Clinical Predictors of Recurrent Supraventricular Tachycardia in Infancy

BACKGROUND Data regarding recurrence risk among infants with supraventricular tachycardia (SVT) are limited.OBJECTIVES The purpose of this study was to determine incidence and factors associated with SVT recurrence.METHODS This was a retrospective single-center study (1984-2020) with prospective phone follow-up of infants with structurally normal hearts diagnosed at age <= 1 year with re-entrant SVT. Primary outcome was first SVT recurrence after hospital discharge. Classification and regression tree analysis was performed to determine a risk algorithm.RESULTS Among 460 infants (62% male), 87% were diagnosed at <= 60 days of age (median 13 days; IQR: 1-31 days). During a median follow-up of 5.2 years (IQR: 1.8-11.2 years), 33% had recurrence. On multivariable analysis, factors associated with recurrence included: fetal or late (>60 days) diagnosis (HR: 1.90; 95% CI: 1.26-2.86; and HR: 1.73; 95% CI: 1.07-2.77, respectively), Wolff-Parkinson-White (WPW) syndrome (HR: 2.46; 95% CI: 1.75-3.45), and need for multi-antiarrhythmic or second-line therapy (HR: 2.08; 95% CI: 1.45-2.99). Based on the classification and regression tree analysis, WPW incurred the highest risk. Among those without WPW, age at diagnosis was the most important factor predicting risk. Fetal or late diagnosis incurred higher risk, and if multi-antiarrhythmic or second-line therapy was also required, risk nearly doubled. Infants without WPW, who were diagnosed early (0-60 days), and who were discharged on propranolol were at lowest recurrence risk. CONCLUSIONS Infants with SVT are most likely to be diagnosed at <= 60 days and be male. Risk factors for recurrence (occurred in 33%), present at time of diagnosis, include WPW, fetal or late diagnosis, and multi-antiarrhythmic or second -line therapy. Infants with early diagnosis, without WPW, and discharged on first-line monotherapy are at lowest recurrence risk. (J Am Coll Cardiol 2022;80:1159-1172) (c) 2022 by the American College of Cardiology Foundation.

Automated summary

Data on recurrence risk among infants with SVT are limited. This study found that factors associated with recurrence included fetal or late diagnosis, WPW syndrome, and the need for multi-antiarrhythmic or second-line therapy. Infants with early diagnosis, without WPW, and discharged on first-line monotherapy had the lowest recurrence risk.