Supraventricular tachycardias in the first year of life: what is the best pharmacological treatment? 24 years of experience in a single centre.

Abstract

BACKGROUND:

Supraventricular tachycardias (SVTs) are common in the first year of life and may be life-threatening. Acute cardioversion is usually effective, with both pharmacological and non-pharmacological procedures. However, as yet no international consensus exists concerning the best drug required for a stable conversion to sinus rhythm (maintenance treatment). Our study intends to describe the experience of a single centre with maintenance drug treatment of both re-entry and automatic SVTs in the first year of life.

METHODS:

From March 1995 to April 2019, 55 patients under one year of age with SVT were observed in our Centre. The SVTs were divided into two groups: 45 re-entry and 10 automatic tachycardias. As regards maintenance therapy, in re-entry tachycardias, we chose to start with oral flecainide and in case of relapses switched to combined treatment with beta-blockers or digoxin. In automatic tachycardias we first administered a beta-blocker, later combined with flecainide or amiodarone when ineffective.

RESULTS:

The patients' median follow-up time was 35 months. In re-entry tachycardias, flecainide was effective as monotherapy in 23/45 patients (51.1%) and in 20/45 patients (44.4%) in combination with nadolol, sotalol or digoxin (overall 95.5%). In automatic tachycardias, a beta-blocker alone was effective in 3/10 patients (30.0%), however, the best results were obtained when combined with flecainide: overall 9/10 (90%).

CONCLUSIONS:

In this retrospective study on pharmacological treatment of SVTs under 1 year of age the combination of flecainide and beta-blockers was highly effective in long-term maintenance of sinus rhythm in both re-entry and automatic tachycardias.

• Authors: Guglielmo Capponi, Gilda Belli, Mattia Giovannini, Giulia Remaschi, Alice Brambilla, Francesca Vannuccini, Silvia Favilli, Giulio Porcedda, Luciano De Simone
• Journal: BMC cardiovascular disorders (BMC Cardiovasc Disord) Vol. 21 Issue 1 Pg. 137 (03 15 2021) ISSN: 1471-2261 [Electronic] England
• PMID: 33722203 (Publication Type: Journal Article, Observational Study)

Chemical References

• Adrenergic beta-Antagonists
• Anti-Arrhythmia Agents
• Voltage-Gated Sodium Channel Blockers
• Nadolol
• Digoxin
• Sotalol
• Flecainide

Topics

• Action Potentials
• Adrenergic beta-Antagonists (therapeutic use)
• Age Factors
• Anti-Arrhythmia Agents (adverse effects, therapeutic use)
• Digoxin (therapeutic use)
• Drug Therapy, Combination
• Female
• Flecainide (therapeutic use)
• Heart Rate (drug effects)
• Humans
• Infant
• Infant, Newborn
• Male
• Nadolol (therapeutic use)
• Recurrence
• Retrospective Studies
• Sotalol (therapeutic use)
• Tachycardia, Supraventricular (diagnosis, drug therapy, physiopathology)
• Time Factors
• Treatment Outcome
• Voltage-Gated Sodium Channel Blockers (therapeutic use)