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Supraventricular tachycardia An approach to therapy in newborn infants

CASE R E P O R T S Case I. Patient M. C., a 7-day-old, was admitted to the Milton S. Hershey Medical Center with a two-day history of worsening tachypnea. The infant was in severe respiratory distress with peripheral cyanosis and evidence of congestive failure. After the diagnosis of supraventricular tachycardia was confirmed, he underwent two brief immersions of his head in a basin of ice and water with no effect; however, a third immersion for approximately 6 seconds resulted in immediate conversion of the arrhythmia (Fig. 1). Digitalis therapy was initiated; he has remained free of recurrences or symptoms. Case 2. Patient J. W., a 10-day-old, developed episodic tachyarrhythmia within the first few days of life and was referred to the Milton S. Hershey Medical Center. On admission no cardiovascular abnormalities were noted. Shortly after admission the infant developed supraventricnlar tachycardia and evidence of congestive heart failure. Conversion to sinus rhythm occurred shortly after parenteral digitalization was begun. Despite full digitalization (blood level 3.3 nglml), the patient had recurrent episodes. These were converted by immersion of the head in ice water for 4 to 5 seconds (Fig. 2). Subsequently, the arrhythmia was controlled after propranolol therapy was added.