Management of Tachyarrhythmias in Children

Abstract

Management of tachycardia in children depends on the accurate characterization of the origin and mechanism of the rhythm, which can usually be achieved using noninvasive tests such as an electrocardiogram, Holter or cardiac event monitoring. Supraventricular tachycardia (SVT), the most common tachyarrhythmia in children, is most often due to an accessory pathway or dual AV nodal pathways. Adenosine and vagal maneuvers are useful to diagnose and terminate an acute event. Long-term management options include prophylactic drug therapy (aimed at suppressing the tachyarrhythmia) and catheter ablation. Ablation for SVT is highly successful with a low complication rate, and is first-line therapy in older patients. Ventricular arrhythmias are fortunately uncommon in children with normal hearts, and are seen primarily in the setting of abnormal myocardium and inherited ion channel defects. Management options for ventricular rhythms include drugs, catheter ablation and implantable cardioverter-defibrillators (ICDs). ICDs are indicated in patients with a risk of sudden death due to an arrhythmia.