Neonatal supraventricular tachycardia (original) (raw)
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Neonatal Supraventricular Tachycardia (SVT)
NeoReviews, 2005
A male neonate born at 31 weeks' gestation had a history of fetal supraventricular tachycardia (SVT) detected at 28 weeks' gestation, with no hydropic changes noticed on ultrasonography. The mother was started on enteral digoxin with instructions for weekly follow-up. On her first return visit at 31 weeks' gestation, ultrasonography revealed hydropic changes and persistent SVT. An emergency cesarean section was performed, and the infant was found to have hydrops and respiratory distress, with a heart rate of 270 beats/min. The patient was intubated and mechanically ventilated and received a dose of intravenous (IV) adenosine, resulting in a transient decrease in heart rate to 120 beats/min before increasing back to 260 to 270 beats/ min. SVT persisted despite institution of an esmolol drip at 500 mcg/kg per minute, and cardioversion was performed when hemodynamic instability developed. Recurrent SVT, associated with hypotension, developed within 45 minutes of successful cardioversion. The patient was given a loading dose of amiodarone, followed by cardioversion, continuous amiodarone, and dobutamine infusion. Echocardiography revealed normal anatomy with moderately reduced function. The patient remained in sinus rhythm and was weaned to oral amiodarone after 1 week of infusion. An echocardiogram revealed normal function. The patient was discharged from the hospital receiving 3 mg/kg per day of oral amiodarone.
Supraventricular Tachycardia in Infants: Epidemiology and Clinical Management
Current Pharmaceutical Design, 2008
Supraventricular tachycardias (SVTs) are observed in 0,1-0,4% of the paediatric population and represent an important clinical problem with related significant health and social issues. Most tachycardias are paroxysmal, being associated with sudden onset and termination, and only a relatively small number of them is permanent, namely chronic. Paroxysmal tachycardias, in addition, can be either sustained (lasting > 30 seconds) or non-sustained whenever their duration is less. Most SVTs are due to re-entry, and only atrial tachycardia and and junctional ectopic tachycardia are caused by enhanced automaticity. Atrial tachycardia, however, can also be due, although rarely, to re-entry or to triggered activity. A prompt recognition of these arrthmias in children by pediatric cardiologist is essential for a correct clinical managemet of the patients. In this review, the epidemiologic data regarding the SVTs in pediatric age are reported along with the description of the pathophysiological mechanisms and the analysis of electrocardiographic findings to be considered for a correct clinical diagnosis and a rational therapeutic approach to these arrhythmias.
Predictors of Refractory Tachycardia in Infants with Supraventricular Tachycardia
Reentrant supraventricular tachycardia (SVT) is the most common arrhythmia in infants. There are few predictors as to which patients will have recurrent or refractory SVT. We retrospectively reviewed records of all infants with SVT evaluated at The Hospital for Sick Children, Toronto, between January 1, 1995, and December 31, 1999. Patients with reentrant SVT documented in infancy and structurally normal hearts were included. Patients were placed in two groups: thè`simple'' group consisted of patients with SVT completely controlled by not more than one medication, and thè`complex'' group consisted of patients with recurrent episodes requiring at least one medication change for control. Forty-two cases were analyzedÐ23 in the simple group and 19 in the complex group. One patient in each group died. Age at presentation was 50.4 13.2 days for the simple group versus 10.2 2.5 days for the complex group (p < 0.01). Complex patients were treated with a median of three medications and were more likely to have echocardiographically reduced ventricular function. The surface electrocardiogram RP interval during SVT was signi®cantly longer in complex patients (p < 0.001). There were no dier-ences between the groups in gender, cycle length in SVT or sinus rhythm, the presence of pre-excitation, initial medication choice, or duration of therapy. Recurrent SVT in infancy is associated with younger age and/or ventricular dysfunction at presentation and also with slower ventriculoatrial conduction. The similar duration of therapy for simple and complex patients suggests that the early clinical course of SVT in infancy is not predictive of long-term outcome.
Diagnosis and treatment of supraventricular tachycardias in infants and children
Cardiologia (Rome, Italy), 1990
Supraventricular tachyarrhythmia (SVT) is the most common tachyarrhythmia in pediatric patients and accounts for more than 90% of pediatric arrhythmias. As many as 16 different mechanisms of pediatric SVT exist; we focused in this review article on the three most common groups of SVT mechanisms in pediatrics: atrioventricular re-entry tachyarrhythmia (AVRT), atrioventricular nodal reentry tachyarrhythmia (AVNRT), and atrial tachyarrhythmia (AT). Many methods have been implicated in the diagnosis of SVT like full history taking regarding onset and frequency of palpitation, syncope, chest pain, dyspnea, heart failure, drug intake and physical examination. Children with suspected SVT must be subjected to resting 12-lead surface ECG and ECG during the attack. Echocardiography must be done for detection of any structural heart diseases. Moreover, recent techniques like Electrophysiologic study (EPS) is the most defi nitive diagnostic procedure. Many therapeutic strategies like drugs and radiofrequency ablation (RFA) have been succeeded to provide a signifi cant reduction of the risk of SVT, but RFA offers the prospect of cure of the arrhythmia and avoidance of drug-associated side effects. It is often becoming the fi rst line of therapy for many children with SVT, as it has a relatively low morbidity and mortality, and it results in a low rate of recurrence of SVT.
Pacing and Clinical Electrophysiology, 2020
Background: We aimed to evaluate the incidence, type and management of supraventricular tachyarrhythmias (SVT) during the first year of life in a retrospective, population-based, single-center study during a 10-year period. Methods: The analyzed patient cohort is based on data from the only specialized center managing all cases of neonatal and infant SVTs between 2009 and 2018 in the Slovak Republic (5.5 million population). A total of 116 consecutive patients < 366 days old were included in the study. Results: Calculated SVT incidence was 1:4500 in the first year of life. AV reentry tachycardia was the leading arrhythmia (49%). SVT in this specific population was frequently a transient problem with spontaneous resolution in 87% of patients during a median 3-year follow-up. Congenital heart disease was common (16%). Intrauterine treatment by drugs administered to mother was safe and effective in preventing unnecessary cesarean deliveries. In arrhythmia termination amiodarone and propafenone were equally safe and effective, This article is protected by copyright. All rights reserved. 3 with possible more favorable pharmacodynamics of the former. For prophylactic treatment sotalol and propafenone were equally safe and effective and became the preferred basis of long-term drug therapy in our center. However, this therapy requires intensive monitoring during its initiation. Conclusion: The prognosis of SVT in the first year of life is good: with optimized pharmacological treatment the need for early catheter ablation and mortality rate are low (<1%) and there is a high rate of spontaneous arrhythmia resolution. Heart failure is a possible predictor of arrhythmia persistence with need for ablation in later life.
Diagnosis, treatment and follow up of neonatal arrhythmias : cardiovascular topic
Cardiovascular Journal Of Africa, 2014
Objective: This study aimed to evaluate the aetiology, spectrum, course and outcomes of neonates with arrhythmias observed in a tertiary neonatal intensive care unit from 2007 to 2012. Methods: Neonates with rhythm problems were included. The results of electrocardiography (ECG), Holter ECG, echocardiography and biochemical analysis were evaluated. The long-term results of follow up were reviewed. Results: Forty-five patients were male (68%) and 21 (32%) were female. Fifty-five patients (83.3%) were term, 11 (16.6%) were preterm, and 34% were diagnosed in the prenatal period. Twenty cases (30.3%) had congenital heart disease. Twenty-three patients (34.8%) were diagnosed during the foetal period. The most common arrhythmias were supraventricular ectopic beats and supraventricular tachycardia (SVT) at 39.3 and 22.7%, respectively. SVT recurred in five patients after the neonatal period. Conclusion: Supraventricular ectopic beats and SVT were the most common arrhythmias during the neonatal period. Although the prognosis of arrhythmias in the neonatal period is relatively good, regular monitoring is required.
Ventricular tachycardia in infants with structurally normal heart: a benign disorder
Cardiology in the Young, 2010
We evaluated the presentation, treatment, and outcome of infants who present with ventricular tachycardia in the first year of life. Seventy-six infants were admitted to our institution with a diagnosis of ventricular tachycardia between January, 1987 and May, 2006. Forty-five infants were excluded from the study because of additional confounding diagnoses including accelerated idioventricular rhythm, Wolff-Parkinson-White syndrome, supraventricular tachycardia with aberrancy, long QT syndrome, cardiac rhabdomyoma, myocarditis, congenital lesions, or incomplete data. The remaining 31 included infants who had a median age at presentation of 1 day, with a range from 1 to 255 days, and a mean ventricular tachycardia rate of 213 beats per minute, with a range from 171 to 280, at presentation. The infants were treated chronically with propranolol (38.7%), amiodarone (12.9%), mexiletine (3.2%), propranolol and mexiletine (9.7%), or propranolol and procainamide (6.5%). The median duration of treatment was 13 months, with a range from 3 to 105 months. Ventricular tachycardia resolved spontaneously in all infants. No patient died, or received catheter ablation or device therapy. Median age at last ventricular tachycardia was 59 days, with a range from 1 to 836 days. Mean follow-up was 45 months, with a range from 5 to 164 months, with a mean ventricular tachycardia-free period of 40 months. Infants with asymptomatic ventricular tachycardia, a structurally normal heart, and no additional electrophysiological diagnosis all had spontaneous resolution of tachycardia. Furthermore, log-rank analysis of the time to ventricular tachycardia resolution showed no difference between children who received chronic outpatient anti-arrhythmic treatment and those who had no such therapy. While indications for therapy cannot be determined from this study, lack of symptoms or myocardial dysfunction suggests that therapy may not be necessary.
Ventricular Tachycardia in an Infant Without Congenital Anomaly: A Case Report
Cardiology Research
Ventricular tachycardia (VT) is a serious form of arrhythmia that can be life-threatening; that's why diagnosis and treatment are very important in order to avoid serious complications. We are reporting this case of VT which is a rare entity, especially, in healthy infants. This infant, without cardiac pathology known from birth, presented with poor food intake and grunting with hepatomegaly on clinical examination, and a heartbeat at 200/ min. The electrocardiogram (ECG) showed wide QRS complex tachycardia, and the echocardiogram showed a dilated and hypokinetic cardiomyopathy. The clinical signs and chest X-ray changes were consistent with mild cardiac failure. This presentation makes the diagnosis challenging, therefore, it is important to take a good history of the case with a complete clinical exam to achieve the correct diagnosis, and to avoid potential complications. VT of an infant may be benign but should not be diagnosed as such before eliminating serious causes.
Pediatric Cardiology, 2011
Supraventricular tachycardia (SVT) presenting in the neonatal period may resolve by 1 year of age. Predicting which patients require therapy beyond 1 year of age is desirable. Pediatric electrophysiology databases from two institutions were reviewed for patients with a history of infant SVT who underwent transesophageal electrophysiology study (TEEPS) after initial SVT and before 2 years of age. All patients were tested off medications and followed for clinical recurrence. Forty-two patients presented with SVT at median age of 4 days (0-300 days). Initial control was achieved with one drug in 31 patients and multiple drugs in 11 patients. Prior to TEEPS, nine patients had clinical recurrence in the first year of life after initial control had been previously achieved. For all patients, TEEPS was performed, without complications, at median 13 months (9-22 months) of age and at median of 13 months (6-22 months) following the initial SVT episode. SVT was inducible in 27/42: 8 atrio-ventricular nodal reentry tachycardia (AVNRT) and 19 atrio-ventricular reciprocating tachycardia (AVRT). Inducibility was not associated with age at presentation, age at TEEPS, ventricular dysfunction at presentation, presence of structural congenital heart disease, number of drugs required to initially control SVT, or SVT recurrence after initial control. Of 15 not inducible at TEEPS, none had known SVT recurrence off medications at median follow-up of 27 months (6-37 months). In conclusion, among patients having SVT in early infancy,