1
|
Kumari N, Yogi TN, Bhusal A, Paudel N. Synchronized cardioversion resolving refractory supraventricular tachycardia in a neonate: a case report with comprehensive analysis. Ann Med Surg (Lond) 2024; 86:1782-1788. [PMID: 38463090 PMCID: PMC10923271 DOI: 10.1097/ms9.0000000000001788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Neonatal supraventricular tachycardia (SVT) poses unique challenges in diagnosis and management, with refractory cases requiring synchronized cardioversion being exceptionally rare. This case report explores the presentation and management of refractory SVT in a neonate, emphasizing the significance of sharing such clinical scenarios. Case presentation A 16-day-old neonate, born via emergency caesarean section, presented with respiratory distress, poor feeding, and vomiting. Initial diagnosis of SVT was made on the basis of electrocardiography (ECG) changes. Initial attempts with adenosine failed, leading to the recurrence of tachycardia. Despite amiodarone administration, the tachycardia persisted, prompting synchronized cardioversion. Post-cardioversion, the neonate was managed with oral medications, showing sustained improvement. Clinical discussion This case report highlights a neonate with refractory SVT, requiring synchronized cardioversion, presenting a rare and challenging scenario. The report addresses diagnostic challenges, treatment approaches, and potential mechanisms for refractory SVT, such as delayed presentation and resistance to adenosine. Emphasizing individualized care plans and vigilant monitoring, this report is a valuable resource for healthcare professionals, contributing to neonatal cardiology understanding and emphasizing the importance of early recognition and effective interventions. Ongoing follow-up and successful outcomes underscore the need for sustained management strategies. Conclusion This case report sheds light on the rarity of refractory SVT in neonates, emphasizing the complexities in diagnosis and management. Successful synchronized cardioversion and subsequent oral therapy highlight the need for a multifaceted approach in neonatal SVT cases. The implications for clinical practice underscore the importance of awareness and continued research in neonatal cardiology and emergency medicine.
Collapse
Affiliation(s)
| | - Tek Nath Yogi
- Internal Medicine; BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Amrit Bhusal
- Internal Medicine; BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Niraj Paudel
- Departments ofPediatrics and Adolescents Medicine
| |
Collapse
|
2
|
Lu Y, Xiong Y, Wen Y, Yang Y, Liu H. Rediscover the predictive capacity of B-type natriuretic peptide applied to neonatal supraventricular tachycardia. BMC Cardiovasc Disord 2023; 23:603. [PMID: 38066422 PMCID: PMC10704628 DOI: 10.1186/s12872-023-03646-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Supraventricular tachycardia (SVT) is one of the most common non-benign arrhythmias in neonates, potentially leading to cardiac decompensation. This study investigated the early risk factors of acute heart failure (AHF) secondary to SVT in neonates, and explored their value in guiding the selection of effective anti-arrhythmic treatment. METHODS A total of 43 newborns diagnosed with and treated for SVT between January 2017 and December 2022 were analyzed. According to the presence of AHF after restoring sinus rhythm in newborns with SVT, they were divided into SVT with AHF group and SVT without AHF group. Clinical data and anti-arrhythmic therapies were analyzed. Risk factors of AHF secondary to SVT in neonates were determined using logistic regression. The cut-off value for predictors of AHF secondary to SVT and demanding of a second-line anti-arrhythmic treatment was determined through receiver operating characteristic (ROC) analysis. RESULTS Time to initial control of tachycardia > 24 h, hyperkalemia, anemia, and plasma B-type natriuretic peptide (BNP) were identified as risk factors of AHF secondary to SVT in neonates. BNP exhibited AUC of 0.80 in predicting AHF, and BNP > 2460.5pg/ml (OR 2.28, 95% CI 1.27 ~ 45.39, P = 0.03) was an independent predictor, yielding sensitivity of 70.6% and specificity of 84.6%. Neonates with BNP > 2460.5pg/ml (37.5% versus 7.4%, P = 0.04) had a higher demand for a second line anti-arrhythmic treatment to terminate SVT, with sensitivity and specificity for BNP in predicting at 75.0%, 71.4%, respectively. CONCLUSIONS BNP could be used to predict an incident of AHF secondary to SVT and a demand of second-line anti-arrhythmic treatment to promptly terminate SVT and prevent decompensation in neonates.
Collapse
Affiliation(s)
- Yaheng Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 611731, China.
| | - Ying Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
| | - Yizhou Wen
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 611731, China
| | - Yanfeng Yang
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 611731, China
| | - Hanmin Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China
- Key Laboratory of Chronobiology (Sichuan University), National Health Commission of China, Chengdu, China
| |
Collapse
|
3
|
Oeffl N, Krainer M, Kurath-Koller S, Koestenberger M, Schwaberger B, Urlesberger B, Mileder LP. Cardiac Arrhythmias Requiring Electric Countershock during the Neonatal Period-A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050838. [PMID: 37238386 DOI: 10.3390/children10050838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND In neonates, cardiac arrhythmias are rare. Electric countershock therapy is an effective alternative to drug therapy for neonatal arrhythmias. There are no randomized controlled studies investigating electric countershock therapy in neonates. OBJECTIVE To identify all studies and publications describing electric countershock therapy (including defibrillation, cardioversion, and pacing) in newborn infants within 28 days after birth, and to provide a comprehensive review of this treatment modality and associated outcomes. METHODS For this systematic review we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). All articles reporting electric countershock therapy in newborn infants within 28 days after birth were included. RESULTS In terms of figures, 113 neonates who received electric countershock due to arrhythmias were reported. Atrial flutter (76.1%) was the most common arrhythmia, followed by supraventricular tachycardia (13.3%). Others were ventricular tachycardia (9.7%) and torsade de pointes (0.9%). The main type of electric countershock therapy was synchronized cardioversion (79.6%). Transesophageal pacing was used in twenty neonates (17.7%), and defibrillation was used in five neonates (4.4%). CONCLUSION Electric countershock therapy is an effective treatment option in the neonatal period. In atrial flutter especially, excellent outcomes are reported with direct synchronized electric cardioversion.
Collapse
Affiliation(s)
- Nathalie Oeffl
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Marlies Krainer
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Lukas P Mileder
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
| |
Collapse
|
4
|
Moore JA, Stephens SB, Kertesz NJ, Evans DL, Kim JJ, Howard TS, Pham TD, Valdés SO, de la Uz CM, Raymond TT, Morris SA, Miyake CY. Clinical Predictors of Recurrent Supraventricular Tachycardia in Infancy. J Am Coll Cardiol 2022; 80:1159-1172. [PMID: 36109110 DOI: 10.1016/j.jacc.2022.06.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Data regarding recurrence risk among infants with supraventricular tachycardia (SVT) are limited. OBJECTIVES The purpose of this study was to determine incidence and factors associated with SVT recurrence. METHODS This was a retrospective single-center study (1984-2020) with prospective phone follow-up of infants with structurally normal hearts diagnosed at age ≤1 year with re-entrant SVT. Primary outcome was first SVT recurrence after hospital discharge. Classification and regression tree analysis was performed to determine a risk algorithm. RESULTS Among 460 infants (62% male), 87% were diagnosed at ≤60 days of age (median 13 days; IQR: 1-31 days). During a median follow-up of 5.2 years (IQR: 1.8-11.2 years), 33% had recurrence. On multivariable analysis, factors associated with recurrence included: fetal or late (>60 days) diagnosis (HR: 1.90; 95% CI: 1.26-2.86; and HR: 1.73; 95% CI: 1.07-2.77, respectively), Wolff-Parkinson-White (WPW) syndrome (HR: 2.46; 95% CI: 1.75-3.45), and need for multi-antiarrhythmic or second-line therapy (HR: 2.08; 95% CI: 1.45-2.99). Based on the classification and regression tree analysis, WPW incurred the highest risk. Among those without WPW, age at diagnosis was the most important factor predicting risk. Fetal or late diagnosis incurred higher risk, and if multi-antiarrhythmic or second-line therapy was also required, risk nearly doubled. Infants without WPW, who were diagnosed early (0-60 days), and who were discharged on propranolol were at lowest recurrence risk. CONCLUSIONS Infants with SVT are most likely to be diagnosed at ≤60 days and be male. Risk factors for recurrence (occurred in 33%), present at time of diagnosis, include WPW, fetal or late diagnosis, and multi-antiarrhythmic or second-line therapy. Infants with early diagnosis, without WPW, and discharged on first-line monotherapy are at lowest recurrence risk.
Collapse
Affiliation(s)
- Judson A Moore
- Department of Pediatrics and the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Sara B Stephens
- Department of Pediatrics and the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Naomi J Kertesz
- Department of Pediatrics and Section of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Danyelle L Evans
- Department of Pediatrics and the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey J Kim
- Department of Pediatrics and the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Taylor S Howard
- Department of Pediatrics and the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Tam Dan Pham
- Department of Pediatrics and the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Santiago O Valdés
- Department of Pediatrics and the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Caridad M de la Uz
- Department of Pediatrics, Division of Pediatric Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tia T Raymond
- Department of Pediatrics, Cardiac Critical Care, Medical City Children's Hospital, Dallas, Texas, USA
| | - Shaine A Morris
- Department of Pediatrics and the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Christina Y Miyake
- Department of Pediatrics and the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|
5
|
Rodriguez-Fernandez K, Gras-Colomer E, Climente-Martí M, Mangas-Sanjuán V, Merino-Sanjuan M. Pharmacometric characterization of entero-hepatic circulation processes of orally administered formulations of amiodarone under complex binding kinetics. Eur J Pharm Sci 2022; 174:106198. [DOI: 10.1016/j.ejps.2022.106198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/19/2022] [Accepted: 04/28/2022] [Indexed: 11/03/2022]
|
6
|
Akduman H, Dilli D, Ergün E, Çakmakçı E, Çelebi SK, Çitli R, Zenciroğlu A. Successful Mesenchymal Stem Cell Application in Supraventricular Tachycardia-Related Necrotizing Enterocolitis: A Case Report. Fetal Pediatr Pathol 2021; 40:250-255. [PMID: 31755792 DOI: 10.1080/15513815.2019.1693672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Necrotizing enterocolitis (NEC) is one of the most important life- threatening diseases in neonates. Recurrent episodes of supraventricular tachycardia (SVT) can lead to gut ischemia, with subsequent reperfusion injury resulting in NEC. Mesenchymal stem cells (MSCs) are multi-potential cells which can differentiate into multiple cell types. Case report: A 22-day old male baby delivered to 34 yr old mother at 37-weeks' gestation via cesarean section, birth weight 3550 g, developed NEC 14 hours after being treated with cardioversion for SVT. At laparotomy, there was pan-NEC, and 60 cm of necrotic and perforated bowel was resected. 1 × 107 umbilical cord origin allogeneic MSCs were given intravenously, with subsequent improvement of the remaining bowel. Conclusion: MSC may be a promising treatment for adjacent ischemic bowel in NEC helping prevent short bowel syndrome.
Collapse
Affiliation(s)
- Hasan Akduman
- Department of Neonatology, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Dilek Dilli
- Department of Neonatology, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ergun Ergün
- Department Pediatric Surgery, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Emin Çakmakçı
- Department of Radyology, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Serpil Kaya Çelebi
- Department of Pediatric Cardiology, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Rumeysa Çitli
- Department of Neonatology, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ayşegül Zenciroğlu
- Department of Neonatology, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
7
|
Romanowicz J, Cross R. Supraventricular Tachycardia in a Term Neonate. Pediatr Rev 2021; 42:S74-S77. [PMID: 33386368 DOI: 10.1542/pir.2019-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jennifer Romanowicz
- Children's National Heart Institute, Children's National Hospital, Washington, DC
| | - Russell Cross
- Children's National Heart Institute, Children's National Hospital, Washington, DC
| |
Collapse
|
8
|
Paroxysmal Supraventricular Tachycardia in Wolff–Parkinson–White Syndrome in a Newborn—Case Report and Mini-Review. Medicina (B Aires) 2020; 56:medicina56110588. [PMID: 33167583 PMCID: PMC7694453 DOI: 10.3390/medicina56110588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/03/2022] Open
Abstract
Wolff–Parkinson–White (WPW) syndrome is a rare abnormal condition frequently associated with paroxysmal supraventricular tachycardia (PSVT) and is described as an arrhythmia under the form of increased heartbeat. Currently, there are various possible treatments going from medicines such as adenosine and beta-blockers to cardioversion. The unknown causes of this condition together with the different responses to treatment in each patient make it difficult to establish the best therapeutic approach. In this context, in the current paper, we were interested in reporting the therapeutic options and their efficiency in the case of associated heart or inflammatory conditions in a 13-day-old patient.
Collapse
|
9
|
Radiofrequency catheter ablation for supraventricular tachycardia in a paediatric population: characteristics of tachycardia mechanisms in a subpopulation with early onset. Cardiol Young 2020; 30:1383-1388. [PMID: 32972474 DOI: 10.1017/s1047951120002954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In children, the first episode of supraventricular tachycardia occurs at various ages. The aim of this study is to describe age-specific tachycardia mechanisms, clinical findings, and outcome in a contemporary cohort of paediatric patients with supraventricular tachycardia. METHODS Retrospective analysis of 531 consecutive patients with structurally normal hearts under the age of 18 years who underwent invasive electrophysiological study for supraventricular tachycardia. The study population was divided into two groups, early-onset group (n = 57) and late-onset group (n = 474), according to the age of the occurrence of the first tachycardia before or after the age of 12 months. RESULTS Accessory pathway-mediated tachycardia was more common (82.5 versus 50.1%, p < 0.001) and the proportion of left-sided accessory pathways was more pronounced (74.5 versus 53.7%, p = 0.01) in the early-onset group than in the late-onset group. The antegrade and retrograde refractory periods of the accessory pathways were similar in both groups, but pre-excitation was more common in the early-onset group (50.9 versus 31.9%, p = 0.007). Typical atrioventricular nodal re-entrant tachycardia was more common (36.7 versus 7.0%, p < 0.001) in the late-onset group. There was no difference among the two groups regarding overall outcome. CONCLUSION Accessory pathway-mediated re-entrant tachycardia is the most common mechanism of recurrent supraventricular tachycardia in infants with structurally normal hearts who are later referred to an electrophysiological study. These pathways often cause pre-excitation and tend to be located on the left side whereas their refractory period is not different from that of patients with late-onset tachycardia.
Collapse
|
10
|
Woodward S, Mundorff M, Weng C, Gamboa DG, Johnson MD. Incidence of supraventricular tachycardia after inhaled short-acting beta agonist treatment in children. J Asthma 2020; 58:471-480. [PMID: 31902263 DOI: 10.1080/02770903.2019.1709867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Albuterol can trigger supraventricular tachycardia (SVT). The clinical characteristics, incidence, and risk factors of SVT after inhaled SABA treatment in children are currently unknown. Through review of regional care delivery, we will describe cases of SVT during asthma treatment in hospital-based settings, define the incidence of SVT in our population, and evaluate risk factors of SABA-induced SVT. METHODS We identified hospital-based care episodes of children 0-18 years old between 2006 and 2015 recorded in the Intermountain Healthcare EDW with either 1) diagnosis codes for both asthma and SVT or 2) both SABA and adenosine listed as billed medications. Controls were matched with cases by age and sex to determine risk factors for SVT after SABA using conditional logistic regression. RESULTS Of 93 care episodes meeting criteria, we found 7 cases of SVT after SABA treatment in 6 patients over 10 years. In our population, the incidence of SVT is 3.9 per 10,000 episodes of SABA treatment, and 5.1 per 10,000 children with asthma receiving hospital-based asthma care. Two episodes of SVT followed treatment with only levalbuterol, three after only albuterol, and two after both albuterol and levalbuterol treatment. Five cases of SVT were converted to sinus rhythm with adenosine, one converted with synchronized electrical cardioversion, and one resolved spontaneously. No cases of SVT led to death. No examined variables were associated with SABA-induced SVT. CONCLUSIONS SVT is rare during hospital-based treatment for acute asthma using inhaled SABAs and has low morbidity and mortality.
Collapse
Affiliation(s)
- Stephanie Woodward
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Cindy Weng
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David G Gamboa
- Department of Pediatrics Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Michael D Johnson
- Department of Pediatrics Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
11
|
Quattrocelli A, Lang J, Davis A, Pflaumer A. Age makes a difference: Symptoms in pediatric supraventricular tachycardia. J Arrhythm 2018; 34:565-571. [PMID: 30327703 PMCID: PMC6174476 DOI: 10.1002/joa3.12103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Supraventricular tachycardia is a group of rhythm disturbances that affect 1 in 300-1200 Australian children annually. The differentiation of supraventricular tachycardia (SVT) symptoms and age of onset according to their subtype is not well understood in the pediatric population. Most studies rely on ECG criteria only to characterize the subtype of the SVT, which is not applicable to all subtypes. The purpose of this study was to identify the symptoms and ages of onset of SVT subtypes, and to analyze whether ethnicity or severity correlated with the SVT subtype confirmed in an invasive Electrophysiology (EP) study. METHODS A retrospective analysis and prospective survey evaluated 364 patients who underwent an EP study at The Royal Children's Hospital, Melbourne between 2009 and 2015. Age of onset, symptoms, and ethnicity were collected by phone survey or medical records in addition to EP study diagnostic data, medication status, and follow-up information about their symptom status following EP procedure. Patients were grouped according to their SVT subtype. Data analysis was performed using chi-squared, Fisher's exact, and ANOVA statistical tests to determine associations between SVT substrates. RESULTS Two hundred and thirty-three suitable cases of SVT were identified (131 men, 102 women) aged between 0 and 18 years. Atrioventricular Reentrant Tachycardia (AVRT) (n = 153) was the most common SVT subtype, followed by Atrioventricular Nodal Reentrant Tachycardia (AVNRT) (n = 55), Atrial Tachycardia (AT) (n = 17), and other SVT subtypes (n = 8) which included Atrial Fibrillation, Atrial Flutter, and Junctional Tachycardia. There was a male predominance in all subtypes, except for AVNRT. AVNRT patients had palpitations, dyspnoea, dizziness, and anxiety more than any other group, AVRT patients complained of vomiting most and patients with AT had the most fatigue. The mean age of symptom onset varied among groups, being earlier in AVRT, later in AVNRT with a significant difference between AVRT with unidirectional retrograde accessory pathway (URAP) and AVNRT subtypes (P < 0.01). CONCLUSION Some specific symptoms were strong discriminators between different SVT subtypes. Ethnicity did not have strong correlations with SVT subtype incidence. This study was able to show clinical differences among children with SVT due to AVRT (URAP) compared to AVNRT, allowing the prognosis and intended management of pediatric SVT to be anticipated by less invasive means.
Collapse
Affiliation(s)
- Amanda Quattrocelli
- Cardiology DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- The University of MelbourneMelbourneVictoriaAustralia
| | - Janet Lang
- Cardiology DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Andrew Davis
- Cardiology DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- The University of MelbourneMelbourneVictoriaAustralia
- Murdoch Childrens Research InstituteMelbourneVictoriaAustralia
| | - Andreas Pflaumer
- Cardiology DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- The University of MelbourneMelbourneVictoriaAustralia
- Murdoch Childrens Research InstituteMelbourneVictoriaAustralia
| |
Collapse
|
12
|
L'Italien K, Conlon S, Kertesz N, Bezold L, Kamp A. Usefulness of Echocardiography in Children with New-Onset Supraventricular Tachycardia. J Am Soc Echocardiogr 2018; 31:1146-1150. [PMID: 30076010 DOI: 10.1016/j.echo.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Supraventricular tachycardia (SVT) is the most common sustained arrhythmia in children. Infants with SVT and ventricular preexcitation (Wolff-Parkinson-White syndrome) are known to have up to 30% prevalence of congenital heart disease (CHD). Infants without ventricular preexcitation who present with SVT at <1 year of age have a similar prevalence of CHD. However, for children without ventricular preexcitation who present with SVT at older ages, the prevalence of CHD is not known. The aim of this study was to determine the prevalence of CHD in older children and adolescents presenting with SVT without ventricular preexcitation, with the goal of providing guidance regarding the usefulness of echocardiography in this patient population. METHODS Children aged 2 to 18 years presenting with confirmed SVT between January 2011 and December 2015 were included in this retrospective review. Patients with any history of ventricular preexcitation or preexisting heart disease were excluded. Medical records were reviewed, and electrocardiographic and echocardiographic findings were classified as normal, incidental, or abnormal. RESULTS Two hundred ninety patients met the inclusion criteria. Echocardiographic examinations were completed on 224 patients. Only one patient was found to have CHD, a moderate primum atrial septal defect. This patient was noted to have electrocardiographic abnormalities consistent with primum atrial septal defect. CONCLUSIONS For older children and adolescents with no known heart disease presenting with SVT without ventricular preexcitation, echocardiography may not be a necessary part of initial evaluation when the results of physical examination and electrocardiography are normal.
Collapse
Affiliation(s)
- Kaitlin L'Italien
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
| | - Steven Conlon
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Naomi Kertesz
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Louis Bezold
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Anna Kamp
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
13
|
Bahadur KA, Johnson S, Lentzner B, Gangat M, Carlson J, Balachandar S. Hypercalcemia, hyperkalemia and supraventricular tachycardia in a patient with subcutaneous fat necrosis. J Pediatr Endocrinol Metab 2018; 31:469-472. [PMID: 29373320 DOI: 10.1515/jpem-2017-0365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/01/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Subcutaneous fat necrosis (SCFN) is a rare, self-limiting condition that has been associated with several complications including hypercalcemia. CASE PRESENTATION We present the case of a 6-week-old male who presented to his pediatrician with a dime-sized erythematous nodule consistent with SCFN, who was also found to have supraventricular tachycardia (SVT). Laboratory findings revealed hypercalcemia and hyperkalemia. Extensive evaluation for the electrolyte disturbances revealed no other etiology. This case reinforces that SCFN should be considered in newborns with hypercalcemia of unknown etiology. Additionally, this case is the first to suggest a connection between SCFN and hyperkalemia. Electrolyte abnormalities can potentially contribute to arrhythmogenesis and may have triggered the arrhythmia in our patient. CONCLUSIONS Our case highlights the importance of remaining vigilant in the workup of atypical rashes of the infant, which should include early assessment of serum electrolytes.
Collapse
Affiliation(s)
- Kandy A Bahadur
- Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, Division of General Pediatrics, 125 Paterson Street, Medical Education Building 308, New Brunswick, NJ 08903, USA
| | - Stacey Johnson
- Duke University Medical Center, Department of Pediatrics, Division of Pediatric Endocrinology, Durham, NC, USA
| | - Benjamin Lentzner
- Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, Division of Pediatric Cardiology, New Brunswick, NJ, USA
| | - Mariam Gangat
- Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, Division of Pediatric Endocrinology, New Brunswick, NJ, USA
| | - Joann Carlson
- Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, Division of Pediatric Nephrology, New Brunswick, NJ, USA
| | - Sadana Balachandar
- Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, Division of Pediatric Endocrinology, New Brunswick, NJ, USA
| |
Collapse
|
14
|
Han CW, Yu HY, Shin JE, Eun HS, Lee SM, Park MS, Namgung R, Lee C, Park KI. Combination Therapies of Amiodarone and Digoxin for Refractory Supraventricular Tachycardia Accompanied by Congenital Heart Diseases in a Preterm Infant with Hydrops Fetalis. NEONATAL MEDICINE 2014. [DOI: 10.5385/nm.2014.21.1.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Chang Woo Han
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Yang Yu
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Seon Eun
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Lee
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Svintsova LI, Popov SV, Kovalev IA. Radiofrequency ablation of drug-refractory arrhythmias in small children younger than 1 year of age: single-center experience. Pediatr Cardiol 2013; 34:1321-9. [PMID: 23389099 DOI: 10.1007/s00246-013-0643-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 01/23/2013] [Indexed: 11/25/2022]
Abstract
The use of radiofrequency ablation (RFA) for the management of supraventricular tachycardia (SVT) in infants and small children remains controversial. The aim of this study was to evaluate the safety and efficacy of RFA in critically ill small children (<1 year of age) with drug-resistant tachycardia accompanied by arrhythmogenic cardiomyopathy and heart failure. The study included 15 patients age 5.3 ± 3.7 months. Wolff-Parkinson-White syndrome and atrial tachycardia were detected in eight (53.3 %) and seven (46.7 %) of patients, respectively. Patients with structural heart pathology, including congenital heart diseases and laboratory-confirmed myocarditis, were excluded from the study. Indications for RFA included drag-refractory SVT accompanied by arrhythmogenic cardiomyopathy and heart failure. Unsuccessful ablation was observed in two 1-month-old patients who underwent successful ablation 3 months later. The follow-up period ranged from 0.5 to 8 years (average 3.9). Only one patient (6.7 %) had tachycardia recurrence 1 month after RFA. The short- and long-term RFA success rates were 86.7 and 93.3 %, respectively. The study did not show any procedure-related complications. Heart failure disappeared within 5-7 days. Complete normalization of heart chamber sizes was documented within 1 month after effective RFA. A three-dimensional CARTO system (Biosense Webster, Inc., USA) was used in three patients with body weight >7 kg. The use of the CARTO system resulted in a remarkable decrease of the fluoroscopy time without vascular injury or other procedure-related complications in all cases. Our study suggests that RFA may be considered the method of choice for SVT treatment in small children when drug therapy is ineffective and arrhythmogenic cardiomyopathy progresses.
Collapse
Affiliation(s)
- Liliya I Svintsova
- Federal State Budgetary Institution "Research Institute for Cardiology" of Siberian Branch Under the Russian Academy of Medical Sciences, 111A Kievskaya Street, Tomsk, Russia.
| | | | | |
Collapse
|
16
|
Chêne MA, Parlier G, Denis J, Siret D. Tachycardie supraventriculaire simultanée chez des jumeaux monozygotes prématurés. Arch Pediatr 2013; 20:192-5. [DOI: 10.1016/j.arcped.2012.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/05/2012] [Accepted: 11/08/2012] [Indexed: 11/15/2022]
|
17
|
Carey HV, Martin SL, Horwitz BA, Yan L, Bailey SM, Podrabsky J, Storz JF, Ortiz RM, Wong RP, Lathrop DA. Elucidating nature's solutions to heart, lung, and blood diseases and sleep disorders. Circ Res 2012; 110:915-21. [PMID: 22461362 DOI: 10.1161/circresaha.111.255398] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Evolution has provided a number of animal species with extraordinary phenotypes. Several of these phenotypes allow species to survive and thrive in environmental conditions that mimic disease states in humans. The study of evolved mechanisms responsible for these phenotypes may provide insights into the basis of human disease and guide the design of new therapeutic approaches. Examples include species that tolerate acute or chronic hypoxemia like deep-diving mammals and high-altitude inhabitants, as well as those that hibernate and interrupt their development when exposed to adverse environments. The evolved traits exhibited by these animal species involve modifications of common biological pathways that affect metabolic regulation, organ function, antioxidant defenses, and oxygen transport. In 2006, the National Heart, Lung, and Blood Institute released a funding opportunity announcement to support studies that were designed to elucidate the natural molecular and cellular mechanisms of adaptation in species that tolerate extreme environmental conditions. The rationale for this funding opportunity is detailed in this article, and the specific evolved mechanisms examined in the supported research are described. Also highlighted are past medical advances achieved through the study of animal species that have evolved extraordinary phenotypes as well as the expectations for new understanding of nature's solutions to heart, lung, blood, and sleep disorders through future research in this area.
Collapse
Affiliation(s)
- Hannah V Carey
- Department of Comparative Biosciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Deep nasopharyngeal aspiration as a treatment option for conversion of supraventricular paroxysmal tachycardia in infants: First experiences. Pediatr Crit Care Med 2011; 12:e402-3. [PMID: 21116208 DOI: 10.1097/pcc.0b013e3181fe3417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Supraventricular paroxysmal tachycardias are the most common paroxysmal rhythm disorders in childhood. Atypical clinical presentations as well as their ability to induce hemodynamic deterioration imply necessity for arrhythmia rapid termination during the first months of life. The objective of this article was to evaluate the efficiency of deep nasopharyngeal aspiration as a potential vagal maneuver for supraventricular paroxysmal tachycardias termination. DESIGN Clinical trial. PATIENTS AND METHODS From June 2005 to October 2009, a total of eight infants, who were admitted at our institutions and diagnosed to have supraventricular paroxysmal tachycardias, were analyzed. To terminate supraventricular paroxysmal tachycardias "diving" reflex was initially tried and in the cases of its inefficacy, deep nasopharyngeal aspiration was performed. MAIN RESULTS Nasopharyngeal aspiration successfully converted arrhythmia in three infants (37.5%). CONCLUSIONS Deep nasopharyngeal aspiration could be an alternative vagal maneuver for infants with supraventricular paroxysmal tachycardia.
Collapse
|
19
|
Yildirim SV, Tiker F, Cengiz N, Kiliçdağ H. Recurrent supraventricular tachycardia in a newborn treated with amiodarone: is hyperkalemia the apparent cause? Pediatr Cardiol 2005; 26:879-80. [PMID: 16235017 DOI: 10.1007/s00246-005-1043-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Supraventricular tachycardia (SVT) is the most common type of arrhythmia observed in children, especially in newborns. Infants with severe SVT must be treated immediately with first-line drugs such as amiodarone. There are some minor and major side effects of amiodarone in this patient group, but no associated electrolyte disorders have been observed. This report describes a newborn whose recurrent SVT attacks during amiodarone treatment were suspected to have been caused by hyperkalemia.
Collapse
Affiliation(s)
- S V Yildirim
- Division of Pediatric Cardiology, Baskent University, Adana Teaching and Medical Research Center, Kurtuluş Mah. 13.sk. Egemert Apt., Kat: 3, Daire No: 7, Adana, Turkey.
| | | | | | | |
Collapse
|
20
|
|