Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, 1 Children's Pl, 8th Floor NWT, St. Louis, MO, 63108, USA.
Michigan Medicine Congenital Heart Center, University of Michigan, Ann Arbor, MI, USA.
Pediatr Cardiol. 2024 Dec;45(8):1724-1728. doi: 10.1007/s00246-023-03263-1. Epub 2023 Aug 10.
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.
大多数表现为室上性心动过速 (SVT) 的婴儿接受抗心律失常药物治疗，主要是为了预防未被识别的未来发作，这些发作可能导致心动过速性心肌病。我们机构的常见做法是，在婴儿 SVT 首次发作后不进行治疗，而是对父母进行心率监测和就诊原因的教育。本研究的目的是评估首次发作婴儿 SVT 的非药物治疗结果，并与接受抗心律失常药物治疗的婴儿进行比较。这是一项回顾性单中心研究，纳入了 2014 年至 2021 年期间首次出现 SVT 的所有婴儿。排除非折返性心动过速、心房扑动、长 RP 心动过速、先天性心脏病或异常心室功能的患者。共有 64 名婴儿纳入研究。36 名婴儿未接受抗心律失常药物治疗。未治疗组 SVT 复发率为 28%，而接受抗心律失常药物治疗组为 50%，p=0.12。住院患者中，未治疗组的住院时间更短，为 1（IQR 1-1）天 vs 3（IQR 2-4）天，p<0.01。未治疗组因 SVT 复发再次就诊的可能性较小，为 6% vs 32%，p<0.01。两组均未发生心动过速性心肌病。对于结构和功能正常的心脏婴儿，首次 SVT 发作后不进行治疗并结合父母教育不会导致不良结局。这种方法避免了婴儿药物治疗的负担，并且可能具有使父母感到舒适地在家中管理临床意义不显著心动过速的额外益处。
