Flecainide and sotalol: a new combination therapy for refractory supraventricular tachycardia in children <1 year of age

Objectives The goal of this study was to assess the efficacy and safety of the combination therapy of flecainide and sotalol for the treatment of refractory supraventricular tachycardia (SVT) in children <1 year of age. Background Supraventricular tachycardia in infants can be refractory to single-drug as well as standard combination medical therapy. Radiofrequency ablation (RFA) is the definitive treatment of refractory SVT; however, interventional therapy poses a high risk of morbidity and mortality in this age group. Methods A retrospective review was performed identifying infants who required flecainide and sotalol to control refractory SVT. Patient age, previous drug therapy, duration of treatment, flecainide levels and corrected QT intervals were recorded; 24 h Holter monitoring was utilized to gauge efficacy of treatment. Efficacy was defined as suppression of SVT to no more than rare nonsustained episodes or slowing of SVT to a clinically tolerable rate. Results Ten patients (median age: 29 days, range: 1 to 241 days) failed at least two antiarrhythmic agents including either flecainide or sotalol as single agents before initiating combination therapy. Efficacy was achieved in all patients. The failure rate for therapy was reduced from 100% to 0% (95% confidence interval: 0% to 26%). The median doses used were: flecainide 100 mg/m2/day (range: 40 to 150 mg/m2/day) and sotalol 175 mg/m2/day (range: 100 to 250 mg/m2/day). Median duration of therapy was 16 months (range: 5 to 35 months). No proarrhythmia occurred. Conclusions The combination of flecainide and sotalol can safely and effectively control refractory SVT and may obviate the need for RFA in children <1 year.