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Erschienen in: Pediatric Cardiology 5/2016

31.03.2016 | Original Article

Variation in Antiarrhythmic Management of Infants Hospitalized with Supraventricular Tachycardia: A Multi-Institutional Analysis

verfasst von: Karine Guerrier, Pirouz Shamszad, Richard J. Czosek, David S. Spar, Timothy K. Knilans, Jeffrey B. Anderson

Erschienen in: Pediatric Cardiology | Ausgabe 5/2016

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Abstract

Supraventricular tachycardia (SVT) is the most frequent form of symptomatic tachyarrhythmia in infants. The purposes of this study were to describe practice patterns of the management of infants hospitalized with SVT and factors associated with 30-day hospital readmission. This was a multi-institutional, retrospective review of the pediatric health information system database of SVT hospitalizations from 2003 to 2013. High-volume centers (HVC) were defined as those at the upper quartile of admissions. Infants with an ICD-9 code of paroxysmal SVT were included. Antiarrhythmics investigated included amiodarone, atenolol, digoxin, esmolol, flecainide, procainamide, propafenone, propranolol, and sotalol. Frequency of antiarrhythmic use based on center volume was the primary end point. Rate of 30-day SVT readmission was the secondary end point. Analysis of factors associated with readmission was assessed by Chi-square analysis and expressed as odds ratio and 95 % confidence interval. A total of 851 patients (60 % male, 44 % neonates) were hospitalized at 43 hospitals. Propranolol, digoxin, and amiodarone were the most frequently utilized antiarrhythmics. HVCs represented 12 hospitals comprising 494 (58 %) patients. Although HVCs were more likely to utilize propranolol (OR 2.5, CI 1.5–4.1), there was no significant difference in the 30-day readmission rate between patients treated at HVCs versus non-HVCs (p = 0.9). The majority of infants with SVT are treated with a small number of antiarrhythmic medications during index hospitalization. Although hospital-to-hospital variation in antiarrhythmic choice exists, there appears to be no difference in readmission. The remaining practice variation may be related to intrinsic patient characteristics.
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Literatur
1.
Zurück zum Zitat Brown DW, Connor JA, Pigula FA, Usmani K, Klitzner TS, Beekman RH 3rd, Kugler JD, Martin GR, Neish SR, Rosenthal GL, Lannon C, Jenkins KJ, Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement C (2011) Variation in preoperative and intraoperative care for first-stage palliation of single-ventricle heart disease: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 6:108–115CrossRefPubMed Brown DW, Connor JA, Pigula FA, Usmani K, Klitzner TS, Beekman RH 3rd, Kugler JD, Martin GR, Neish SR, Rosenthal GL, Lannon C, Jenkins KJ, Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement C (2011) Variation in preoperative and intraoperative care for first-stage palliation of single-ventricle heart disease: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 6:108–115CrossRefPubMed
2.
Zurück zum Zitat Pasquali SK, Jacobs JP, He X, Hornik CP, Jaquiss RD, Jacobs ML, O’Brien SM, Peterson ED, Li JS (2012) The complex relationship between center volume and outcome in patients undergoing the Norwood operation. Ann Thorac Surg 93:1556–1562CrossRefPubMed Pasquali SK, Jacobs JP, He X, Hornik CP, Jaquiss RD, Jacobs ML, O’Brien SM, Peterson ED, Li JS (2012) The complex relationship between center volume and outcome in patients undergoing the Norwood operation. Ann Thorac Surg 93:1556–1562CrossRefPubMed
3.
Zurück zum Zitat Pasquali SK, Jacobs ML, He X, Shah SS, Peterson ED, Hall M, Gaynor JW, Hill KD, Mayer JE, Jacobs JP, Li JS (2014) Variation in congenital heart surgery costs across hospitals. Pediatrics 133:e553–e560CrossRefPubMedPubMedCentral Pasquali SK, Jacobs ML, He X, Shah SS, Peterson ED, Hall M, Gaynor JW, Hill KD, Mayer JE, Jacobs JP, Li JS (2014) Variation in congenital heart surgery costs across hospitals. Pediatrics 133:e553–e560CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Pasquali SK, Sun JL, d’Almada P, Jaquiss RD, Lodge AJ, Miller N, Kemper AR, Lannon CM, Li JS (2011) Center variation in hospital costs for patients undergoing congenital heart surgery. Circ Cardiovasc Qual Outcomes 4:306–312CrossRefPubMedPubMedCentral Pasquali SK, Sun JL, d’Almada P, Jaquiss RD, Lodge AJ, Miller N, Kemper AR, Lannon CM, Li JS (2011) Center variation in hospital costs for patients undergoing congenital heart surgery. Circ Cardiovasc Qual Outcomes 4:306–312CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Schidlow DN, Anderson JB, Klitzner TS, Beekman RH 3rd, Jenkins KJ, Kugler JD, Martin GR, Neish SR, Rosenthal GL, Lannon C, Collaborative JNPCQI (2011) Variation in interstage outpatient care after the Norwood procedure: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 6:98–107CrossRefPubMed Schidlow DN, Anderson JB, Klitzner TS, Beekman RH 3rd, Jenkins KJ, Kugler JD, Martin GR, Neish SR, Rosenthal GL, Lannon C, Collaborative JNPCQI (2011) Variation in interstage outpatient care after the Norwood procedure: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 6:98–107CrossRefPubMed
6.
Zurück zum Zitat Simsic JM, Harrison S, Evans L, McClead R, Teske D, Institute of Healthcare I (2014) Reducing variation in the use of inhaled nitric oxide. Pediatrics 133:e1753–e1758CrossRefPubMed Simsic JM, Harrison S, Evans L, McClead R, Teske D, Institute of Healthcare I (2014) Reducing variation in the use of inhaled nitric oxide. Pediatrics 133:e1753–e1758CrossRefPubMed
7.
Zurück zum Zitat Chang PM, Silka MJ, Moromisato DY, Bar-Cohen Y (2010) Amiodarone versus procainamide for the acute treatment of recurrent supraventricular tachycardia in pediatric patients. Circ Arrhythm Electrophysiol 3:134–140CrossRefPubMed Chang PM, Silka MJ, Moromisato DY, Bar-Cohen Y (2010) Amiodarone versus procainamide for the acute treatment of recurrent supraventricular tachycardia in pediatric patients. Circ Arrhythm Electrophysiol 3:134–140CrossRefPubMed
8.
Zurück zum Zitat Shah A, Moon-Grady A, Bhogal N, Collins KK, Tacy T, Brook M, Hornberger LK (2012) Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias. Am J Cardiol 109:1614–1618CrossRefPubMed Shah A, Moon-Grady A, Bhogal N, Collins KK, Tacy T, Brook M, Hornberger LK (2012) Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias. Am J Cardiol 109:1614–1618CrossRefPubMed
9.
Zurück zum Zitat Knudson JD, Cannon BC, Kim JJ, Moffett BS (2011) High-dose sotalol is safe and effective in neonates and infants with refractory supraventricular tachyarrhythmias. Pediatr Cardiol 32:896–903CrossRefPubMed Knudson JD, Cannon BC, Kim JJ, Moffett BS (2011) High-dose sotalol is safe and effective in neonates and infants with refractory supraventricular tachyarrhythmias. Pediatr Cardiol 32:896–903CrossRefPubMed
10.
Zurück zum Zitat Wong KK, Potts JE, Etheridge SP, Sanatani S (2006) Medications used to manage supraventricular tachycardia in the infant a North American survey. Pediatr Cardiol 27:199–203CrossRefPubMed Wong KK, Potts JE, Etheridge SP, Sanatani S (2006) Medications used to manage supraventricular tachycardia in the infant a North American survey. Pediatr Cardiol 27:199–203CrossRefPubMed
11.
Zurück zum Zitat Gupta P, Tang X, Gossett JM, Gall CM, Lauer C, Rice TB, Wetzel RC (2015) Variation of ventilation practices with center volume after pediatric heart surgery. Clin Cardiol 38(3):178–184CrossRefPubMed Gupta P, Tang X, Gossett JM, Gall CM, Lauer C, Rice TB, Wetzel RC (2015) Variation of ventilation practices with center volume after pediatric heart surgery. Clin Cardiol 38(3):178–184CrossRefPubMed
12.
Zurück zum Zitat Husain SA, Pasquali SK, Jacobs JP, Hill KD, Kim S, Kane LC, Calhoon JH, Jacobs ML (2014) Congenital heart operations performed in the first year of life: does geographic variation exist? Ann Thorac Surg 98:912–918CrossRefPubMedPubMedCentral Husain SA, Pasquali SK, Jacobs JP, Hill KD, Kim S, Kane LC, Calhoon JH, Jacobs ML (2014) Congenital heart operations performed in the first year of life: does geographic variation exist? Ann Thorac Surg 98:912–918CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Seslar SP, Garrison MM, Larison C, Salerno JC (2013) A multi-institutional analysis of inpatient treatment for supraventricular tachycardia in newborns and infants. Pediatr Cardiol 34:408–414CrossRefPubMed Seslar SP, Garrison MM, Larison C, Salerno JC (2013) A multi-institutional analysis of inpatient treatment for supraventricular tachycardia in newborns and infants. Pediatr Cardiol 34:408–414CrossRefPubMed
14.
Zurück zum Zitat Hornik CP, Chu PY, Li JS, Clark RH, Smith PB, Hill KD (2014) Comparative effectiveness of digoxin and propranolol for supraventricular tachycardia in infants. Pediatr Crit Care Med 15(9):839–845CrossRefPubMedPubMedCentral Hornik CP, Chu PY, Li JS, Clark RH, Smith PB, Hill KD (2014) Comparative effectiveness of digoxin and propranolol for supraventricular tachycardia in infants. Pediatr Crit Care Med 15(9):839–845CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Kang KT, Etheridge SP, Kantoch MJ, Tisma-Dupanovic S, Bradley DJ, Balaji S, Hamilton RM, Singh AK, Cannon BC, Schaffer MS, Potts JE, Sanatani S (2014) Current management of focal atrial tachycardia in children: a multi-center experience. Circ Arrhythm Electrophysiol 7(4):664–670CrossRefPubMed Kang KT, Etheridge SP, Kantoch MJ, Tisma-Dupanovic S, Bradley DJ, Balaji S, Hamilton RM, Singh AK, Cannon BC, Schaffer MS, Potts JE, Sanatani S (2014) Current management of focal atrial tachycardia in children: a multi-center experience. Circ Arrhythm Electrophysiol 7(4):664–670CrossRefPubMed
16.
Zurück zum Zitat Sanatani S, Potts JE, Reed JH, Saul JP, Stephenson EA, Gibbs KA, Anderson CC, Mackie AS, Ro PS, Tisma-Dupanovic S, Kanter RJ, Batra AS, Fournier A, Blaufox AD, Singh HR, Ross BA, Wong KK, Bar-Cohen Y, McCrindle BW, Etheridge SP (2012) The study of antiarrhythmic medications in infancy (SAMIS): a multicenter, randomized controlled trial comparing the efficacy and safety of digoxin versus propranolol for prophylaxis of supraventricular tachycardia in infants. Circ Arrhythm Electrophysiol 5:984–991CrossRefPubMed Sanatani S, Potts JE, Reed JH, Saul JP, Stephenson EA, Gibbs KA, Anderson CC, Mackie AS, Ro PS, Tisma-Dupanovic S, Kanter RJ, Batra AS, Fournier A, Blaufox AD, Singh HR, Ross BA, Wong KK, Bar-Cohen Y, McCrindle BW, Etheridge SP (2012) The study of antiarrhythmic medications in infancy (SAMIS): a multicenter, randomized controlled trial comparing the efficacy and safety of digoxin versus propranolol for prophylaxis of supraventricular tachycardia in infants. Circ Arrhythm Electrophysiol 5:984–991CrossRefPubMed
17.
Zurück zum Zitat Blaufox AD, Warsy I, D’Souza M, Kanter R (2011) Transesophageal electrophysiological evaluation of children with a history of supraventricular tachycardia in infancy. Pediatr Cardiol 32:1110–1114CrossRefPubMed Blaufox AD, Warsy I, D’Souza M, Kanter R (2011) Transesophageal electrophysiological evaluation of children with a history of supraventricular tachycardia in infancy. Pediatr Cardiol 32:1110–1114CrossRefPubMed
Metadaten
Titel
Variation in Antiarrhythmic Management of Infants Hospitalized with Supraventricular Tachycardia: A Multi-Institutional Analysis
verfasst von
Karine Guerrier
Pirouz Shamszad
Richard J. Czosek
David S. Spar
Timothy K. Knilans
Jeffrey B. Anderson
Publikationsdatum
31.03.2016
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 5/2016
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-016-1375-x

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