Supraventricular Tachycardia in a Neonate Repeatedly Induced by Ectopic Ventricular Couplet During Breast-feeding

Excerpt

To the Editor: A male infant weighing 3495 g was born at term by emergency section after fetal tachycardia (250 bpm) was noted. Initially well, on day 2 he had an episode of supraventricular tachycardia (SVT; 270 bpm), and was treated with adenosine. On day 3 he had further episodes, was started on propranolol 1 mg/kg TDS and transferred to our cardiac unit. Echocardiography showed patent ductus arteriosus, and structurally and functionally normal heart. Twelve-lead ECG was normal whilst ECG in SVT was consistent with atrio-ventricular re-entry tachycardia (AVRT). He continued to have episodes which were noted every time he was fed. Telemetry revealed that each episode was triggered by a ventricular ectopic couplet, whilst single ectopy did not trigger SVT. He was therefore started on flecainide 2 mg/kg TDS. His subsequent course was uneventful, and at discharge on day 8 of life SVT had not occurred for >36 h. …