Abstract
Supraventricular tachycardia is the most frequent form of symptomatic tachydysrhythmia in children. Neonates and infants with paroxysmal supraventricular tachycardias generally present with signs of acute congestive heart failure. In school-aged children and adolescents, palpitations are the leading symptom. Chronic-permanent tachycardia results in a secondary form of dilated cardiomyopathy.
Therapy for episodes of tachycardia depends on the individual situation. In severe haemodynamic compromise, or if ventricular tachycardia is suspected, tachycardia should immediately be terminated by external cardioversion during deep sedation. Vagal manoeuvres are effective in patients with atrioventricular reentrant tachycardias. Adenosine is the drug of first choice in any age group for tachycardias involving the atrioventricular node; its advantages include short half-life and minimal or absent negative inotropic effects. Adenosine may also be used in patients with wide QRS complex tachycardia. Intravenous verapamil is contraindicated in neonates and infants because of the high risk of electromechanical dissociation. In older children (<5 years) and adolescents, verapamil may be administered with the same restrictions as in adult patients (wide QRS complex tachycardia, significant haemodynamic compromise).
Spontaneous cessation of tachycardia can be expected in most neonates and infants during the first year of life. Prophylactic pharmacological treatment in this age group is advisable because recognition of tachycardia is often delayed until the occurrence of symptoms. Withdrawal of drug treatment should be attempted around the end of the first year. However, in older children, spontaneous cessation of tachycardia is rare.
Prophylactic drug therapy is performed on an empirical basis. Digoxin may be administered in all forms of supraventricular tachycardia in which the atrioventricular node is involved, except in patients with pre-excitation syndrome aged <1 year. In patients with atrioventricular reentrant tachycardia, class 1C drugs such as flecainide and propafenone are effective. Sotalol is also effective in atrioventricular reentrant tachycardia, as well as in primary atrial tachycardia. Although amiodarone has the highest antiarrhythmic potential, it should be used with caution because of its high rate of adverse effects.
In school-aged children and adolescents, radiofrequency catheter ablation of the anatomical substrate is an attractive alternative to drug therapy, with a rate of permanent cessation of the tachycardia of up to 90%. Despite the clear advantages of this procedure, it should be performed only with unquestionable indication; the long term morphological and electrophysiological sequelae on the growing atrial and ventricular myocardium are still unknown.
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References
Fish F, Benson DW. Disorders of cardiac rhythm and conduction. In: Emmanouilidis GC, Riemenschneider TA, Allen HD, et al., editors. Heart disease in infants, children, and adolescents: including the fetus and young adult. Baltimore (MD): Williams & Wilkins, 1995: 1555–603
Paul T. Langzeit-EKG bei Kindern unter der besonderen Berücksichtigung der angeborenen Herzfehler. In: Schuster HP, editor. Langzeit-Elektrokardiographie. Stuttgart: Gustav Fischer Verlag, 1990: 73–99
Janousek J, Paul T, Bartakova J. Role of late potentials in identifying patients at risk for ventricular tachycardia after surgical correction of congenital heart disease. Am J Cardiol 1995; 75: 146–50
Ludomirsky A, Garson A. Supraventricular tachycardia. In: Gillette PC, Garson A, editors. Pediatric arrhythmias: electrophysiology and pacing. Philadelphia (PA): WB Saunders, 1990: 380–426
Bökenkamp R, Bertram H, Trappe HJ, et al. Hochfrequenz-strom-Katheterablation bei jungen Patienten mit permanenter junktionaler Reentry-Tachykardie und atrialer ektoper Tachykardie. Z Kardiol 1998; 87: 364–71
Lindinger A, Heisel A, von Bernuth G, et al. Permanent junctional reentry tachycardia: a multicenter long-term follow-up study in infants, children and young adults. Eur Heart J 1998; 19: 936–42
Benson Jr DW. Transoesophageal electrocardiography and cardiac pacing: state of the art. Circulation 1987; 75(4 Pt 2): III86–92
Kugler JD. Electrophysiologic studies. In: Emmanouilides GC, Riemenschneider TA, Allen HD, et al., editors. Heart disease in infants, children, and adolescents: including the fetus and young adult. Baltimore (MD): Williams & Wilkins, 1995: 347–66
Paul T, Pfammatter JP. New antiarrhythmic drugs in pediatric use: adenosine. Pediatr Cardiol 1997; 18: 118–26
Rankin AC, Rae AP, Cobbe SM. Misuse of intravenous verapamil in patients with ventricular tachycardia. Lancet 1987; II: 472–4
Epstein ML, Kiel EA, Victoria BE. Cardiac decompensation following verapamil therapy in infants with supraventricular tachycardia. Pediatrics 1985; 75: 737–40
Belhassen B, Glick A, Laniado S. Comparative clinical and electrophysiologic effects of adenosine triphosphate and verapamil on paroxysmal reciprocating junctional tachycardia. Circulation 1988; 77: 795–805
Perry JC, Garson A. Supraventricular tachycardia due to Wolff-Parkinson-White syndrome in children: early disappearance and late recurrence. J Am Coll Cardiol 1990; 16: 1215–20
Perry JC, McQuinn RL, Smith RT, et al. Flecainide acetate for resistant arrhythmias in the young: efficacy and pharmacokinetics. J Am Coll Cardiol 1989; 14: 185–91
Paul T, Janousek J. New antiarrhythmic drugs in pediatric use: propafenone. Pediatr Cardiol 1994; 15: 190–7
Fish FA, Gillette PC, Benson DW, et al. Proarrhythmia, cardiac arrest and death in young patients receiving encainide and flecainide. J Am Coll Cardiol 1991; 18: 356–65
Pfammatter JP, Stocker FP. Results of restrictive use of anti-arrhythmic drugs in the chronic treatment of atrioventricular reentrant tachycardias in infancy and childhood. Am J Cardiol 1998; 82: 72–5
Pfammatter JP, Paul T. New antiarrhythmic drugs in pediatric use: sotalol. Pediatr Cardiol 1997; 18: 28–34
Guccione P, Paul T, Garson A. Long-term follow-up of amiodarone therapy in the young: continued efficacy, unimpaired growth, moderate side effects. J Am Coll Cardiol 1990; 15: 1118–24
Janousek J, Paul T. Safety of oral propafenone in the treatment of arrhythmias in infants and children (European retrospective multicenter study). Working group on pediatric arrhythmias and electrophysiology of the Association of European Pediatric Cardiologists. Am J Cardiol 1998; 81: 1121–4
Paul T, Guccione P. New antiarrhythmic drugs in pediatric use: amiodarone. Pediatr Cardiol 1994; 15: 132–8
Saul JP. Electrophysiologic therapeutic catheterization. In: Emmanouilides GC, Riemenschneider TA, Allen HD, et al., editors. Heart disease in infants, children, and adolescents: including the fetus and young adult. Baltimore (MD): Williams & Wilkins, 1994: 452–68
Van Hare GF. Indications for radiofrequency ablation in the pediatric population. J Cardiovasc Electrophysiol 1997; 8: 952–62
Morady F. Radio-frequency ablation as treatment for cardiac arrhythmias. N Engl J Med 1999; 340: 534–44
Kugler JD, Danford DA, Houston K, et al. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Am J Cardiol 1997; 80: 1438–43
Trohman RG, Pinski SL, Sterba R, et al. Evolving concepts in radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia. Am Heart J 1994; 128: 586–94
Teixeira OH, Balaji S, Case CL, et al. Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in children. Pacing Clin Electrophysiol 1994; 17: 1621–6
Windhagen-Mahnert B, Bertram H, Peuster M, et al. AV-Knoten-Reentry-Tachykardien bei jungen Patienten: Therapie durch Ablation/Modulation des langsam leitenden Schenkels [abstract]. Z Kardiol 1998; 87: 736
Van Hare GF. Electrical/ablational therapeutic cardiac catheterization. Pediatr Cardiol 1998; 19: 95–105
Walsh EP, Saul JP, Hulse JE, et al. Transcatheter ablation of ectopic atrial tachycardia in young patients using radiofrequency current. Circulation 1992; 86: 1138–46
Kugler JD, Danford DA, Deal BJ, et al. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. N Engl J Med 1994; 330: 1481–7
Schaffer MS, Silka MJ, Ross BA, et al. Inadvertent atrioventricular block during radiofrequency catheter ablation: results of the pediatric radiofrequency ablation registry. Pediatric Electrophysiology Society. Circulation 1996; 94: 3214–20
Tanel RE, Walsch EP, Triedman JK, et al. Five-year experience with radiofrequency catheter ablation: implication for management of arrhythmias in pediatric and young adult patients. J Pediatr 1997; 131: 878–87
Van Hare GF, Witherell CL, Lesh MD. Follow-up of radiofrequency catheter ablation in children: results in 100 consecutive patients. J Am Coll Cardiol 1994; 23: 1651–9
Schlüter M, Kuck KH. Radiofrequency current for catheter ablation of accessory atrioventricular connections in children and adolescents: emphasis on the single-catheter technique. Pediatrics 1992; 89: 930–5
Case CL, Gillette PC, Oslizlok PC, et al. Radiofrequency catheter ablation of incessant, medically resistant supraventricular tachycardia in infants and small children. J Am Coll Cardiol 1992; 20: 1405–10
Haissaguerre M, Puel V, Bekheit S, et al. Catheter ablation of accessory pathways in children. Eur Heart J 1994; 15: 200–5
Sreeram N, Smeets JL, Pulles-Heintzberger CF, et al. Radiofrequency catheter ablation of accessory atrioventricular pathways in children and young adults. Br Heart J 1993; 70: 160–5
Saul JP, Hulse JE, Papagiannis J, et al. Late enlargement of radiofrequency lesions in infant lambs: implications for ablation procedures in small children. Circulation 1994; 90: 492–9
Paul T, Bökenkamp R, Mahnert B, et al. Coronary artery involvement early and late after radiofrequency current application in young pigs. Am Heart J 1997; 133: 436–40
Paul T, Mahnert B, Trappe HJ, et al. Lack of evidence of areas of slow conduction early after radiofrequency current application at porcine atrial myocardium. Pacing Clin Electrophysiol 1996; 19: 2009–13
Van Hare GF. Radiofrequency ablation of accessory pathways associated with congenital heart disease. Pacing Clin Electrophysiol 1997; 20: 2077–81
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Paul, T., Bertram, H., Bökenkamp, R. et al. Supraventricular Tachycardia in Infants, Children and Adolescents. Paediatr Drugs 2, 171–181 (2000). https://doi.org/10.2165/00128072-200002030-00002
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DOI: https://doi.org/10.2165/00128072-200002030-00002