Capponi Guglielmo, Belli Gilda, Giovannini Mattia, Remaschi Giulia, Brambilla Alice, Vannuccini Francesca, Favilli Silvia, Porcedda Giulio, De Simone Luciano
Department of Health Sciences, Post-Graduate School of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy.
Neonatology Department and Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy.
BMC Cardiovasc Disord. 2021 Mar 15;21(1):137. doi: 10.1186/s12872-020-01843-0.
Supraventricular tachycardias (SVTs) are common in the first year of life and may be life-threatening. Acute cardioversion is usually effective, with both pharmacological and non-pharmacological procedures. However, as yet no international consensus exists concerning the best drug required for a stable conversion to sinus rhythm (maintenance treatment). Our study intends to describe the experience of a single centre with maintenance drug treatment of both re-entry and automatic SVTs in the first year of life.
From March 1995 to April 2019, 55 patients under one year of age with SVT were observed in our Centre. The SVTs were divided into two groups: 45 re-entry and 10 automatic tachycardias. As regards maintenance therapy, in re-entry tachycardias, we chose to start with oral flecainide and in case of relapses switched to combined treatment with beta-blockers or digoxin. In automatic tachycardias we first administered a beta-blocker, later combined with flecainide or amiodarone when ineffective.
The patients' median follow-up time was 35 months. In re-entry tachycardias, flecainide was effective as monotherapy in 23/45 patients (51.1%) and in 20/45 patients (44.4%) in combination with nadolol, sotalol or digoxin (overall 95.5%). In automatic tachycardias, a beta-blocker alone was effective in 3/10 patients (30.0%), however, the best results were obtained when combined with flecainide: overall 9/10 (90%).
In this retrospective study on pharmacological treatment of SVTs under 1 year of age the combination of flecainide and beta-blockers was highly effective in long-term maintenance of sinus rhythm in both re-entry and automatic tachycardias.
室上性心动过速（SVT）在生命的第一年很常见，可能危及生命。急性心脏复律通常有效，包括药物和非药物方法。然而，关于稳定转复为窦性心律所需的最佳药物（维持治疗），目前尚无国际共识。我们的研究旨在描述一个单一中心对生命第一年的折返性和自律性SVT进行维持药物治疗的经验。
1995年3月至2019年4月，我们中心观察了55例1岁以下的SVT患者。SVT分为两组：45例折返性心动过速和10例自律性心动过速。关于维持治疗，对于折返性心动过速，我们选择开始口服氟卡尼，复发时改用β受体阻滞剂或地高辛联合治疗。对于自律性心动过速，我们首先给予β受体阻滞剂，无效时联合氟卡尼或胺碘酮。
患者的中位随访时间为35个月。在折返性心动过速中，氟卡尼单药治疗对23/45例患者（51.1%）有效，与纳多洛尔、索他洛尔或地高辛联合治疗对20/45例患者（44.4%）有效（总体有效率95.5%）。在自律性心动过速中，单独使用β受体阻滞剂对3/10例患者（30.0%）有效，然而，与氟卡尼联合使用时效果最佳：总体9/10例（90%）。
在这项关于1岁以下SVT药物治疗的回顾性研究中，氟卡尼和β受体阻滞剂联合使用在折返性和自律性心动过速的窦性心律长期维持方面非常有效。
