Multicenter cohort study on duration of antiarrhythmic medication for supraventricular tachycardia in infants

• Published in: European journal of pediatrics Vol. 182; no. 3; pp. 1089 - 1097
• Main Authors: Mecklin, Minna, Linnanmäki, Anniina, Hiippala, Anita, Leino, Topias, Arola, Anita, Leskinen, Markku, Ruotsalainen, Hanna, Happonen, Juha-Matti, Poutanen, Tuija
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2023; Springer Nature B.V
• Subjects: Anti-Arrhythmia Agents - therapeutic use; Antiarrhythmics; Arrhythmia; Cardiac arrhythmia; Cohort analysis; Cohort Studies; Humans; Infant; Infants; Medicine; Medicine & Public Health; Pediatrics; Prophylaxis; Propranolol; Propranolol - therapeutic use; Risk factors; Statistical analysis; Tachycardia; Tachycardia, Atrioventricular Nodal Reentry - chemically induced; Tachycardia, Atrioventricular Nodal Reentry - drug therapy; Tachycardia, Supraventricular - diagnosis; Tachycardia, Supraventricular - drug therapy; Antiarrhythmic medication; Atrioventricular reentrant tachycardia; Infants; Supraventricular tachycardia; Prophylaxis
• ISSN: 1432-1076; 0340-6199; 1432-1076
• DOI: 10.1007/s00431-022-04757-5

Antiarrhythmic medication (AM) is commonly used to prevent supraventricular tachycardia (SVT) recurrence in infants. Our aim was to determine whether a shorter duration of AM is sufficient to prevent atrioventricular reentrant tachycardia (AVRT) recurrence and evaluate risk factors for recurrence of SVT after discontinued AM.This multicenter cohort study included all infants diagnosed with SVT in the five university hospitals in Finland between 2005 and 2017. Those diagnosed between 2005 and 2012 received AM for 12 months (group 1), and those diagnosed between 2013 and 2017 received AM for 6 months (group 2). A total of 278 infants presented with AVRT (group 1, n  = 181; group 2, n  = 97), and the median AM duration was 12.0 months (interquartile range [IQR] 11.4–13.4) and 7.0 months (IQR 6.0–10.2), respectively. Propranolol was the most frequently used first-line AM (92% and 95%). Recurrence-free survival rates were over 88% until 12 months after AM prophylaxis in both groups, without any statistically significant difference between them. Independent risk factors for recurrence of SVT after discontinuation of AM were need of combination AM ( HR 2.2, 95% CI 1.14–4.20), Wolff-Parkinson-White (WPW) syndrome ( HR 2.4, 95% CI 1.25–4.59), and age over 1 month at admission ( HR 2.2, 95% CI 1.12–4.48).     Conclusion : Shortening AM duration in infants from 12 to 6 months does not seem to lead to more frequent SVT recurrence. The risk factors for recurrence of SVT were WPW syndrome, need of combination AM, and age over 1 month. What is Known: • Despite the evidence of spontaneous resolution of supraventricular tachycardia episodes in infants, the antiarrhythmic medication is often continued for up to twelve months. • The optimal approach for duration of antiarrhythmic medication remains unknown. . What is New: • Shortening the duration of antiarrhythmic medication in infants with supraventricular tachycardia does not seem to increase the risk of subsequent recurrence. • Infants whose arrhythmia was successfully controlled with monotherapy were the group least likely to have recurrence after discontinuation of antiarrhythmic medication.