title: Efficacy of digoxin in comparison with propranolol for treatment of infant supraventricular tachycardia: analysis of a large, national database.
abstract: BACKGROUND
  Digoxin or propranolol are used as first-line enteral agents for treatment of infant supraventricular tachycardia. We used a large national database to determine whether enteral digoxin or propranolol was more efficacious as first-line infant supraventricular tachycardia therapy.
  
  
  METHODS
  The Pediatric Health Information System database was queried over 10 years for infants with supraventricular tachycardia initiated on enteral digoxin or propranolol monotherapy. Patients were excluded for Wolff-Parkinson-White, intravenous antiarrhythmics (other than adenosine), or death. Success was considered as discharge on the initiated monotherapy. Risk factors for successful monotherapy and risk factors for readmission for supraventricular tachycardia for patients discharged on monotherapy were determined.
  
  
  RESULTS
  A total of 374 patients (59.6% male) met the study criteria. Median length of stay was 7 days (interquartile range of 3-16 days). Patients had CHD (n=199, 53.2%) and underwent cardiac surgery (n=123, 32.9%), ICU admission (n=238, 63.6%), mechanical ventilation (n=146, 39.0%), and extracorporeal membrane oxygenation (n=3, 0.8%). Pharmacotherapy initiation was at median 37 days of life (interquartile range of 12-127 days) and 47.3% were initiated on digoxin. Success was similar between digoxin (73.1%) and propranolol (73.5%). Initial therapy with digoxin was not associated with success (odds ratio 1.01, 95% CI 0.64-1.61, p=0.93). Multivariable analysis demonstrated hospital length of stay (odds ratio 0.98, 95% CI 0.98-1.00) and involvement of a paediatric cardiologist (odds ratio 0.46, 95% CI 0.29-0.75) associated with monotherapy failure, and male gender (odds ratio 1.66, 95% CI 1.03-2.67) associated with monotherapy success. No variables were significant for readmission on multivariable analysis.
  
  
  CONCLUSIONS
  Digoxin or propranolol may be equally efficacious for inpatient treatment of infant supraventricular tachycardia.
authors.affiliation: 1Department of Pharmacy,Texas Children's Hospital,Houston,Texas,United States of America.
authors.forename: Brady S
authors.initials: BS
authors.lastname: Moffett
authors.affiliation: 1Department of Pharmacy,Texas Children's Hospital,Houston,Texas,United States of America.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Lupo
authors.affiliation: 2Department of Pediatrics,Baylor College of Medicine,Houston,Texas,United States of America.
authors.forename: Caridad M
authors.initials: CM
authors.lastname: delaUz
authors.affiliation: 2Department of Pediatrics,Baylor College of Medicine,Houston,Texas,United States of America.
authors.forename: Santiago O
authors.initials: SO
authors.lastname: Valdes
authors.affiliation: 2Department of Pediatrics,Baylor College of Medicine,Houston,Texas,United States of America.
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Miyake
authors.affiliation: 3Department of Pediatrics,Johns Hopkins Medicine,All Children's Hospital,St Petersburg,Florida,United States of America.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Decker
authors.affiliation: 2Department of Pediatrics,Baylor College of Medicine,Houston,Texas,United States of America.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D019992:Databases as Topic; D004077:Digoxin / Q000627:therapeutic use*; D005260:Female; D006330:Heart Defects, Congenital / Q000145:classification / Q000150:complications* / Q000601:surgery; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D011433:Propranolol / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013617:Tachycardia, Supraventricular / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D011433:Propranolol
keywords: CHD; Supraventricular tachycardia; digoxin; outcomes; propranolol