Study finds large variation in treatment of SVT in infants

May 12, 2015 – Christoph Hornik, MD, MPH, was senior author of the study, which is the largest to date evaluating current practices and outcomes of SVT in infants.

Researchers at the DCRI have found significant variation in prescribing habits for both acute management and secondary prevention therapies of supraventricular tachycardia (SVT) in infants.

The study, conducted by the DCRI’s Patricia Y. Chu, Kevin D. Hill, P. Brian Smith, Christoph P. Hornik (pictured), and the Pediatrix-Obstetrix Center for Research and Education’s Reese H. Clark, appears in the online edition of the journal Early Human Development.

christopher-hornikSVT, an abnormally fast beating of the heart that involves the organ’s upper atria, is the most common type of arrhythmia in infants. It arises from irregular electrical activity within the heart. Although not usually fatal by itself, SVT can exacerbate other, potentially lethal, conditions such as congenital heart disease.

There are a number of possible treatments for the condition, including abortive therapies, acute management therapies to achieve rate control or increase the likelihood of halting the arrhythmia, and secondary prevention therapies used to prevent SVT recurrence. However, few of these treatments are supported by scientific evidence, and to date, there are no U.S. Food and Drug Administration-labeled SVT drugs for use in infant populations.

To obtain a clearer picture of infant SVT treatment patterns in the United States, the researchers conducted a retrospective cohort study using patient data from 348 neonatal intensive care units managed by the Pediatrix Medical Group between 1998 and 2012. The study is the largest to date evaluating current practices and outcomes of SVT in infants.

Of the 887,910 infants included in the database, 2,848 (0.3 percent) received treatment for SVT. Of these infants, approximately half (1,379, 48 percent) received abortive therapy, 179 (6 percent) received management therapy, and 2,523 (89 percent) received prevention therapy. Adenosine was the most commonly used abortive therapy, but the researchers found wide variation in management and prevention therapies. Amiodarone, esmolol, and procainamide were some of the most frequently used drugs for management therapy. Prevention therapies have changed over time, with beta-blockers slowly replacing digoxin as the most commonly used prevention therapy. Fifty-eight (2 percent) of the infants with SVT died, and 508 (18percent) experienced some type of adverse event.

The researchers suggested that the significant variation in treatment strategies reflects the lack of evidence in infant SVT management. More clinical trials are needed to determine best practices in treating SVT in infants, they concluded.