Evaluation and Management of Neonatal Supraventricular Tachycardia

Abstract

Background: Supraventricular Tachycardia (SVT) is the most frequent arrhythmia requiring a medical treatment in neonates. Objectives: The aim of our study was to evaluate and manage neonatal supraventricular tachycardia. Methods: This study was performed on 22 newborns that were diagnosed with SVT at two neonatal intensive care units (NICU) in south west of Iran from October 2012 to October 2015. Data on gender, age, weight, maternal age, gestational age, presence of congenital heart disease, blood pressure in admission, duration of hospitalization period, duration of SVT, medicine for the control of SVT, list of medicine administered at releasing time were collected. Echocardiography was performed for all patients. Data was analyzed by the SPSS version 18 software.

Management of neonatal supraventricular tachycardias; A single center experience

“…[14,16] The incidence of congenital heart disease in newborns diagnosed with SVT is reported as 6.5%-37%. [12,13,[17][18][19] In our study, frequency of structural heart disease was 39.2%. In decreasing order of frequency, the accompanying heart diseases were as follows: ASD (21.7%), PDA (6.5%), VSD (6.5%), c-TGA (2.1%) and tricuspid atresia (2.1%).…”

Management of intractable supraventricular tachycardia unresponsive to primary therapy with Verapamil in a neonatal case

“…For infants in whom cardio version is difficult and with recurrent episodes of SVT, they need stronger anti arrhythmic drugs such as sotalol, flecainide, or amiodarone alone or in combination with a beta-blocker. 4,5,11 In addition, digoxin is usually used as a classic drug for tachycardia within limitations. Furthermore, it is not used in the presence of a delta wave, and its slow onset time of 10 h is distressingly long in intolerable patients who may require other anti arrhythmic drugs with combined adverse effects.…”

“…3 Chronic tachycardias can lead to dilated cardiomyopathy. 4 Vagal maneuvers and adenosine are an appropriate first treatment in patients with hemodynamically stable SVT, although circulatory collapse with tachycardias needs synchronized direct-current cardio version during acute episodes. 2 For infants in whom cardio version is difficult or who have recurrent or intractable SVT, a more powerful anti arrhythmic drug such as digoxin, sotalol, flecainide, or amiodarone, is needed with intensive monitoring.…”

“…Radiofrequency ablation could be attempted when the infant is approximately 15 kg, although the long-term potential for coronary artery stenosis exists in young cases. [4][5][6] Verapamil is a class IV anti arrhythmic agent that acts as a selective inhibitor of myocardial calcium channels. It is used for the acute termination of SVT when first therapeutic options fail with a strong effectiveness in over 90% of children, although it is unlikely to be indicated in infants due to the risk for circulatory hypo perfusion 2,4,7 Many articles have recommended Verapamil for infants as a second-line agent for unresponsive-to-first-line therapies for SVT.…”

“…[4][5][6] Verapamil is a class IV anti arrhythmic agent that acts as a selective inhibitor of myocardial calcium channels. It is used for the acute termination of SVT when first therapeutic options fail with a strong effectiveness in over 90% of children, although it is unlikely to be indicated in infants due to the risk for circulatory hypo perfusion 2,4,7 Many articles have recommended Verapamil for infants as a second-line agent for unresponsive-to-first-line therapies for SVT. [8][9][10] Here, we report a case of an intractable Supraventricular tachycardia successfully managed with intravenous Verapamil in a newborn unresponsive to multiple first-line therapies.…”