Abstract
Three children with accelerated ventricular rhythms (AVR), ages 12, 14 and 15 years, were evaluated. Symptoms included chest pain (2 patients) and dizziness (1 patient). Chest x-rays were normal; EGG revealed normal axis, voltage and QT interval in sinus rhythm. Echocardiogram revealed only mitral valve prolapse (in 2 patients with chest pain). Exercise testing resulted in suppression of AVR in all patients. Holter monitor revealed multiple runs of nonsustained AVR in all patients (rate 70, 80, and 130 bpm). The QRS demonstrated a LBBB pattern in all patients (2 with RAD). Isoproterenol infusion resulted in suppression of fast AVR in one patient, while it resulted in acceleration in both patients with slow AVR (rate 110 and 130 bpm after infusion). Thus, all 3 patients demonstrated VT (rate >100 bpm). Electrophysiologic testing including programmed ventricular stimulation, revealed normal conduction systems and no inducible VT. Overdrive suppression of AVR was possible. Earliest endocardial activation was in the RVOT in 2 patients. Propranolol resulted in AVR suppression in 2 patients, exacerbation in 1. Verapamil and procainamide resulted in AVR suppression in 2 patients to whom the drugs were given. Monomorphic VT in children with normal myocardium is a subset of VT with a unique mechanism and variable pharmacologic response. Prognosis is probably good.
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