Key result
Among 2,534 infants with SVT, propranolol was the most common treatment, digoxin use was rare, and no differences in acute or prophylactic effectiveness between medications were observed.
Why the study?
Several medication choices exist for acute and prophylactic treatment of refractory infant SVT, but controlled trials are lacking and choices are not necessarily evidence based.
What are the effectiveness and outcomes of different medical management strategies for infants with supraventricular tachycardia?
Observational (n=2,534)
Yes
What are the effectiveness and outcomes of different medical management strategies for infants with supraventricular tachycardia?
In infants with SVT, there is limited evidence to support one antiarrhythmic medication over another, though contemporary practice favors propranolol over digoxin, with overall low recurrence and mortality rates.
No medication superior for infant SVT; confirms limited comparative evidence and highlights registry-literature recurrence gaps.
Background Several medication choices are available for acute and prophylactic treatment of refractory supraventricular tachycardia (SVT) in infants. There are almost no controlled trials, and medication choices are not necessarily evidence based. Our objective was to report the effectiveness of management strategies for infant SVT. Methods A registry of infants admitted to hospital with re-entrant SVT and no haemodynamically significant heart disease were prospectively followed at 11 international tertiary care centres. In addition, a systematic review of studies on infant re-entrant SVT in MEDLINE and EMBASE was conducted. Data on demographics, symptoms, acute and maintenance treatments, and outcomes were collected. Results A total of 2534 infants were included: n=108 from the registry (median age, 9 days [0-324 days], 70.8% male) and n=2426 from the literature review (median age, 14 days; 62.3% male). Propranolol was the most prevalent acute (61.4%) and maintenance treatment (53.8%) in the Registry, whereas digoxin was used sparingly (4.0% and 3.8%, respectively). Propranolol and digoxin were used frequently in the literature acutely (31% and 33.2%) and for maintenance (17.8% and 10.1%) ( P < 0.001). No differences in acute or prophylactic effectiveness between medications were observed. Recurrence was higher in the Registry (25.0%) vs literature (13.4%) ( P < 0.001), and 22 (0.9%) deaths were reported in the literature vs none in the Registry. Conclusion This was the largest cohort of infants with SVT analysed to date. Digoxin monotherapy use was rare amongst contemporary paediatric cardiologists. There was limited evidence to support one medication over another. Overall, recurrence and mortality rates on antiarrhythmic treatment were low.
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Wei et al. (2022) conducted an observational in Supraventricular Tachycardia (SVT) (n=2,534). Antiarrhythmic medications (e.g., propranolol, digoxin) vs. Other antiarrhythmic medications was evaluated on Acute and prophylactic effectiveness. Among 2,534 infants with SVT, propranolol was the most common treatment, digoxin use was rare, and no differences in acute or prophylactic effectiveness between medications were observed.
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