Age makes a difference: Symptoms in pediatric supraventricular tachycardia

Evaluating antiarrhythmic drugs for managing infants with supraventricular tachycardia; a review

Supraventricular tachycardia (SVT) is the most prevalent arrhythmia observed in infants, impacting individuals with or without congenital cardiac dysfunction. Infantile-onset SVT typically manifests within the initial one to two months of life. A variety of anti-arrhythmic medications are employed to treat SVT in infants during their first year of life. Nevertheless, a consensus has yet to be reached on the most efficacious drug, and treatment approaches continue to vary considerably As SVT remains a frequent problem around the world, with different management approaches and no obvious optimal option, we conducted a systematic review of the new update of antiarrhythmic drugs for managing SVT in infants under one year old.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Prise en charge de la tachycardie supraventriculaire aiguë chez les enfants

Question

Récemment, un patient âgé de 3 ans que je voyais en cabinet a dû être rapidement transporté au service d’urgence. On lui a diagnostiqué une tachycardie supraventriculaire (TSV), et de l’adénosine lui a été immédiatement administrée. De quelles données probantes disposons-nous relativement à la prise en charge de la TSV chez les enfants?

Réponse

La tachycardie supraventriculaire est un trouble cardiaque courant chez les patients pédiatriques. Elle se manifeste par une diminution de l’amplitude des complexes QRS sur l’électrocardiogramme. Les symptômes vont des palpitations, du manque d’appétit et de l’irritabilité à une instabilité hémodynamique plus significative. Les patients stables sur le plan hémodynamique peuvent bénéficier d’interventions comme les manœuvres vagales, qui peuvent être effectuées en cabinet. Ces manœuvres comprennent la manœuvre de Valsalva, la stimulation du réflexe de plongée (chez les enfants) et la compression unilatérale du sinus carotidien. Chez certains enfants, le rétablissement du rythme cardiaque normal peut demander un traitement pharmacologique consistant en de rapides injections intraveineuses d’adénosine administrées sous surveillance. Les patients présentant une instabilité hémodynamique pourraient nécessiter une cardioversion d’urgence.

Management of acute supraventricular tachycardia in children

QUESTION

Recently, a 3-year-old patient in my practice urgently needed to go to the emergency department. The patient was found to have supraventricular tachycardia (SVT) and needed immediate treatment with adenosine. What evidence is currently available for management of SVT in children?

ANSWER

Supraventricular tachycardia is a common cardiac condition in the pediatric population that manifests as a narrow QRS complex tachycardia on electrocardiography. Symptoms may range from palpitations, poor feeding, and irritability to more substantial hemodynamic instability. Patients who are hemodynamically stable can benefit from interventions such as vagal maneuvers, which can be done in the office. Such maneuvers include the Valsalva maneuver, stimulation of the diving reflex (for infants), and unilateral carotid sinus massage. Other children may need pharmacologic therapies to restore normal heart rhythm, which usually consists of a rapid intravenous injection of adenosine under monitoring. For patients who are hemodynamically unstable, emergency cardioversion may be needed.

Prognostic Value of Cardiac Troponin and Risk Assessment in Pediatric Supraventricular Tachycardia

Cardiac troponin I (cTnI) elevation is common in an acute episode of supraventricular tachycardia (SVT). However, there is limited evidence regarding the prognostic value of cTnI and the predictors of SVT recurrence in pediatric patients. We screened the electronic medical records of all pediatric patients presenting to the emergency departments at five Taiwanese hospitals from 1 January 2010 to 31 May 2021. Our primary outcomes were the occurrence of major adverse cardiac events (MACEs) during the follow-up period and 30-day SVT recurrence. A total of 112 patients were included in our study. Of these, 29 (25.9%) patients had positive cTnI values. Patients with cTnI elevation had significantly more complaints of dyspnea (27.6% vs. 7.2%, p = 0.008) and gastrointestinal discomfort (24.1% vs. 4.8%, p = 0.006). There were significantly more intensive care unit admissions (41.4% vs. 16.9%, p = 0.007) among the cTnI-positive group. One MACE was found in the cTnI-negative group. For 30-day SVT recurrence, the cTnI-positive group had a higher recurrence rate, without a statistically significant difference (20.7% vs. 7.2%, p = 0.075). Multivariable logistic regression analysis showed hypotension as an independent predictor of 30-day SVT recurrence (OR = 4.98; Cl 1.02-24.22; p = 0.047). Troponin had low value for predicting the outcomes of pediatric patients with SVT. The only significant predictor for recurrent SVT was initial hypotension.

Essentials of Paroxysmal Supraventricular Tachycardia for the Pediatrician

Paroxysmal supraventricular tachycardia (SVT) is the most common clinical arrhythmia in young patients. With an estimated prevalence of roughly 1 in 500 children, a pediatrician may knowingly or unknowingly see several patients who are affected each year. SVT symptoms can sometimes be vague or conflated with common pediatric complaints. Different forms of SVT are predominant at different ages, sometimes complicating timely recognition and referral. Differing pathophysiology and age distribution impact risk of complications such as heart failure, or rarely, sudden death. Treatment choices continue to evolve as new medications, monitoring devices, and ablation technologies continue to mature. This review focuses on the most common types of paroxysmal SVT: atrioventricular nodal reentrant tachycardia, atrioventricular reciprocating tachycardia, and Wolff-Parkinson White syndrome. Atrial arrhythmia mechanisms are also briefly outlined. It is meant to provide practical guidelines for the diagnosis and management of patients with SVT from infancy through adolescence. [Pediatr Ann. 2021;50(3):e113-e120.].

Long-Term Patient Experience Following Acutely Successful Ablation of Supraventricular Tachycardia Substrate in Children

Definitive treatment of supraventricular tachycardia (SVT) substrate involves catheter ablation. While objective success rates have been well established, long-term subjective patient experiences have not been well described. We quantify a subjective cure rate and characterize long-term patient experience after acutely successful ablation. A cross-sectional survey of pediatric patients with accessory pathways or atrioventricular nodal reentrant tachycardia who underwent acutely successful ablation from 2008 to 2012 was performed. Data were obtained from medical records and patient surveys. Patients with congenital heart disease other than patent ductus arteriosus, patent foramen ovale, or coronary artery abnormalities were excluded. Statistical analyses included Student's t-test and χ² analysis for continuous and categorical variables, respectively. Surveys were sent to 153 patients of which 147 responded with median follow-up of 7.2 (IQR 6.1-8.5) years. Of the 147 responders, 124 (84%) patients reported cure with a male predominance. Symptoms were present in 130/147 (88%) patients pre-ablation and in 53/147 (36%) post-ablation. Among those with post-ablation symptoms, 50/53 (94%) reported symptomatic improvement. Recurrence occurred in 23/147 (16%) patients and was more prevalent following cryoablation. Ablation of SVT substrate can be curative with excellent long-term results and patient satisfaction. Long-term subjective cure rate is high and there is a substantial decrease in symptoms post-ablation. Many patients continue to have symptoms following ablation; however, the majority of these patients consider themselves cured and symptoms can be attributed to other etiologies. Recurrence is uncommon and occurs more frequently following cryoablation.

Supraventricular tachycardia in children from the perspective of a specialised between-hospital transport team

AIMS

The aim of this study is to establish the incidence of supraventricular tachycardia (SVT) as a main reason for between-hospital transfer in children, as well as to describe the clinical presentation, prognosis and treatment, risk factors presenting with haemodynamic compromise, and to propose a specific management protocol for the transport.

METHODS

A retrospective observational study was conducted on all patients with supraventricular tachycardia transferred by the Hospital Vall d'Hebron Sistema de Emergencias Médicas Pediátricas (SEM-P) between January 2005 and June 2017.

RESULTS

During the study period, 67 (0.9%) patients (out of a total number of 7348 transfers) suffered from SVT. The median age was 57 days (2 h-18 years old). There was clinical evidence of cardiogenic shock on admission in 14 (20.9%) patients. Age ≤1 year was the only independent risk factor associated with presenting with cardiogenic shock on admission, with an OR of 10.2 (95% CI: 1.2-89.9; p = 0.004). The majority of patients could be treated appropriately by the local hospital team, except for oral intubation and cardioversion that were performed mainly by the transport team on arrival at the local hospital. Median stabilisation time was 35 min (9-169), and median total transport time was 30 min (9-165).

CONCLUSIONS

Only 0.9% of transport cases are due to SVT, but this can be highly demanding as patients can be critically ill. Age ≤1 year was the only independent risk factor associated with presenting with cardiogenic shock on admission. Coordination between the local and the transport teams is crucial for a good clinical outcome.