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Bah MNM, Zahari N, Boparam BK, Sapian MH. The Incidence and Factors Associated with the Recurrence of Supraventricular Tachycardia in Children: 15 Years Experience from Middle-Income Country. Pediatr Cardiol 2024; 45:292-299. [PMID: 38165467 DOI: 10.1007/s00246-023-03374-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
Limited data are available concerning supraventricular tachycardia (SVT) recurrence. Hence, this study aimed to determine the incidence, outcome, and factors associated with SVT recurrence. This retrospective, observational, population-based study was conducted among children with SVT from 2006 to 2020. The primary outcome measure was SVT recurrence. Kaplan Meier analysis was used to estimate SVT-free at 1, 5, and 10 years after diagnosis. Cox regression analysis was used to identify independent factors associated with recurrence. There were 156 patients with SVT with a median age at diagnosis of 1.9 years (Interquartile range [IQR] 11 days to 8.7 years) and follow-up for a median of 3.5 years (IQR 1.7 to 6.1 years). 35 patients (22%) had recurrent SVT at a median age of 7.8 years (IQR 4.4 to 12 years). Infants with Wolff-Parkinson-White Syndrome (WPW) had the highest recurrence (11/16, 68%), with 33% SVT-free at 5 years follow-up. The lowest recurrence rate was observed in neonatal diagnosis (2/54, 3.7%) with 98% SVT-free at 5 years follow-up. The independent factors associated with the recurrence of SVT were the diagnosis of WPW with an adjusted hazard ratio (aHR) of 5.2 (95% CI 2.4-11.2), age of more than 1 year at diagnosis (aHR 3.7 95% CI 1.4-9.7), and combine with or need second-line therapy (aHR 4.0 95% CI 1.5-10.7). One in five children with SVT experienced a recurrence, which is more likely for those with WPW, multiple maintenance therapy, and older age at first presentation. Whereas neonates with non-WPW may benefit from shorter maintenance therapy.
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Affiliation(s)
- Mohd Nizam Mat Bah
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia.
| | - Norazah Zahari
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Baljit Kaur Boparam
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
| | - Mohd Hanafi Sapian
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
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Kanter RJ. Care of the Infant With Supraventricular Tachycardia: Toward a Better Paradigm. J Am Coll Cardiol 2022; 80:1173-1176. [PMID: 36109111 DOI: 10.1016/j.jacc.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Ronald J Kanter
- Nicklaus Children's Hospital, Miami, Florida, USA; Duke University School of Medicine, Durham, North Carolina, USA.
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Evaluation of Clinical Course and Maintenance Drug Treatment of Supraventricular Tachycardia in Children During the First Years of Life. A Cohort Study from Eastern Germany. Pediatr Cardiol 2022; 43:332-343. [PMID: 34524484 DOI: 10.1007/s00246-021-02724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Supraventricular tachycardia (SVT) is considered the most common cause of arrhythmia in children and infants. Regarding the likelihood of a spontaneous resolution of SVTs during the first years of life, drug treatment aims to bridge the time until children 'grow out' out of the arrhythmia. The choice of antiarrhythmic agents and the planning of maintenance therapy are mainly based on clinical experience and retrospective single- and multi-institutional analyses and databases from all over the world approaching differently to this topic. The current study aimed to evaluate the clinical course, pharmacological treatment strategies, and constellations of risk for recurrences in the management of SVTs in children aged 3 < years. The database of the Heart Center Leipzig, Department of Pediatric cardiology, was searched for pediatric patients aged < 3 years with a clinically documented SVT between 2000 and 2019 that received pharmacologic treatment. Patients with complex congenital heart disease or arrhythmias following cardiac surgery were excluded. 69 patients were included. Pharmacologic treatment, follow-up schedule, recurrences, outcomes, and risk factors for complicated courses are reported. Drug therapy of SVTs in young children remains a controversial topic with heterogeneous treatment and follow-up strategies applied. Risk factors for recurrences and/or stubborn clinical courses are difficult rhythm control with 3 or more antiarrhythmic drugs, ectopic atrial tachycardias, and a first occurrence of the SVT in the fetal period. Prospective studies are needed to sufficiently evaluate optimal treatment strategies.
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Borquez AA, Williams MR. Essentials of Paroxysmal Supraventricular Tachycardia for the Pediatrician. Pediatr Ann 2021; 50:e113-e120. [PMID: 34038647 DOI: 10.3928/19382359-20210217-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Paroxysmal supraventricular tachycardia (SVT) is the most common clinical arrhythmia in young patients. With an estimated prevalence of roughly 1 in 500 children, a pediatrician may knowingly or unknowingly see several patients who are affected each year. SVT symptoms can sometimes be vague or conflated with common pediatric complaints. Different forms of SVT are predominant at different ages, sometimes complicating timely recognition and referral. Differing pathophysiology and age distribution impact risk of complications such as heart failure, or rarely, sudden death. Treatment choices continue to evolve as new medications, monitoring devices, and ablation technologies continue to mature. This review focuses on the most common types of paroxysmal SVT: atrioventricular nodal reentrant tachycardia, atrioventricular reciprocating tachycardia, and Wolff-Parkinson White syndrome. Atrial arrhythmia mechanisms are also briefly outlined. It is meant to provide practical guidelines for the diagnosis and management of patients with SVT from infancy through adolescence. [Pediatr Ann. 2021;50(3):e113-e120.].
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Wu MH, Chen HC, Kao FY, Huang SK. Postnatal cumulative incidence of supraventricular tachycardia in a general pediatric population: A national birth cohort database study. Heart Rhythm 2016; 13:2070-5. [DOI: 10.1016/j.hrthm.2016.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Indexed: 11/30/2022]
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Abstract
A 2-year-old child having Wolff–Parkinson–White syndrome presented with recurrent drug-refractory tachycardia episodes. On electrophysiological analysis, a coronary sinus diverticulum was discovered. The accessory pathway was successfully eliminated by radiofrequency ablation within the diverticulum.
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de Caen AR, Kleinman ME, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e213-59. [PMID: 20956041 DOI: 10.1016/j.resuscitation.2010.08.028] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Allan R de Caen
- Stollery Children's Hospital, University of Alberta, Canada.
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Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126:e1261-318. [PMID: 20956433 PMCID: PMC3784274 DOI: 10.1542/peds.2010-2972a] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Part 10: Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S466-515. [PMID: 20956258 PMCID: PMC3748977 DOI: 10.1161/circulationaha.110.971093] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Note From the Writing Group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (eg, “Family Presence During ResuscitationPeds-003”). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.
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Wu MH, Wang JK, Lin JL, Lin MT, Chiu SN, Chen CA. Long-term outcome of twin atrioventricular node and supraventricular tachycardia in patients with right isomerism of the atrial appendage. Heart Rhythm 2007; 5:224-9. [PMID: 18242544 DOI: 10.1016/j.hrthm.2007.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Twin AV nodes and resulting supraventricular tachycardia (SVT) have been described in right atrial isomerism (RAI). OBJECTIVE We sought to analyze the long-term outcome of patients with RAI with a focus on rhythm disturbances. METHODS Retrospective study of 257 patients (152 male and 105 female, 1,171 patient-years) with RAI diagnosed between 1980 and 2005. RESULTS SVT in 68 patients (26%) occurred at various ages from the prenatal period to 15 years and was only significantly associated with balanced ventricles (P = .009). Cardioversion was achieved in by verapamil in 6 of 6 cases (100%), adenosine in 18 of 21 cases (88%) and propranolol in 10 of 12 cases (83%). Electrocardiographic evidence of twin AV nodes, as shown by 2 discrete non-pre-excited QRS complexes, was found in 28 of 44 (64%) patients with more than 2 electrocardiograms, and was more frequent in those with balanced ventricles rather than a dominant ventricle and would increase risk of SVT. Recurrence of SVT was documented in 27 (40%) patients 1 day to 4.5 years after the first episode. However, the occurrence or recurrence of SVT was not associated with increased all-cause or surgical mortality or sudden death. Successful catheter ablation of ventriculoatrial pathways with junctional ectopic tachycardia at radiofrequency energy delivery was obtained in 5 of 6 patients. CONCLUSION This study showed that twin AV nodes in RAI patients could be disclosed by serial electrocardiograms and that SVT, most likely a twin node tachycardia, was common and tended to recur but could be managed by ablation or medication.
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Affiliation(s)
- Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Tortoriello TA, Snyder CS, Smith EO, Fenrich AL, Friedman RA, Kertesz NJ. Frequency of recurrence among infants with supraventricular tachycardia and comparison of recurrence rates among those with and without preexcitation and among those with and without response to digoxin and/or propranolol therapy. Am J Cardiol 2003; 92:1045-9. [PMID: 14583354 DOI: 10.1016/j.amjcard.2003.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Approximately 60% of children with supraventricular tachycardia (SVT) develop their initial episode by 1 year of age. Despite resolution in most of these patients by 1 year, approximately 30% of the SVT will recur. We performed a retrospective review of all patients <1 year of age with SVT between January 1984 and December 2000. Recurrence was defined as documented SVT at >1 year of age. Patients were divided into: (1) a first line (FL) group (controlled with digoxin and/or propranolol) and (2) a second line (SL) group (requiring additional antiarrhythmics). The groups were divided based on the presence of preexcitation. The FL group included 116 patients, 20 of whom (17%) had Wolff-Parkinson-White (WPW) syndrome. The SL group included 34 patients, 21 of whom (62%) had WPW (p <0.001). Recurrence of SVT occurred in 32 patients (28%) in the FL group and in 23 patients (68%) in the SL group (p <0.001). SVT recurred in 36 of 41 patients (88%) with WPW compared with 19 of 109 patients (17%) without WPW syndrome (p <0.001). Logistic regression analysis demonstrated that the presence of WPW syndrome was associated with a 29-fold higher odds of SVT recurrence (p <0.001), and that patients with WPW syndrome were more likely to require additional antiarrhythmic therapy (p <0.001). Thus, patients with WPW syndrome who had SVT at <1 year of age have 29-fold higher odds of recurrence at >1 year of age versus those patients with preexcitation. These patients are also more likely to require additional antiarrhythmic therapy to control SVT. Furthermore, children with WPW syndrome who are refractory to treatment with digoxin and/or propranolol are at increased risk of SVT recurrence.
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Affiliation(s)
- Tia A Tortoriello
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston 77030, USA
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Abstract
Supraventricular tachycardia (SVT) is the most common sustained arrhythmia to present in the neonatal and infancy age group. Predisposing factors (congenital heart disease, drug administration, illness and fever) occur only in 15% of infants. The presentation of SVT in the neonate is frequently subtle, and may include pallor, cyanosis, restlessness, irritability, feeding difficulty, tachypnea, diaphoresis and grunting. Congestive heart failure is more common in infants under 4 months of age (35% incidence). Age-related differences in the distribution of SVT mechanisms occur in different age groups. In infants under 1 year of age, the mechanisms underlying SVT are atrial tachycardia (15%), AV nodal re-entry tachycardia (5%), and AV reciprocating tachycardia (80%). Options for acute management include: use of the diving reflex, intravenous adenosine, transesophageal pacing, and cardioversion. Intravenous administration of verapamil should be avoided. Data regarding freedom from recurrence of untreated SVT in the first year of life are limited, and may be in the range of 25-60%. Chronic therapy with digoxin, beta-blockers, flecainide, sotalol and amiodarone has proved effective in controlling recurrent episodes of SVT. Radiofrequency ablation can be employed successfully in medically refractory cases, but should be avoided in this age group (increased complication rate).
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Affiliation(s)
- JP Moak
- Children's National Medical Center, Department of Cardiology, George Washington University School of Medicine, 111 Michigan Avenue, NW 20010, Washington, DC, USA
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Wu MH, Lin JL, Lai LP, Young ML, Lu CW, Chang YC, Wang JK, Lue HC. Radiofrequency catheter ablation of tachycardia in children with and without congenital heart disease: indications and limitations. Int J Cardiol 2000; 72:221-7. [PMID: 10716130 DOI: 10.1016/s0167-5273(99)00183-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
From 1993 to 1998, a total of 100 consecutive pediatric patients with tachycardia (45 male and 55 female, aged 1 year 10 months to 17 years, 11+/-4 year) who underwent electrophysiological study were reviewed. Eleven of them were younger than 5 years. Two had tachycardia-related cerebrovascular accident. Congenital heart disease was found in 12 patients. After propofol anesthesia, the clinical tachycardia could not be induced in three (two atrial tachycardia and one AV nodal re-entrant tachycardia) and became nonsustained in five (atrial tachycardia). Mechanical ablation occurred in three and two had subsequent recurrences. Among the 85 cases who received radiofrequency ablation, the overall final success rate of RF ablation for all diagnoses was 94% with a diagnosis-specific success rate ranging from 100 to 57%. Tachycardia cardiomyopathy was noted in four (three atrial tachycardia and one junctional ectopic tachycardia) and all regressed after successful ablation. Success in two patients with left posterioseptal accessory pathway could only be achieved by delivering the energy at the middle cardiac vein. Two patients with right atrial isomerism had an 'AV nodal-to-AV nodal tachycardia' which was eliminated by ablation. Total recurrence rate was 13% but final success was achieved in all during re-study except the three patients who refused re-intervention. The atrial tachycardia developed in postoperative congenital heart disease was associated with the lowest success rate (57%) and highest recurrence rate (25%). Procedure-related complications occurred in four; two with transient brachial palsy, one with first-degree AV block and one with blood loss requiring blood transfusion. In conclusion, the experience of this single center confirmed the efficacy and safety of radiofrequency catheter ablation in treating pediatric arrhythmias, but the limitations in postoperative arrhythmias and the effects of propofol on tachycardia induction (especially the atrial tachycardia) need to be improved.
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Affiliation(s)
- M H Wu
- Department of Pediatrics and Internal Medicine, National Taiwan University Hospital, Taipei.
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Pudpud AA, Linares MY, Greenberg B. Is hospitalization necessary for treatment of SVT? Predictive variables for recurrence and negative outcome. Am J Emerg Med 1999; 17:512-6. [PMID: 10530525 DOI: 10.1016/s0735-6757(99)90187-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In this article we attempt to identify variables that may predict which pediatric patients presenting with supraventricular tachycardia to the emergency department are at risk for immediate recurrence or negative outcome. We studied an 11-year chart review and follow-up of pediatric patients presenting to the pediatric ED with a diagnosis of SVT. Recurrences of SVT during the first 24 hours after initial episode and occurrences of negative outcome (ie, respiratory distress, cardiac arrest) during hospital stay were measured. 51 patients met our inclusion criteria: 74.5% were treated as inpatients. 18% experienced a recurrence during 24 hours; 3 patients were less than 3 months of age. Recurrence within 90 minutes of conversion occurred in 4/7 patients. All negative outcomes (3.9%) occurred in the less than 3-month age group. Patients less than 3 months or with immediate supraventricular tachycardia recurrence may have a higher probability of recurrence and negative outcome and therefore may require hospitalization.
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Affiliation(s)
- A A Pudpud
- Miami Children's Hospital, FL 33155, USA
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Luedtke SA, Kuhn RJ, McCaffrey FM. Pharmacologic management of supraventricular tachycardias in children. Part 1: Wolff-Parkinson-White and atrioventricular nodal reentry. Ann Pharmacother 1997; 31:1227-43. [PMID: 9337449 DOI: 10.1177/106002809703101016] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To review the literature regarding the use of antiarrhythmic agents in the management of Wolff-Parkinson-White (WPW) syndrome and atrioventricular nodal reentry tachycardia (AVNRT) in infants and children, and to discuss the advantages and disadvantages of specific agents in each arrhythmia in an effort to develop treatment guidelines. DATA SOURCES A MEDLINE search encompassing the years 1966-1996 was used to identify pertinent literature for discussion. Additional references were found in the articles that were retrieved via MEDLINE. STUDY SELECTION Clinical trials that address the use of antiarrhythmic agents for the treatment of the supraventricular tachycardias WPW and AVNRT in children were selected. Literature pertaining to dosage, pharmacokinetics, efficacy and toxicity of antiarrhythmic agents in children were considered for possible inclusion in the review, and information judged to be pertinent by the authors was included in the discussion. DATA EXTRACTION Although there are numerous reports of antiarrhythmic use in children, very few large studies are designed to evaluate an individual antiarrhythmic agent for a specific arrhythmia. Controlled, comparison trials of antiarrhythmic agents in children are virtually nonexistent. Ideally, controlled clinical trials are used to develop clinical guidelines; however, in this situation, most data and information must be obtained from case series of children treated. Although the results from these type of studies may be useful in developing guidelines for the optimal use of these agents, controlled trials are required for establishing standard treatment guidelines for all patients. DATA SYNTHESIS Despite limited scientific evaluation of conventional agents in the treatment of WPW and AVNRT in children, they continue to be used as standard of care. Most information regarding the use of conventional agents in children has been extrapolated from the adult literature. Little justification for the use of agents or dosing in children is available. Controlled trials regarding the use of new antiarrhythmic agents (propafenone, amiodarone, flecainide) are available; however, the variance in dosing schemes, presence of structural heart disease, and patient age make the development of recommendations difficult. CONCLUSIONS Because of greater clinical experience with these conventional antiarrhythmic agents, they continue to be first-line therapy in the management of most supraventricular tachycardia (SVT) in children. The management of SVT in children with WPW syndrome should begin with the use of a beta-blocker with the addition of digoxin or procainamide for treatment failures. The use of digoxin monotherapy, although frequently used by many practitioners in infants and children with WPW, cannot be recommended. For failures to conventional agents, flecainide is the preferred agent, while therapy with propafenone, amiodarone, and sotalol remains to be elucidated. The management of AVRNT is similar to that of WPW; however, digoxin is the agent of first choice. Trials of beta-blockers and procainamide should follow for treatment failures with flecainide again being the preferred "newer" antiarrhythmic for use in resistant cases. Additional well-designed, controlled trials are needed to further evaluate the comparative efficacy of antiarrhythmics in the management of WPW and AVNRT in children, as well as to evaluate dosing and toxicity in various age groups.
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Affiliation(s)
- S A Luedtke
- University of Kentucky Children's Hospital, Lexington, USA
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