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

• Published in: BMC cardiovascular disorders Vol. 21; no. 1; p. 137
• Main Authors: Capponi, Guglielmo, Belli, Gilda, Giovannini, Mattia, Remaschi, Giulia, Brambilla, Alice, Vannuccini, Francesca, Favilli, Silvia, Porcedda, Giulio, De Simone, Luciano
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.03.2021; BioMed Central; BMC
• Subjects: Adenosine; Amiodarone; Beta blockers; Cardiac arrhythmia; Cardiology; Cardioversion; Digoxin; Diseases; Drug dosages; Drug therapy; Flecainide; Heart failure; Heart rate; Infant; Infants (Newborn); Medical records; Patient outcomes; Patients; Pediatric research; Sinuses; Supraventricular tachycardia; Italy; Infant; Beta-blockers; Supraventricular tachycardia; Flecainide
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-020-01843-0

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. 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. 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%). 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.