealed. Three children had nodal atrioventricular re-entrant
tachycardia, two had a re-entrant
tachycardia, the exact mechanism of which was not known, one child had
ectopic atrial tachycardia, and one had
atrial flutter associated with an
atrial septal defect. The remaining 12 children had structurally normal hearts.
Flecainide (2 mg/kg intravenously) resulted in termination of the
tachycardia in 11 of the 12 children treated during
tachycardia. In 11 of the children successful prophylaxis was achieved with oral
flecainide. Side effects occurred in two children during
intravenous administration, but there were no side effects with oral treatment. This experience indicates that
flecainide, which has not been used extensively in children, is an effective and safe antiarrhythmic agent, capable of terminating and controlling
supraventricular tachycardia in children. Furthermore,
flecainide may be successful where conventional agents fail.