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Re-entrant supraventricular tachycardia in infancy: current role of prophylactic digoxin treatment
1Paediatric Cardiology, Children's Hospital, Freiburgstrasse, Berne, Switzerland.
Insights
Oral digoxin effectively treated supraventricular tachycardia in infants, preventing the need for other anti-arrhythmic drugs in many cases. This study highlights digoxin
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Background:
- Re-entrant supraventricular tachycardia is a common infant arrhythmia.
- Risk-benefit analysis of antiarrhythmic agents is crucial in infants.
- Long-term pharmacological prevention is recommended for infants under 1 year.
Purpose of the Study:
- To evaluate the efficacy of oral long-term digoxin for supraventricular tachycardia in infants.
- To assess the safety and effectiveness of digoxin in pediatric patients.
- To compare digoxin's outcomes with other antiarrhythmic agents.
Main Methods:
- Retrospective study of 26 infants with supraventricular tachycardia onset in the first 4 months of life.
- Patients received long-term oral digoxin prophylaxis.
- Follow-up assessment of treatment success, recurrence, and side-effects.
Main Results:
- Digoxin was successful in 65% of patients (17/26).
- 73% of children were recurrence-free at a mean follow-up of 54 months.
- No significant side-effects were observed; serum digoxin levels did not correlate with treatment success or failure.
Conclusions:
- Digoxin is an effective treatment for infant supraventricular tachycardia.
- Digoxin can help avoid long-term use of other antiarrhythmic drugs with potential pro-arrhythmic side-effects.
- Digoxin offers a favorable risk-benefit profile in this pediatric population.
Unlabelled:
Re-entrant supraventricular tachycardia is the most common cardiac arrhythmia in infancy. Pharmacological prevention of recurrencies is a standard recommendation for infants less than 1 year of age. In view of the often benign spontaneous clinical course of the disease, the risk-benefit analysis of any antiarrhythmic agent given is important. It was the aim of this retrospective study, to assess the value of oral long-term digoxin given to paediatric patients with supraventricular tachycardia with onset in the first 4 months of life. Twenty-six newborns and infants fulfilled the inclusion criteria. Median age at first presentation of the patients was 7 days. Eight patients (31%) had structural heart disease, 9 patients had a pre-excitation syndrome, and the other 17 children had a concealed accessory atrioventricular pathway. Long-term prophylaxis with oral digoxin was considered successful in 17 children (65%). In 2 patients therapy with digoxin was considered partially effective and in 7 patients (27%) failure of digoxin to improve symptoms led to the introduction of other anti-arrhythmic agents. Serum digoxin levels were no different in the patients with successful therapy as compared to those with treatment failure. No side-effects due to digoxin were noted in all the patients treated. After a mean followup of 54 months (12-130 months), 19 children (73%) were free of recurrencies and on no medication, 5 children were free of recurrencies but had anti-arrhythmic therapy. Only 2 patients, both on anti-arrhythmic therapy, were still suffering from tachycardia.
Conclusion:
Digoxin remains an effective treatment option in infants with supraventricular tachycardia and it helped to avoid the long-term use of other anti-arrhythmic drugs with potentially more serious side-effects (pro-arrhythmia) in a considerable proportion of infants treated.