The records of 90 patients with Wolff-Parkinson-White syndrome who presented with supraventricular tachycardia in the first 4 months of life were reviewed. Among these, 63% were male. Structural heart disease was present in 20%, most commonly Ebstein's anomaly. All patients presented with a regular narrow QRS tachycardia, and pre-excitation became evident only when normal sinus rhythm was established. Only one infant had atrial flutter and none had atrial fibrillation. Type A Wolff-Parkinson-White syndrome was most common (49%), with heart disease occurring in only 5% of these patients. In contrast, heart disease was identified in 45% of those with type B syndrome. Initially, normal sinus rhythm was achieved in 88% of the 66 infants treated with digoxin with no deaths. Normal sinus rhythm resumed after electrical countershock in 87% of the 15 infants so treated. Maintenance digoxin therapy was used in 85 patients. The Wolff-Parkinson-White pattern disappeared in 36% of the patients. Four infants died of cardiac causes during the mean follow-up period of 6.5 years. Two of these four infants had congenital heart disease; the third, with a normal heart initially, developed ventricular fibrillation and died from a cardiomyopathy considered related to resuscitation. The remaining infant, with a normal heart, died suddenly at 1 month of age. All were receiving digoxin. A wide QRS tachycardia later appeared in three patients, all with heart disease, one of whom died. In the initial treatment of narrow regular QRS supraventricular tachycardia in this group of patients, digoxin was a safe and effective (88%) drug for restoration of normal sinus rhythm, with electrical cardioversion being equally effective (87%) in those critically ill. After age 1 year, 33% of the infants experienced recurrent tachycardias; these were more frequent in patients with type B Wolff-Parkinson-White syndrome (p < 0.05) and in those requiring more than one drug to maintain normal sinus rhythm during the initial hospitalization (p < 0.001).
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine