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A comparison of oral flecainide and amiodarone for the treatment of recurrent supraventricular tachycardia in children
Author(s) -
Hill Allison C.,
Silka Michael J.,
BarCohen Yaniv
Publication year - 2019
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13662
Subject(s) - flecainide , medicine , amiodarone , supraventricular tachycardia , tachycardia , cardiology , digoxin , anesthesia , antiarrhythmic agent , heart disease , heart failure , atrial fibrillation
Background Supraventricular tachycardia (SVT) in children can be difficult to treat when first‐line therapies (beta‐blockade or digoxin) are not effective. Both flecainide and amiodarone are used as second‐line therapies. We sought to compare the efficacy and safety of flecainide and amiodarone in pediatric patients with recurrent SVT. Methods Pediatric patients treated with oral flecainide or oral amiodarone for SVT between 2006 and 2015 were studied. Tachycardia mechanisms included orthodromic reciprocating tachycardia (ORT), intra‐atrial reentrant tachycardia (IART), and ectopic atrial tachycardia (EAT). Outcomes were classified as full success, partial success (requiring additional intervention), or failure. Results Seventy‐four patients were included (median age 46 days, range 1 day to 19 years). Flecainide was used in 47 patients and amiodarone in 27 patients. Full success was achieved in 68% and 59%, respectively ( P = 0.28). Partial success was achieved in 13% and 19%, respectively ( P = 0.12). Treatment failed in 19% and 22%, respectively ( P = 0.97). Ten crossover patients received the second medication after the first failed. Of five amiodarone‐to‐flecainide crossovers, four achieved success on flecainide alone. Of five flecainide‐to‐amiodarone crossovers, two achieved success. Minor adverse events occurred in 9% of flecainide and 22% of amiodarone patients ( P = 0.16). No significant differences were seen by arrhythmia subtype (36 EAT, 28 ORT, 10 IART), congenital heart disease ( n = 38), or age group (56 infants). Conclusions Oral flecainide and amiodarone achieved meaningful arrhythmia control in 81% and 78% of pediatric patients with recurrent SVT, respectively. Those who failed amiodarone had encouraging outcomes when changed to flecainide.