Table 3.

Acute interventions to control supraventricular tachycardia in neonates.

Treatment	Dosing	Comments
DC shock	ORT or AVNRT 0.25 J/kg A.flutter 0.5 J/kg A.fib 1–2 J/kg All of above double for each subsequent attempt	•Effective for reentrant tachycardias, some triggered arrhythmias •Ineffective for automatic tachycardias
Adenosine	0.1–0.3 mg/kg rapid IV bolus. Preferably administered via a venous access close to heart	•Response to Adenosine may be useful for diagnosis. •For terminating AV nodal dependent reentrant arrhythmias and some triggered arrhythmias
Amiodarone	Loading 5 mg/kg over 20–60 min (infusion rate not exceeding 0.25 mg/kg/min); may repeat twice up to maximum total dose of 15 mg/kg during. Followed by initial: 10 mg/kg/day, increase incrementally as clinically needed range: 10–20 mg/kg/day. There is variability in the preferred administration rates and acute loading dosage of Amiodarone based on institutional preference.	Follow QTc interval on serial ECG. Baseline labs including complete blood count, thyroid function tests and liver enzymes is recommended when considering Amiodarone.
Esmolol	0.5 mg/kg rapid IV bolus followed by 50–200 mcg/kg/min	Watch for exacerbation of bronchospasm in patients with asthma
Procainamide	7–15 mg/kg IV over 15–30 min followed by 20–60 mcg/kg/min	Particularly useful in SVT involving AV bypass tracts and stable wide complex tachycardia. Dosing adjustment and serum drug concentrations recommended in hepatic/renal impairment. Drug levels also required in those receiving higher maintenance doses for >24 h.
Transesophageal Overdrive Pacing	A 4- to 7-French bi- to quadripolar intracardiac/5- to 10-French esophageal electrode catheter is introduced through the mouth/nose to the estimated depth (distance from the tip of the nose to about 2–5 cm above the xiphoid) in the esophagus. At that point, a transoesophageal stimulator is attached. After determination of the tachycardia cycle length, pacing is established at a cycle length at least 20–30 ms shorter than the spontaneous tachycardia cycle length.	A standard temporary external pacemaker might not provide sufficient impulse duration (10–15 ms) to capture the atrium with the lowest possible, yet effective amplitude tolerated by the patient.

A.fib, atrial fibrillation; A.flutter, atrial flutter; ORT, orthodromic atrioventricular reentrant tachycardia; AV, atrioventricular; AVNRT, Atrioventricular nodal reentrant tachycardia; IART, intra-atrial reentrant tachycardia; IV, intravenous; WPW, Wolff-Parkinson-White syndrome.