Effective Control of Supraventricular Tachycardia in Neonates May Requires Combination Pharmacologic Therapy

Abstract

Introduction: Supraventricular tachycardia (SVT) is one of the arrhythmias that can occur in newborns. Most SVT incidents in the neonatal period are spontaneously resolved around the first year of life, but since tachycardia can frequently occur before complete resolution, appropriate medication use is required. However, no clear guidelines or consensus on the treatment of neonatal SVT have been established yet. Methods: From January 2011 to December 2021, demographic data and antiarrhythmic medications used were retrospectively analyzed for 18 newborns diagnosed with SVT at a single center. Results: A total of four medications (propranolol, amiodarone, flecainide, and atenolol) were used as maintenance therapy to prevent tachycardia recurrence, and propranolol was the most used, followed by amiodarone. Thirty-nine percent of the patients were controlled with monotherapy, but the remainder required two or more medications. The median period from medication initiation after diagnosis to the last tachycardia event was 15.5 days, and the median total duration of medication use was 362 days. None of the patients experienced any side effects of antiarrhythmic medications. The total duration of medication use was statistically significant according to the mechanism of SVT, and the usage time of the increased automaticity group was shorter than that of the re-entry group. Conclusion: Since most neonatal SVT resolves within 1 year, it is significant to provide prophylactic medication to prevent tachycardia recurrence at least until 1 year of age, and depending on the patient, the appropriate combination of medications should be identified.

Supraventricular Tachycardia in the Setting of Neonatal COVID-19 Infection

“…As a result, during the first neonatal life, the main treatment is conservative with or without the use of prophylactic antiarrhythmic medications to prevent tachycardia recurrence until the first year of life. 7 Treatment options for the initial management of cardiac arrhythmias include nonpharmacological agents. 8 Among them, eliciting a dive reflex by applying ice over the face for 30 seconds, but no longer as it can cause skin "burn" injury, may result in therapeutic reflex bradycardia.…”

“…When the neonate reaches the first year of life, the annulus fibrosus between the atrium and ventricles matures and this may explain the spontaneous disappearance of SVT. As a result, during the first neonatal life, the main treatment is conservative with or without the use of prophylactic antiarrhythmic medications to prevent tachycardia recurrence until the first year of life 7…”

Pediatric Beta Blocker Therapy: A Comprehensive Review of Development and Genetic Variation to Guide Precision-Based Therapy in Children, Adolescents, and Young Adults

“…As there is little evidence to drive agent selection in the management of SVT, there is also limited predictability in knowing what antiarrhythmic agent, dose, or combination of agents may achieve rhythm control. Overall, the available evidence demonstrates only 50% of pediatric SVT quiescence with monotherapy, suggesting that determining the most effective, minimal dose exposure (i.e., dose optimization) is needed for this population [ 25 , 26 , 27 ].…”

Management of acute supraventricular tachycardia in children

“…Vagal maneuvers are considered non-invasive first-line treatment of children with SVT who are hemodynamically stable. 5 These maneuvers work by increasing parasympathetic tone, which can increase the refractory period of the AV node and terminate SVT. 6 Some commonly used maneuvers include the Valsalva maneuver (eg, squatting, forced expiration against a closed glottis), stimulating the diving reflex in infants (eg, placing a bag of ice over the face), and carotid sinus massage (important to do it unilaterally only).…”