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Outcomes of Infant Supraventricular Tachycardia Management Without Medication

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Abstract

Most infants presenting with supraventricular tachycardia (SVT) are treated with an antiarrhythmic, primarily to prevent unrecognized future episodes that could lead to tachycardia-induced cardiomyopathy. A common practice at our institution is to not treat after the first presentation of infant SVT and instead educate parents on heart rate monitoring and reasons to present to care. The goal of this study was to evaluate the outcomes of non-pharmacologic treatment of infant SVT at first presentation and compare to outcomes of infants treated with an antiarrhythmic. This was a retrospective single center study of all infants presenting with a first episode of SVT from 2014 to 2021. Excluded were patients with a non-reentry type tachyarrhythmia, atrial flutter, long-RP tachycardia, congenital heart disease, or abnormal ventricular function. Sixty-four infants were included in the study. Thirty-six were managed without an antiarrhythmic. SVT recurred in 28% of the non-treatment group vs 50% in those treated with antiarrhythmics, p = 0.12. Of the patients admitted to the hospital, those in the non-treatment group had a shorter length of stay, 1(IQR 1–1) vs 3(IQR 2–4) days, p < 0.01. Non-treated patients were less likely to present to the emergency department for recurrent SVT, 6% vs 32%, p < 0.01. Neither group had a patient develop tachycardia-induced cardiomyopathy. For infants with structurally and functionally normal hearts, non-treatment combined with parental education after the first episode of SVT does not lead to worse outcomes. This approach avoids the burden of medication administration in an infant and may have the added benefit of empowering parents to feel comfortable managing clinically insignificant tachycardia at home.

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Abbreviations

SVT:

Supraventricular tachycardia

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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  1. Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, 1 Children’s Pl, 8th Floor NWT, St. Louis, MO, 63108, USA

    Anthony G. Pompa

  2. Michigan Medicine Congenital Heart Center, University of Michigan, Ann Arbor, MI, USA

    Martin J. LaPage

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All authors participated in the concept and design of the study, interpretation of data, and drafting or revising of the manuscript. All authors also approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Pompa, A.G., LaPage, M.J. Outcomes of Infant Supraventricular Tachycardia Management Without Medication. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03263-1

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