CURRENT MANAGEMENT OF REENTRANT SUPRAVENT RICULAR TACHYCARDIA IN INFANTS

Aim. - The effectiveness and safety of antiarrhythmic agents, mostly d igoxin and amiodarone given to prevent recurrences, were compared in 1 41 infants of less than 1 year (77% < 1 month) with re-entrant suprave ntricular tachycardia. Results. - Digoxin was the drug of first choice in 114 patients at a dose of 10-20 mu g/kg/d and was effective in 74 cases (65%). Amiodarone was used as first line therapy or after failur e of digoxin. It was given at a maintenance dose of 250 mg/m(2)/d, alo ne in 22 infants and together with digoxin in another 36; it was effec tive in 56 cases (96.55). Early adverse events occurred in sir patient s receiving digoxin: venticular fibrillation requiring cardioversion i n three, two of whom had Wolff-Parkinson-White syndrome, significant s inus bradycardia in two, accidental overload in one. At further follow -up, one child treated with digoxin but having also gastroesophageal r eflux died suddenly at 3 months of age; autopsy was normal and the dig oxin blood level was 3 ng/mL. Among the 58 infants who received amioda rone, there were no proarrhythmia, a slight and transient increase in TSH in six infants and only one required a short-term treatment for hy pothyroidism. Prophylactic therapy was maintained for 6 to 12 months a nd only ten patients had recurrences in the year following withdrawal. Conclusion. - Amiodarone was found to be safer and more effective lan digoxin. No significant side-effect was demonstrated in infants recei ving a short-term treatment. Amiodarone may be proposed as first line therapy for prophylaxis of re-entrant supraventricular tachycardia in infancy, especially for those patients with reentry and Wolff-Parkinso n-White syndrome. (C) 1998 Elsevier, Paris.