Effective Control of Supraventricular Tachycardia in Neonates May Requires Combination Pharmacologic Therapy

Introduction: Supraventricular tachycardia (SVT) is one of the arrhythmias that can occur in newborns. Most SVT incidents in the neonatal period are spontaneously resolved around the first year of life, but since tachycardia can frequently occur before complete resolution, appropriate medication use is required. However, no clear guidelines or consensus on the treatment of neonatal SVT have been established yet. Methods: From January 2011 to December 2021, demographic data and antiarrhythmic medications used were retrospectively analyzed for 18 newborns diagnosed with SVT at a single center. Results: A total of four medications (propranolol, amiodarone, flecainide, and atenolol) were used as maintenance therapy to prevent tachycardia recurrence, and propranolol was the most used, followed by amiodarone. Thirty-nine percent of the patients were controlled with monotherapy, but the remainder required two or more medications. The median period from medication initiation after diagnosis to the last tachycardia event was 15.5 days, and the median total duration of medication use was 362 days. None of the patients experienced any side effects of antiarrhythmic medications. The total duration of medication use was statistically significant according to the mechanism of SVT, and the usage time of the increased automaticity group was shorter than that of the re-entry group. Conclusion: Since most neonatal SVT resolves within 1 year, it is significant to provide prophylactic medication to prevent tachycardia recurrence at least until 1 year of age, and depending on the patient, the appropriate combination of medications should be identified.

Automated summary

This study retrospectively analyzed the clinical data of 18 newborns with SVT. It found that medication is required to prevent tachycardia recurrence in the treatment of SVT in neonates. The commonly used medications include propranolol, amiodarone, flecainide, and atenolol, with propranolol being the most frequently used. Some patients required the use of two or more medications. The duration of medication use was related to the mechanism of SVT, with the increased automaticity group requiring shorter usage time.