Variation in Antiarrhythmic Management of Infants Hospitalized with Supraventricular Tachycardia: A Multi-Institutional Analysis

Abstract

Supraventricular tachycardia (SVT) is the most frequent form of symptomatic tachyarrhythmia in infants. The purposes of this study were to describe practice patterns of the management of infants hospitalized with SVT and factors associated with 30-day hospital readmission. This was a multi-institutional, retrospective review of the pediatric health information system database of SVT hospitalizations from 2003 to 2013. High-volume centers (HVC) were defined as those at the upper quartile of admissions. Infants with an ICD-9 code of paroxysmal SVT were included. Antiarrhythmics investigated included amiodarone, atenolol, digoxin, esmolol, flecainide, procainamide, propafenone, propranolol, and sotalol. Frequency of antiarrhythmic use based on center volume was the primary end point. Rate of 30-day SVT readmission was the secondary end point. Analysis of factors associated with readmission was assessed by Chi-square analysis and expressed as odds ratio and 95 % confidence interval. A total of 851 patients (60 % male, 44 % neonates) were hospitalized at 43 hospitals. Propranolol, digoxin, and amiodarone were the most frequently utilized antiarrhythmics. HVCs represented 12 hospitals comprising 494 (58 %) patients. Although HVCs were more likely to utilize propranolol (OR 2.5, CI 1.5-4.1), there was no significant difference in the 30-day readmission rate between patients treated at HVCs versus non-HVCs (p = 0.9). The majority of infants with SVT are treated with a small number of antiarrhythmic medications during index hospitalization. Although hospital-to-hospital variation in antiarrhythmic choice exists, there appears to be no difference in readmission. The remaining practice variation may be related to intrinsic patient characteristics.

Sustained tachyarrhythmia in children younger than 1 year of age: Six year single‐center experience

“…Guerrier et al . used anti‐arrhythmic therapy in 73% of patients in their series, including 851 newborns and infants . In that study, monotherapy was used in 86% of patients.…”

“…Of the patients who underwent multi‐agent therapy, a combination of propranolol and digoxin was the most common multi‐agent regimen (21%), followed by flecainide with digoxin (12%). When amiodarone was utilized in multi‐agent therapy, it was frequently combined with digoxin (32%), propranolol (26%), and esmolol (13%) . In another study, 44% of infants received second‐line treatment, and 45% received multidrug treatment at the time of discharge .…”

“…The majority of tachyarrhythmias presenting in infancy depend on the presence of an accessory pathway. In one‐third of patients, tachyarrhythmia never recurs after 1 year of age, but heart failure may develop more easily in neonates and infants depending on the duration, mechanism, and rate of tachycardia …”

“…In one-third of patients, tachyarrhythmia never recurs after 1 year of age, but heart failure may develop more easily in neonates and infants depending on the duration, mechanism, and rate of tachycardia. 2,3 Patients usually present with non-specific symptoms, such as pallor, difficulty feeding, tachypnea, and excessive sweating. It is diagnosed either during routine physical examination or evaluation for dilated cardiomyopathy.…”

“…1 The majority of sustained tachyarrhythmias in children <1 year were treated with a single anti-arrhythmic drug or a combination of such drugs depending on the spontaneous regression rate. 3,4 Although it is more risky in those under 1 year than in other age groups, radiofrequency ablation (RFA) or cryoablation can be applied successfully in a limited number of patients refractory to medical treatment. In this study, we report on sustained tachyarrhythmia patients aged <1 year age in terms of presentation, clinical findings, tachyarrhythmia type, and treatment modality.…”