Supraventricular tachycardias in the first year of life: what is the best pharmacological treatment? 24 years of experience in a single centre.
Action Potentials
Adrenergic beta-Antagonists
/ therapeutic use
Age Factors
Anti-Arrhythmia Agents
/ adverse effects
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
Time Factors
Treatment Outcome
Voltage-Gated Sodium Channel Blockers
/ therapeutic use
Beta-blockers
Flecainide
Infant
Supraventricular tachycardia
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
15 03 2021
15 03 2021
Historique:
received:
17
06
2020
accepted:
27
12
2020
entrez:
16
3
2021
pubmed:
17
3
2021
medline:
5
10
2021
Statut:
epublish
Résumé
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.
Sections du résumé
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.
Identifiants
pubmed: 33722203
doi: 10.1186/s12872-020-01843-0
pii: 10.1186/s12872-020-01843-0
pmc: PMC7958399
doi:
Substances chimiques
Adrenergic beta-Antagonists
0
Anti-Arrhythmia Agents
0
Voltage-Gated Sodium Channel Blockers
0
Nadolol
42200-33-9
Digoxin
73K4184T59
Sotalol
A6D97U294I
Flecainide
K94FTS1806
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
137Références
J Am Coll Cardiol. 2019 Aug 20;74(7):874-885
pubmed: 31416531
Heart Rhythm. 2019 Sep;16(9):1436-1442
pubmed: 30904484
Clin Pharmacol Ther. 2001 Mar;69(3):145-57
pubmed: 11240979
Am J Cardiol. 1992 Aug 20;70(5):26A-32A
pubmed: 1509995
Am J Cardiol. 1985 May 1;55(11):1402-6
pubmed: 3993578
Pediatr Cardiol. 2017 Mar;38(3):525-530
pubmed: 27995288
Early Hum Dev. 2015 Jun;91(6):345-50
pubmed: 25933212
N Engl J Med. 1989 Aug 10;321(6):406-12
pubmed: 2473403
Eur Heart J. 1993 Apr;14(4):546-50
pubmed: 8472721
Ann Noninvasive Electrocardiol. 2015 Jul;20(4):314-27
pubmed: 25530184
Europace. 2008 May;10(5):629-35
pubmed: 18385122
J Am Coll Cardiol. 1988 Feb;11(2):379-85
pubmed: 3339178
J Am Coll Cardiol. 1989 Jul;14(1):185-91; discussion 192-3
pubmed: 2500470
Pediatr Cardiol. 2015 Jan;36(1):146-50
pubmed: 25107546
J Matern Fetal Neonatal Med. 2011 Mar;24(3):541-4
pubmed: 20807153
Pacing Clin Electrophysiol. 2019 Jun;42(6):670-677
pubmed: 30875081
J Am Coll Cardiol. 2002 Feb 6;39(3):517-20
pubmed: 11823091
J Am Coll Cardiol. 1991 Aug;18(2):356-65
pubmed: 1906902
Cardiol Young. 2000 Oct;10(4):367-75
pubmed: 10950334
Europace. 2013 Sep;15(9):1337-82
pubmed: 23851511
Am Heart J. 1992 Dec;124(6):1614-21
pubmed: 1462922
J Am Coll Cardiol. 1995 Oct;26(4):991-4
pubmed: 7560629
J Am Coll Cardiol. 2004 Feb 4;43(3):438-44
pubmed: 15013128
Curr Pharm Des. 2008;14(8):729-35
pubmed: 18393871
Eur Heart J. 2002 Sep;23(17):1329-44
pubmed: 12269267
J Cardiovasc Med (Hagerstown). 2009 May;10(5):372-5
pubmed: 19300276
Pediatr Cardiol. 2011 Oct;32(7):896-903
pubmed: 21553267
Biopharm Drug Dispos. 2014 Apr;35(3):145-53
pubmed: 24166085
Circ Arrhythm Electrophysiol. 2012 Oct;5(5):984-91
pubmed: 22962431
Pediatr Rep. 2020 Nov 11;12(3):108-113
pubmed: 33187141