Supraventricular tachycardia in infancy: evaluation, management, and follow-up
1Department of Pediatrics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City 84113, USA.
Insights
Supraventricular tachycardia (SVT) in infants is manageable, but most infants still have inducible SVT at one year. Initial presentation and electrophysiology study data do not predict clinical outcomes or continued SVT inducibility.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Infant Health
Background:
- Supraventricular tachycardia (SVT) is common in infants, with some experiencing spontaneous resolution.
- Approximately 30% of infants lose SVT inducibility by age one.
Purpose of the Study:
- To identify predictors of non-reliance on antiarrhythmic medication for SVT in infants.
- To determine factors predicting the absence of inducible SVT at one year of age.
Main Methods:
- Prospective evaluation of clinical and tachycardia characteristics at SVT presentation.
- Esophageal electrophysiology (EP) studies performed at diagnosis and one-year follow-up.
- Inclusion of infants aged 3 months or younger presenting with SVT.
Main Results:
- SVT was controlled in all 33 infants studied.
- At one year, 76% of patients were medication-free and SVT-free.
- However, 11 of 16 patients without clinical SVT still had inducible SVT on follow-up EP study.
- Only 24% of one-year-old patients had neither clinical nor inducible SVT.
Conclusions:
- Infant SVT is controllable, with infrequent clinical episodes post-discharge.
- Most infants retain inducible SVT at one year, irrespective of initial findings.
- No presenting data or initial EP study results predicted the clinical course or SVT inducibility.
Background:
Supraventricular tachycardia (SVT) occurs frequently in infancy. However, some infants have no recurrences after the initial presentation of SVT, and approximately 30% of infants lose SVT inducibility by 1 year of age.
Objective:
To determine whether features at presentation, tachycardia characteristics, or data from an esophageal electrophysiology (EP) study could predict which infants will not require antiarrhythmic medication and which infants will not have inducible SVT at 1 year.
Design:
Clinical and tachycardia characteristics at presentation of SVT and data obtained from an esophageal EP study were evaluated prospectively. Patients were followed up for 1 year, and an esophageal EP study was performed to evaluate for continued SVT inducibility.
Setting:
Primary Children's Medical Center is a tertiary care hospital affiliated with the University of Utah that provides primary care to local patients and is a referral center for a 4-state region.
Patients:
All infants aged 3 months or younger who presented with SVT between August 1995 and October 1997 were evaluated.
Interventions:
An esophageal EP study was performed at diagnosis and at 1 year.
Results:
The SVT was controlled in all 33 infants. At the initial esophageal EP study, the mechanism of SVT was atrioventricular node reentry in 5 patients (15%) and orthodromic reciprocating tachycardia via an accessory atrioventricular connection in 28 patients (85%). One infant was lost to follow-up, 5 never required medication, 11 had SVT controlled with propranolol hydrochloride, 10 had SVT controlled with amiodarone, and 6 required more than 1 medication. Of the 21 patients who have reached 1 year of age, 16 (76%) were not taking any medication and were free of SVT at the time of follow-up. All 16 patients without clinical SVT have undergone a follow-up esophageal EP study, and 11 of 16 had inducible SVT on esophageal EP study. Thus, of the 21 one-year-old patients, 5 (24%) no longer had clinical or inducible SVT.
Conclusions:
Control of SVT was possible in all patients. Clinical episodes of SVT were uncommon after discharge, yet most still had inducible SVT at 1 year of age. No data at presentation or initial esophageal EP study were predictive of the clinical course or of continued SVT.
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