REENTRANT SUPRAVENTRICULAR TACHYCARDIA IN INFANCY - CURRENT ROLE OF PROPHYLACTIC DIGOXIN TREATMENT

Re-entrant supraventricular tachycardia is the most common cardiac arr hythmia in infancy. Pharmacological prevention of recurrencies is a st andard recommendation for infants less than 1 year of age. In view of the often benign spontaneous clinical course of the disease, the risk- benefit analysis of any antiarrhythmic agent given is important. It wa s the aim of this retrospective study, to assess the value of oral lon g-term digoxin given to paediatric patients with supraventricular tach ycardia with onset in the first 4 months of life. Twenty-six newborns and infants fulfilled the inclusion criteria. Median age at first pres entation of the patients was 7 days. Eight patients (31%) had structur al heart disease, 9 patients had a pre-excitation syndrome, anti the o ther 17 children had a concealed accessory atrioventricular pathway. L ong-term prophylaxis with oral digoxin was considered successful in 17 children (65%). In 2 patients therapy with digoxin was considered par tially effective and in 7 patients (27%) failure of digoxin to improve symptoms led to the introduction of other anti-arrhythmic agents. Ser um digoxin levels were no different in the patients with successful th erapy as compared to those with treatment failure. No side-effects due to digoxin were noted in all the patients treated. After a mean follo wup of 54 months (12-130 months), 19 children (73%) were free of recur rencies and on no medication, 5 children were free of recurrencies but had anti-arrhythmic therapy. Only 2 patients, both on anti-arrhythmic therapy, were still suffering from tachycardia. Conclusion. Digoxin r emains an effective treatment option in infants with supraventricular tachycardia and it helped to avoid the long-term use of other antiarrh ythmic drugs with potentially more serious side-effects (pro-arrhythmi a) in a considerable proportion of infants treated.