Chu Patricia Y, Hill Kevin D, Clark Reese H, Smith P Brian, Hornik Christoph P
Duke Clinical Research Institute, Durham, NC, United States.
Duke Clinical Research Institute, Durham, NC, United States; Department of Pediatrics, Duke University Medical Center, Durham, NC, United States.
Early Hum Dev. 2015 Jun;91(6):345-50. doi: 10.1016/j.earlhumdev.2015.04.001. Epub 2015 Apr 28.
Supraventricular tachycardia (SVT) is the most common arrhythmia in infants. Infants are typically treated with antiarrhythmic medications, but there is a lack of evidence guiding management, thus exposing infants to risks of both inadequate therapy and medication adverse events. We used data from a large clinical database to better understand current practices in SVT management, safety of commonly used medications, and outcomes of hospitalized infants treated for SVT.
This retrospective data analysis included all infants discharged from Pediatrix Medical Group neonatal intensive care units between 1998 and 2012 with a diagnosis of SVT who were treated with antiarrhythmic medications. We categorized infants by the presence of congenital heart disease other than patent ductus arteriosus. Medications were categorized as abortive, acute, or secondary prevention therapies. We used descriptive statistics to describe medication use, adverse events, and outcomes including SVT recurrence and mortality.
A total of 2848 infants with SVT were identified, of whom 367 (13%) had congenital heart disease. Overall, SVT in-hospital recurrence was high (13%), and almost one fifth of our cohort (18%) experienced an adverse event. Mortality was 2% in the overall cohort and 6% in the congenital heart disease group (p<0.001). Adenosine was the most commonly used abortive therapy, but there was significant practice variation in therapies used for acute treatment and secondary prevention of SVT.
Significant variation in SVT treatment and suboptimal outcomes warrant future clinical trials to determine best practices in treating SVT in infants.
室上性心动过速（SVT）是婴儿最常见的心律失常。婴儿通常采用抗心律失常药物治疗，但缺乏指导治疗的证据，这使婴儿面临治疗不足和药物不良事件的风险。我们使用大型临床数据库中的数据，以更好地了解SVT管理的当前实践、常用药物的安全性以及接受SVT治疗的住院婴儿的结局。
这项回顾性数据分析纳入了1998年至2012年间从Pediatrix医疗集团新生儿重症监护病房出院、诊断为SVT并接受抗心律失常药物治疗的所有婴儿。我们根据是否存在动脉导管未闭以外的先天性心脏病对婴儿进行分类。药物分为终止发作、急性或二级预防治疗。我们使用描述性统计来描述药物使用、不良事件以及包括SVT复发和死亡率在内的结局。
共识别出2848例SVT婴儿，其中367例（13%）患有先天性心脏病。总体而言，SVT住院复发率较高（13%），近五分之一的队列（18%）发生了不良事件。总体队列的死亡率为2%，先天性心脏病组为6%（p<0.001）。腺苷是最常用的终止发作治疗药物，但在SVT急性治疗和二级预防所使用的治疗方法上存在显著的实践差异。
SVT治疗的显著差异和次优结局值得未来进行临床试验，以确定婴儿SVT治疗的最佳实践。
