[Recommendations for the treatment of recurrent supraventricular tachycardia in infants].
OBJECTIVE
The effectiveness and safety of antiarrhythmic agents, mostly digoxin and amiodarone given to prevent recurrences, were compared in 141 infants of less than 1 year (77% < 1 month) with re-entrant supraventricular tachycardia.


RESULTS
Digoxin was the drug of first choice in 114 patients at a dose of 10-20 micrograms/kg/d and was effective in 74 cases (65%). Amiodarone was used as first line therapy or after failure of digoxin. It was given at a maintenance dose of 250 mg/m2/d, alone in 22 infants and together with digoxin in another 36; it was effective in 56 cases (96.5%). Early adverse events occurred in six patients receiving digoxin: ventricular fibrillation requiring cardioversion in three, two of whom had Wolff-Parkinson-White syndrome, significant sinus bradycardia in two, accidental overload in one. At further follow-up, one child treated with digoxin but having also gastroesophageal reflux, died suddenly at 3 months of age; autopsy was normal and the digoxin blood level was 3 ng/mL. Among the 58 infants who received amiodarone, there were no proarrhythmia, a slight and transient increase in TSH in six infants and only one required a short-term treatment for hypothyroidism. Prophylactic therapy was maintained for 6 to 12 months and only ten patients had recurrences in the year following withdrawal.


CONCLUSIONS
Amiodarone was found to be safer and more effective than digoxin. No significant side-effect was demonstrated in infants receiving a short-term treatment. Amiodarone may be proposed as first line therapy for prophylaxis of re-entrant supraventricular tachycardia in infancy, especially for those patients with reentry and Wolff-Parkinson-White syndrome.
Villain
E
E
Service de cardiologie pédiatrique, hôpital Necker-Enfants-malades, Paris, France.
Bonnet
D
D
Acar
P
P
Aggoun
Y
Y
Sidi
D
D
Kachaner
J
J
D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use*; D004554:Electric Countershock; D004562:Electrocardiography; D006801:Humans; D007223:Infant; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D014693:Ventricular Fibrillation / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D000638:Amiodarone