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Treatment of atrial ectopic tachycardia in infants < 6 months old
U Bauersfeld1, R M Gow, R M Hamilton
1Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Atrial ectopic tachycardia (AET) in infants under six months can be effectively treated with antiarrhythmic drugs. A recommended three-step approach involving digoxin, a class 1C drug, and a class 3 drug leads to frequent AET resolution.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Pharmacology
Background:
- Atrial ectopic tachycardia (AET) is an uncommon arrhythmia in infants.
- Management strategies for AET in neonates and infants are not well-established.
- Antiarrhythmic drug therapy is a primary treatment option for infant AET.
Purpose of the Study:
- To evaluate the efficacy and safety of antiarrhythmic drugs for treating AET in infants younger than six months.
- To propose a stepwise treatment algorithm for managing AET in this population.
Main Methods:
- Retrospective analysis of 19 infants (< 6 months) diagnosed with AET.
- Treatment involved various antiarrhythmic drug combinations (digoxin, propafenone, amiodarone).
- Radiofrequency ablation was considered for drug-refractory cases.
Main Results:
- AET was successfully controlled in 18 out of 19 infants.
- Fourteen of 15 infants achieved AET resolution within one year.
- Five patients experienced drug-related side effects.
Conclusions:
- Antiarrhythmic drug therapy is a safe and effective treatment for AET in infants.
- A three-step therapeutic approach (digoxin, class 1C, class 3 drugs) is recommended.
- High rates of AET resolution suggest favorable long-term outcomes.
Abstract:
Nineteen infants < 6 months old who had atrial ectopic tachycardia (AET) were treated with antiarrhythmic drugs. AET was controlled with digoxin in 1 patient, propafenone in 2, digoxin with propafenone in 9, digoxin with amiodarone in 4, and digoxin with propafenone and amiodarone in 2; radiofrequency ablation was performed in 1 drug-resistant case. AET resolved in 14 of 15 infants within 1 year. Drug side effects occurred in 5 patients. We conclude that AET in infants < 6 months old can be successfully treated with antiarrhythmic drugs, and we recommend a three-step approach with digoxin, a class 1C antiarrhythmic drug, and a class 3 drug. Resolution of AET in infants is frequent.