Supraventricular tachycardia (SVT) is the most common arrhythmia in neonates. The incidence of SVT is about 1 to 200-250. This tachyarrhythmia can be a recurrent and persistent condition, can be responsive to a single antiarrhythmic agent but some require a combination of antiarrhythmic medications. The authors report a case of a 20-day old full term girl admitted to our NICU with the heart rate 280 and circulatory compromise, diagnosed with narrow complex SVT. An initial SVT was terminated by adenosine but recurrent SVTs with cardiac compromise were not responsive either to adenosine, cordarone or cardioversion. The refractory SVT were finally managed by a combination of Fleceinide and propranolol for both termination and maintenance. In conclusion, SVT in neonatal period is not uncommon but its early signs and symptoms are non-specific, hence there often is a delay in their recognition and management. Initial management should be based on the guidelines of the advanced paediatric life support. Recurrent and persistent SVT with circulatory collapse, which may need a combination of antiarrhythmic drugs, should be managed and follow-up with the consultation of the cardiologist.
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