Oral flecainide is effective in management of refractory tachycardia in infants

Propranolol and digoxin have been used as first line drugs for treatment of supraventricular tachycardia (SVT) in infants. Flecainide and other drugs have been effective as a second line treatment for controlling refractory SVT.

This is a prospective study without randomization and control. The inclusion criteria were: infants (≤12 months) with tachyarrhythmia who failed to respond to first line drugs. Patients having post-surgical arrhythmias were excluded from the study.

A total of 8 infants were treated with flecainide for refractory tachyarrhythmia's. Diagnosis on electrocardiogram (ECG) was atrioventricular reentry tachycardia (AVRT) in 5, atrial ectopic tachycardia (AET) in 2, a combination of AVRT and atrioventricular nodal reentry tachycardia (AVNRT) in 1. All patients had failed trial of antiarrhythmic drugs prior to presentation: digoxin and propranolol in 7, amiodarone in 3, cardioversion in 1. Flecainide (80-130 mg/m(2) orally) resulted in termination of the tachycardia in all 8 patients. Acute pharmacological termination of arrhythmia occurred with oral flecainide loading in 1 and temporarily with intravenous esmolol loading in 1 patient. Adjuvant therapy in form of propranolol was used in 5 and digoxin in 2. There were no side effects noted. Four episodes of recurrence were noted in 3 patients over 2 years, all of which responded to dose increase. Mean follow up time is 24.75 months.

This small case series indicates that flecainide is an effective antiarrhythmic agent, free of side effects and when used orally is capable of terminating and controlling relatively resistant supraventricular tachycardia in children.