Re-entrant supraventricular tachycardia in infancy : current role of prophylactic digoxin treatment

• Published in: European journal of pediatrics 1998-02, Vol.157 (2), p.101-106
• Main Authors: PFAMMATTER, J.-P, STOCKER, F. P
• Format: Article
• Language: English
• Subjects: Anti-Arrhythmia Agents - therapeutic use; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Digoxin - therapeutic use; Disease prevention; Drug dosages; Drug therapy; Female; Heart; Heart Defects, Congenital - complications; Hemodynamics; Humans; Infant; Infant, Newborn; Male; Medical sciences; Newborn babies; Outpatient care facilities; Patients; Pediatrics; Recurrence; Retrospective Studies; Sinuses; Tachycardia, Atrioventricular Nodal Reentry - drug therapy; Tachycardia, Atrioventricular Nodal Reentry - prevention & control; Treatment Outcome; Wolff-Parkinson-White Syndrome - complications
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s004310050778

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. 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.