Supraventricular Tachycardia Treatment Efficacy in Infants
On Further Review
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In this issue of Circulation: Arrhythmia and Electrophysiology, Sanatani et al1 report a randomized, double-blind study of a comparison of digoxin and propranolol for chronic therapy of supraventricular tachycardia (SVT) in infants <4 months of age. The key findings in 61 patients were that there were no differences in SVT recurrence for the 2 drug treatment groups and that there were no recurrences of SVT after 4 months of therapy with either antiarrhythmic agent. Another salient point to be taken includes an expectation that perhaps 10% of infants diagnosed with SVT can be expected to require subsequent hospitalization for management of SVT recurrences.
Article see p 984
As is often the case with even thoughtful attempts to perform these types of clinical trials in pediatric electrophysiology, and pediatric cardiology generally, the study is underpowered to make feasible many of the desired statistical analyses between the 2 treatment groups. As a result of the relatively small numbers of patients in a given institution, multicenter studies in our field are frequently required to achieve the requisite N for these study designs. As the authors note, issues of patient enrollment, physician biases, parental consent, and inadequate follow-up plague this and other similar efforts. The history of this specific article is telling, in its attempts to clear the hurdle of peer …