Supraventricular tachyarrhythmia (SVT) is the most common cause of arrhythmias that require medical treatment in childhood, with a prevalence of 0.6/1,000 in neonates, lower than in other age groups in childhood. 
Clinical findings may vary depending on the type of tachyarrhythmia and duration of SVT in newborns. Cases with various clinical findings such as restlessness, rapid breathing, pallor, and cardiogenic shock have been reported. [2,3]
The main objective in the acute treatment of SVT is to quickly convert the rhythm to sinus and ensure the durability of this rhythm. Considering that tachyarrhythmias can regress in one third of cases by 1 year of age, single or combined antiarrhythmic treatment options are implemented in different clinics. Furthermore, ablation therapy is also used as a treatment option in refractory cases despite medical treatment or in cases where heart failure cannot be controlled. [2-4]
In this study, we evaluated neonatal patients admitted to the pediatric cardiac intensive care unit (PICU) of our cardiac center due to SVT. The aim of the study was to evaluate the demographic characteristics of the cases, type of SVT, treatments used and treatment results.
Materials and methods
This study was retrospectively performed in neonates with SVT admitted to the PICU between August 1, 2020 and August 1, 2022. Premature cases, sinus tachycardia, ventricular tachycardia and postoperative tachyarrhythmias were excluded from the study. The study was conducted in accordance with the Declaration of Helsinki after obtaining permission from the local committee.
A survey form was prepared for each patient, including gender, weight, age at diagnosis, presenting complaint, electrocardiogram (ECG) and 12-lead echocardiographic findings, 24-hour Holter ECG result, antiarrhythmics used, and presence of ablation.
Symptoms and complaints were categorized into four main groups: (a) restlessness, lack of feeding, and pallor, (b) rapid breathing or respiratory distress, (c) routine physical examination, and (d) routine fetal echocardiography.
ECG was performed in 12 leads at 25 mm/s and 10 mm/mV amplitude using a Philips Page Writer Trim II unit. Tachycardia is defined as a heart rate in the 95th percentile or higher according to age-specific default values. 12-lead ECG and 24-hour Holter recordings were evaluated for classification of arrhythmias. Similar to previous studies, the arrhythmia was diagnosed by standard electrocardiographic criteria or invasive electrophysiological studies showing a non-sinus tachycardia mechanism in each patient. [2-6]
Echocardiographic evaluation was performed as recommended by the American Society of Echocardiography guideline.  Systolic dysfunction has been seen in cases of ejection fraction less than 55% or shortening fraction <28%. Patients with systolic dysfunction and a left ventricular end-diastolic diameter Z-score >+2 were classified as having dilated cardiomyopathy.
Medical treatment was divided into three categories: (a) abortive treatments; (b) acute treatment, which includes treatments used to gain control of the heart rate or to improve the likelihood that the arrhythmia will stop; and (c) prophylactic therapies used to prevent SVT recurrence. 
Abortion therapy was defined as the use of adenosine or cardioversion at any time. Acute treatment was defined as amiodarone or esmolol if started on day 1 after diagnosis. Prophylactic therapy was defined as amiodarone, esmolol or any other beta-blocker, digoxin or flecainide if started on the first day after diagnosis or at any time.
Treatment-refractory tachyarrhythmia was defined as systolic or diastolic dysfunction and/or worsening heart failure despite treatment with two or more antiarrhythmic agents. These patients underwent an electrophysiological study and a catheter ablation procedure.
Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, Chicago, Illinois, USA) version 21.0 for Windows. Descriptive analysis (median, frequency and interquartile range (IQR)) was performed to identify the general and specific characteristics of the studied sample.
Examine the characteristics of the population
22 patients met the inclusion criteria. Of these 22 patients, 11 were men and 11 were women. The mean age was 21 days (IQR 15–27) and the mean weight was 3.6 kg (IQR 3.2–4).
The most common symptoms were restlessness (n=11), tachypnea (n=7) or tachycardia determined during routine physical examination (n=6) or fetal echocardiography (n=2). A patient with restlessness subsequently developed cardiorespiratory arrest.
Five patients had congenital heart disease (CHD). Twenty-five percent of the patients had systolic dysfunction on the initial echocardiogram. Two patients had arrhythmia-induced dilated cardiomyopathy. Patient demographics are summarized in Table 1.
Tachycardia was subclassified by ECG and Holter ECG in 15 patients with SVT. Focal atrial tachycardia (FAT) was diagnosed in six patients and is the most common form of SVT. Wolff-Parkinson-White syndrome (WPW) and atrial fibrillation, observed in four patients each, were the second most frequent form of tachycardia. Occult accessory pathway and permanent reciprocal junctional tachycardia (PJRT) observed in two patients each. Congenital junctional ectopic tachycardia was the least common form. And seen in only one patient, only one patient with an unclassified form of tachycardia had SVT with a narrow QRS and a short PR (probably atrioventricular reentry tachycardia).
One patient with WPW syndrome had associated patent ductus arteriosus. Another patient with WPW also had Ebstein anomaly. One patient with corrected transposition of the great arteries (cTGA) had SVT, while another patient with cTGA had WPW syndrome. Two patients with dilated cardiomyopathy also had SVT. While two patients with rhabdomyoma had ATF, another patient with left ventricular non-compaction also had ATF. Two patients with PJRT and one patient with congenital JET were not associated with CHD.
Medical therapy and catheter ablation
Of the 22, in 21 (95%) patients, tachycardia control with drug treatment was effective.
one. Miscarriage treatment: Adenosine was the first treatment in 18 patients. In eight patients, clinical treatment was combined with cardioversion.
b) Acute therapy: Amiodarone was the most used acute therapy (n=8), followed by esmolol infusion (n=5). Acute therapy was more frequently used in infants with CHD compared to those without CHD (5/5 patients, 100%, vs. 4/17 patients, 23%, p=0.02).
w. Prophylactic therapy was given to 19 of 22 (88%) infants. Propranolol was started as monotherapy in six patients and amiodarone in four patients.
The most common combination therapy was propranolol and amiodarone (n=7), followed by the combination of propranolol, amiodarone, and flecainide (n=3). Nearly 95% of patients (n=21) with tachycardia were treated with medical therapy, while the remainder were treated with catheter ablation due to drug therapy failure and left ventricular dysfunction. This patient was diagnosed with PJRT and was successfully converted to sinus rhythm with ablation therapy.
One patient with atrial fibrillation (LV dysfunction in the fetal period and sepsis) and one patient with WPW (coinfection with COVID-19) received ECMO support. Although the tachyarrhythmia was controlled in both patients, they died due to ECMO-related complications and secondary causes. The characteristics of patients treated with drug therapy are detailed in Table 2.
In this study, newborns admitted to the PICU due to SVT were evaluated. It was observed that neonates with SVT may present several complaints and findings may be accompanied by CHD or cardiac tumors. Most SVTs develop with an atrioventricular reentry mechanism, and several antiarrhythmic therapies can be used in mono or combined treatment. The present study is significant in that it includes results from our unit, which is a pediatric cardiac center and a high-volume pediatric hospital.
The presenting complaint in neonates with SVT varies, with the arrhythmia mechanism, duration and age at diagnosis being the main factors. [3,4] Tunca Sahin et al.  reported that in their series of 99 cases less than 1 year old, the first admission was due to palpitations and restlessness in 49%, routine physical examination in 25% and tachypnea in 12%.
In the present study, the most common reasons for hospitalization were restlessness in 50%, routine physical examination in 27% and tachypnea in 30%.
The frequency of arrhythmia in patients with CHD is higher than in the general population (7-27% vs. 0.8%). [1,9] The association between SVT and CHD in infants has been observed in several studies with rates ranging from 7 to 27%. Ebstein's anomaly and cTGA have been reported as the most frequent concomitant cardiac disease, and the need for echocardiographic examination has been demonstrated. Furthermore, several authors have suggested that findings of heart failure may be associated with a rate of 34-48%. [10,11] In this study, the incidence of SVT and CHD was 32%, and the rate of left ventricular dysfunction on echocardiography was 25%. In several reported series in neonates and infants, AVRTs make up the majority of SVTs. In Bjelosevic's series consisting of 116 cases, AVRT was reported as 70% (49% occult, 18% WPW and 3% PJRT), FAT (23%), FA (6%) and congenital JET (1%).  Likewise, in our study, the most common types of arrhythmia were AVRT (45%) and ATF (27%).
Adenosine is the first-line abortive treatment for most infants and should be the main drug used to treat SVT, with the exception of atrial fibrillation. Cardioversion should be the first treatment option in patients with atrial fibrillation. Tunca Sahin et al.  preferred adenosine in all cases of their series and stated that cardioversion was implemented in 17% of cases. In a study of 2848 babies with SVT, 48% (n=1379) of patients received abortive treatment. Adenosine was administered to 90% of them and the remaining 10% of patients had cardioversion. 
In the present study, adenosine was used in 80% of cases and cardioversion in 36% of cases. This could be due to the relatively high number of patients with atrial fibrillation and the use of cardioversion as a first option.
Acute treatment of SVT in newborns and infants can vary in practice.  This could be due to the heterogeneity of patient groups or the lack of studies identifying optimal treatment. Esmolol, amiodarone, and procainamide are the most common treatments and are used in cases of abortive treatment failure or immediately recurrent SVT. [12,13]
In this study, the most used medical treatment for the acute treatment of SVT was amiodarone. Esmolol was administered to 23% of patients. The preference for amiodarone in patients with impaired cardiac function may explain its predominant use.
In general, antiarrhythmic prophylaxis is recommended for a period of 12 months. However, there is considerable regional variation in the choice of prophylactic antiarrhythmic drug therapy. Antiarrhythmics such as sotalol, propafenone, digoxin, propranolol, amiodarone and flecainide have been administered as monotherapy or in combination. [11,14] Although propranolol or amiodarone have been the most preferred drugs as monotherapy, we prefer the combination of propranolol and amiodarone over the use of combination drugs.
Radiofrequency or cryoablation has been used as an alternative treatment in patients with cardiomyopathy associated with tachycardia or refractory to medical therapy with favorable results. [R][R] A case series of catheter ablation (two cryoablation and three RFA) of five patients with a mean age of 3.3 [+ or -] 3.9 months (12 days-9.5 months) and mean weight of 5.4 [+ or -] 2.2 kg (3.5-9 kg) was reported by Akdeniz et al.  None developed serious complications, and the acute success rate was reported to be 100%.
In our study, RFA was performed in a patient with PJRT due to the development of tachycardia-induced cardiomyopathy despite antiarrhythmic treatment and was successful.
The main limitation of this study is that it was performed in a single center and retrospectively in a limited number of patients. Another limitation is that patient follow-up data were not included in the assessment.
SVT is one of the important causes of arrhythmias in newborns, most of which are caused by the mechanism of atrioventricular reentry. Newborns with tachyarrhythmias should be investigated for concomitant CHD and cardiac rhabdomyoma. If detected, prophylaxis with combined antiarrhythmic therapy should be considered.
Ethics Committee Approval: The study was approved by the Clinical Research Ethics Committee of Basaksehir Cam and Sakura Hospital (No.: 2022.09.357, Date: 09/14/2022).
Informed consent: Written informed consent was obtained from all patients.
Peer review: Eksternt peer review.
Authors Contributions: Concept: DY.O., G.T.S.; Design: DY.O., G.T.S.; Supervision: DY.O., G.T.S.; Financing: DY.O., G.T.S.; Materials: D.Y.O., G.T.S.; Data collection or processing: D.Y.O., G.T.S.; Analysis or interpretation: D.Y.O., G.T.S.; Bibliographical research: D.Y.O., GT.S.; Writing: D.Y.O., GT.S.; Critical review: DY.O., G.T.S. Conflict of interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declare that this study did not receive financial support.
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[ID] Dilek Yavuzcan Ozturk (1), [ID] Gulhan Tunca Sahin (2)
(1) Department of Neonatology, Istanbul University of Health Sciences, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkiye
(2) Department of Pediatric Cardiology, Istanbul University of Health Sciences, Basaksehir Cam og Sakura Hospital, Istanbul, Turkey
Mailing address: Dilek Yavuzcan Ozturk, Department of Neonatology, Istanbul University of Health Sciences, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkiye
E-mail: firstname.lastname@example.org ID ORCID: 0000-0001-5270-4294
Receipt date: 10.05.2022
Accepted date: 10.19.2022
Online data: 01.26.2023
Table 1. General characteristics of patients Variable n=22 %Age/day 21 (15-27) Weight/kg 3.6 (3.2-4) Male 11 50 Symptom Restlessness 11 50 Tachypnea 7 30 Routine physical examination 6 27 Tachycardia 9 Fetal normal 9 4 4 4 4 4 5 WPW 4 18PJRT 2 9JET 1 5AF 4 18Initial echocardiogram Normal 10 44Ebstein anomaly 1 5Corrected transposition of the great arteries 1 5LV non-compact cardiomyopathy 1 5Dilated cardiomyopathy or LV dysfunction 2 9Fadomy 2 9F adomy 8 38 Mechanical ventilation 6 27 Type of arrhythmia AVRT (occult accessory pathway) 4 18WPW 4 18PJRT 2 9FAT 6 27AF 4 18JET congenital 1 5WPW: Wolff-Parkinson-White, given as median (IQR) or n, %; IQR: Interquartile range; PJRT: Permanent junctional reciprocating tachycardia; JET: Junctional ectopic tachycardia; BY: AtrialFlutter; LV: left ventricle; PDA: patent ductus arteriosus; ASD: Interatrial communication; AVRT: Atrioventricular reentry tachycardia; FAT: Focal atrial tachycardia
Table 2. Treatment options in casesTreatment n=22%a) Abortive treatmentsAdenosine 18 81Cardioversion 8 36b) Acute treatmentEsmolol 5 23Amiodarone 8 36Flecainide 3 16c) Prophylactic therapiesMonotherapyPropraniol 271Mtherapy6Propranolol271 n+Propranolol 1 5Propranolol+Amiodarone 5 23PropranoLoL+ Amiodarone+FLecainide 2 9Membrane Oxygenator extracorporeal 2 9Radiofrequency ablation 1 5
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How do you treat supraventricular tachycardia in newborns? ›
Some babies are affected by episodes that last longer so you may be given regular medication to reduce or stop the chance of prolonged periods of SVT. This is often a beta blocker medicine to keep the child's heart rate regular. Other medicines such as flecanide, digoxin and amiodarone can also be used.How serious is SVT in newborns? ›
It can cause a heart to beat at rates of 180 to 220 beats per minute in children and up to 300 beats per minute in infants. It can happen at any age and may be your child's only heart problem. SVT can start and stop quickly. It may last for minutes or continue for hours.What is the most common cause of SVT in infants? ›
Causes of SVT
There are many types of SVT, but the most common form in children occurs when there is an extra electrical connection between the top and bottom chambers of the heart, called an accessory electrical pathway.
The most common cause of CHF in infants is a ventricular septal defect that presents around 6–8 weeks of age. This is because the volume of the left to right shunt increases as the pulmonary resistance falls. Although a murmur of VSD is apparent by one week, the full blown picture of CHF occurs around 6–8 weeks.
The initial treatment for a sudden episode of SVT is vagal maneuvers, such as bearing down, coughing, or holding your breath. These actions can slow the electrical impulses in your heart and may stop the SVT.How will you manage a case of child with supraventricular tachycardia? ›
Medical treatment The purpose of using anti-arrhythmic drugs is to slow conduction, preferentially within one limb of the re-entrant circuit and therefore terminate the tachycardia. Treatment options include digoxin, beta-blockers, calcium-channel blockers and the sodium-channel blocker, flecainide.What can supraventricular tachycardia lead to? ›
Over time, untreated and frequent episodes of supraventricular tachycardia (SVT) may weaken the heart and lead to heart failure, particularly if there are other medical conditions. In extreme cases, an episode of SVT may cause unconsciousness or cardiac arrest.What are the symptoms of supraventricular tachycardia in pediatrics? ›
Children may say that "my heart is racing", "my heart is fluttering", "my heart is beeping", or " my heart is beating out of my chest". Other symptoms include dizziness or lightheadedness, chest pain, pressure in the neck, shortness of breath, and/or fainting.Are you born with SVT or does it develop? ›
SVT can be congenital, which means a child is born with it. Or it can develop later in life. Sometimes it happens because of other heart conditions. Supraventricular tachycardia usually affects infants, young kids, and teens.What is the best treatment for supraventricular tachycardia? ›
Many people with SVT have a procedure called catheter ablation. This procedure can stop the rhythm problem in most people. During this procedure, the extra electrical pathway or cells in the heart that are causing the fast heart rate can often be identified and destroyed. Ablation is considered safe.
What is the survival rate for babies born with heart failure? ›
About 75% of babies born with a critical CHD are expected to survive to one year of age. About 69% of babies born with critical CHDs are expected to survive to 18 years of age.How fast is supraventricular tachycardia? ›
If you have supraventricular tachycardia (SVT) you'll usually feel your heart racing in your chest or throat and a very fast pulse (140-180 beats per minute).What is the survival rate of fetal SVT? ›
This rhythm may be intermittent (see Figure 1) or incessant leading to fetal hydrops. Overall mortality for sustained fetal SVT is 8.9%,7,11 and higher in hydropic fetuses. First-line therapy in a non-hydropic fetus is digoxin;4,8,10,14,17,19,20 however, in hydropic fetuses, it has limited utility.When is SVT life threatening? ›
Immediate action required: Call 999 or go to A&E if: you have been diagnosed with SVT and your episode has lasted longer than 30 minutes. you have sudden shortness of breath with chest pain.Can fetal SVT resolve on its own? ›
SVT typically resolves before or after birth, either by itself or with medical therapy. Sometimes treatment is needed during the first year or so of life, and for a small number of patients, beyond their first year.Can supraventricular tachycardia go away? ›
SVT can go away on its own, with medication, or with certain actions used to slow heart rate: holding your breath, coughing, or immersing your face in cold water. SVT may last only briefly or for several hours.What is the first treatment for unstable SVT? ›
Unstable patients with SVT and a pulse are always treated with synchronized cardioversion. The appropriate voltage for cardioverting SVT is 50-100 J. This is what AHA recommends and also SVT converts quite readily with 50-100 J.What is considered an initial management priority in managing tachyarrhythmias? ›
The interventions for the initial management of both stable and unstable tachyarrhythmias are identical to the treatment for any critically-ill child. Begin with the support of the airway, breathing, and circulation and treating the underlying cause of the tachyarrhythmia.
Is Supraventricular Tachycardia dangerous? In the vast majority of cases SVT is a benign condition. This means that it will not cause sudden death, damage the heart or cause a heart attack. It will not shorten life expectancy.Which three 3 are examples of supraventricular tachycardia? ›
- Atrioventricular Node Re-Entrant Tachycardia (AVNRT)
- Atrioventricular Reciprocating Tachycardia (AVRT)
- Atrial Tachycardia.
What is the most common form of supraventricular tachycardia? ›
Atrioventricular nodal re-entrant tachycardia
AVNRT is the most common SVT in the general population and accounts for over 60% of patients undergoing invasive cardiac electrophysiology study.
Obstetricians often feel a Caesarean section is the safest mode of delivery for women in SVT, but increasing Caesarean rates have impacts on individuals and services. This case shows that with appropriate selection and management, vaginal delivery can be safe in women with SVT.Is SVT a birth defect? ›
In addition, we found what's known as supraventricular tachycardia (or SVT), a congenital heart defect in which the heart muscles are working overtime and, often, uncontrollably.Is SVT an inherited condition? ›
Some types of SVT run in families, so genes may play a role. Other types may be caused by lung problems. It can also be linked to some lifestyle habits or health problems.Can SVT be cured permanently? ›
SVT does not usually cure itself. However, sometimes the attacks occur very frequently and at other times less frequently. However, the tendency is for attacks to occur more frequently as the patient gets older.Will my baby survive heart surgery? ›
“Approximately one third of babies born with congenital heart disease will require at least one lifesaving intervention in the first few days or weeks of life,” she said. “The good news is that most babies will survive.”How many babies survive heart surgery? ›
The national average survival rate is 86%. This means children who have one of these surgeries at UVA are more likely to survive.Why are so many babies born with heart problems? ›
Some babies have heart defects because of changes in their individual genes or chromosomes. CHDs also are thought to be caused by a combination of genes and other factors, such as things in the environment, the mother's diet, the mother's health conditions, or the mother's medication use during pregnancy.Is supraventricular tachycardia painful? ›
SVT (supraventricular tachycardia) is a common kind of arrhythmia when your heartbeat is too fast. You may or may not have symptoms like chest pain or dizziness. There are some things you can do on your own, but you may need medicine or surgery to help with symptoms.What drugs are given for neonatal SVT? ›
Digoxin is an old and effective antiarrhythmic drug. In some centers, it is the preferred drug for infants with SVT [6, 12, 16].
How common is SVT in newborns? ›
Supraventricular tachycardia (SVT) is the most common arrhythmia (abnormal heart rhythm) diagnosed in children. It is said to occur in up to 1 in 2500 children. While the problem is often congenital, meaning it is present at birth, the onset and severity of symptoms varies.Which medication is the first choice for supraventricular tachycardia in a child? ›
Adenosine is the drug of first choice in any age group for tachycardias involving the atrioventricular node; its advantages include short half-life and minimal or absent negative inotropic effects. Adenosine may also be used in patients with wide QRS complex tachycardia.What is the drug treatment of fetal tachycardia? ›
Conclusions— Orally administered amiodarone is safe and effective treatment for drug-refractory fetal tachycardia, specifically reentrant supraventricular tachycardia, junctional ectopic, or ventricular tachycardia, even when accompanied by hydrops fetalis or ventricular dysfunction.What are risk factors of SVT in infants? ›
Narrowed heart arteries, heart failure, damage to the heart or heart valves, cardiomyopathy, and other heart disease may increase the risk of developing SVT . Congenital heart disease. A heart problem present at birth (congenital heart defect) may cause irregular heartbeats such as SVT .What causes SVT in newborns? ›
Causes of SVT in children and infants
In most children, an electrical short-circuiting causes SVT and is due to a small birth defect. This abnormal tissue is too small to be seen by X-ray or a heart ultrasound (echocardiogram).
SVT can go away on its own, with medication, or with certain actions used to slow heart rate: holding your breath, coughing, or immersing your face in cold water.