Abstract 12297: Comparative Effectiveness of Digoxin and Beta Blockers for Supraventricular Tachycardia in Infants
Background: Supraventricular tachycardia (SVT) is the most common arrhythmia in infants. Prior trials have been underpowered and there is no consensus regarding pharmacotherapy. We sought to evaluate comparative effectiveness of beta blockers vs digoxin in a large cohort of neonates.
Methods: Infants discharged from Pediatrix Medical Group neonatal intensive care units (1998-2011) with SVT and treated with beta-blockers or digoxin were included. Infants with WPW, structural heart defects (other than ASD, VSD or PDA), those started on multi-drug therapy at presentation and those with ventricular tachycardia were excluded. Multivariable logistic regression with GEE methodology was used to evaluate the association between pharmacotherapy and treatment failure defined as the administration of adenosine or cardioversion after the first day of pharmacotherapy. Covariates included in the model were gestational age, birth weight, small for gestational age status, discharge year, age at initiation of therapy, diagnosis of atrial flutter, inotrope and ventilator use, and presence of a central venous line.
Results: We identified 1814 infants from 221 centers. Initial antiarrhythmic was digoxin in 1259 (69%), and beta-blocker in 555 (31%).Digoxin use decreased over time (84% in 1998-2004 vs. 64% in 2005-2011, p≤0.001). At initiation of pharmacotherapy, infants treated with digoxin were more likely to receive mechanical ventilation, supplemental oxygen, inotropic support, and have a central line compared to infants treated with beta blockers (P≤0.001 for all). Treatment failure occurred in 110 infants (6%). Adjusted odds of treatment failure were higher on beta-blockers compared to digoxin (Table). Results were similar for late treatment failure (>48 hours after therapy).
Conclusions: While digoxin is more often used in sicker infants, it is associated with less treatment failure. Further investigation is needed to identify optimal infant therapy for SVT.
- © 2013 by American Heart Association, Inc.