Tachycardia In Infants Research Articles

Epidemiology of Postoperative Junctional Ectopic Tachycardia in Infants Undergoing Cardiac Surgery

BackgroundJunctional ectopic tachycardia (JET) complicates congenital heart surgery in 2% to 8.3% of cases. JET is associated with postoperative morbidity in single-center studies. We used the Pediatric Cardiac Critical Care Consortium data registry to provide a multicenter epidemiologic description of treated JET. MethodsThis is a retrospective study (February 2019-August 2022) of patients with treated JET. Inclusion criteria were (1) <12 months old at the index operation, and (2) treated for JET <72 hours after surgery. Diagnosis was defined by receiving treatment (pacing, cooling, and medications). A multilevel logistic regression analysis with hospital random effect identified JET risk factors. Impact of JET on outcomes was estimated by margins/attributable risk analysis using previous risk-adjustment models. ResultsAmong 24,073 patients from 63 centers, 1436 (6.0%) were treated for JET with significant center variability (0% to 17.9%). Median time to onset was 3.4 hours, with 34% present on admission. Median duration was 2 days (interquartile range, 1-4 days). Tetralogy of Fallot, atrioventricular canal, and ventricular septal defect repair represented >50% of JET. Patient characteristics independently associated with JET included neonatal age, Asian race, cardiopulmonary bypass time, open sternum, and early postoperative inotropic agents. JET was associated with increased risk-adjusted durations of mechanical ventilation (incidence rate ratio, 1.6; 95% CI, 1.5-1.7) and intensive care unit length of stay (incidence rate ratio, 1.3; 95% CI, 1.2-1.3), but not mortality. ConclusionsJET is treated in 6% of patients with substantial center variability. JET contributes to increased use of postoperative resources. High center variability warrants further study to identify potential modifiable factors that could serve as targets for improvement efforts to ameliorate deleterious outcomes.

Assessing the Risk of Hypoglycemia Secondary to Propranolol Therapy for the Treatment of Supraventricular Tachycardia in Infants

Supraventricular tachycardia (SVT) is the most common arrhythmia among infants. Prevention of SVT is frequently managed through propranolol therapy. Hypoglycemia is a known adverse effect of propranolol therapy, but little research has been done on the incidence and risk of hypoglycemia in treatment of SVT in infants with propranolol. This study attempts to offer insight into the risk of hypoglycemia associated with propranolol therapy when treating infantile SVT to help inform future glucose screening guidelines. We conducted a retrospective chart review of infants treated with propranolol in our hospital system. Inclusion criteria were infants < 1year of age who received propranolol for the treatment of SVT. A total of 63 patients were identified. Data was collected on sex, age, race, diagnosis, gestational age, nutrition source (Total Parenteral Nutrition (TPN) vs oral), weight (kg), weight for length (kg/cm), propranolol dose (mg/kg/day), comorbidities, and whether or not a hypoglycemic event was identified (< 60mg/dL). Hypoglycemic events were identified in 9/63 (14.3%) patients. Of the patients with hypoglycemic events, 9/9 (88.9%) had comorbid conditions. Patients with hypoglycemic events had significantly lower weight and propranolol dose than those without hypoglycemic events. Weight for length also tended to increase risk for hypoglycemic events. The high incidence of comorbid conditions in the patients who had hypoglycemic events suggests that hypoglycemic monitoring may only be necessary in patients with conditions predisposing to hypoglycemia.

Multicenter cohort study on duration of antiarrhythmic medication for supraventricular tachycardia in infants

Antiarrhythmic medication (AM) is commonly used to prevent supraventricular tachycardia (SVT) recurrence in infants. Our aim was to determine whether a shorter duration of AM is sufficient to prevent atrioventricular reentrant tachycardia (AVRT) recurrence and evaluate risk factors for recurrence of SVT after discontinued AM.This multicenter cohort study included all infants diagnosed with SVT in the five university hospitals in Finland between 2005 and 2017. Those diagnosed between 2005 and 2012 received AM for 12 months (group 1), and those diagnosed between 2013 and 2017 received AM for 6 months (group 2). A total of 278 infants presented with AVRT (group 1, n = 181; group 2, n = 97), and the median AM duration was 12.0 months (interquartile range [IQR] 11.4–13.4) and 7.0 months (IQR 6.0–10.2), respectively. Propranolol was the most frequently used first-line AM (92% and 95%). Recurrence-free survival rates were over 88% until 12 months after AM prophylaxis in both groups, without any statistically significant difference between them. Independent risk factors for recurrence of SVT after discontinuation of AM were need of combination AM (HR 2.2, 95% CI 1.14–4.20), Wolff-Parkinson-White (WPW) syndrome (HR 2.4, 95% CI 1.25–4.59), and age over 1 month at admission (HR 2.2, 95% CI 1.12–4.48). Conclusion: Shortening AM duration in infants from 12 to 6 months does not seem to lead to more frequent SVT recurrence. The risk factors for recurrence of SVT were WPW syndrome, need of combination AM, and age over 1 month.What is Known:• Despite the evidence of spontaneous resolution of supraventricular tachycardia episodes in infants, the antiarrhythmic medication is often continued for up to twelve months.• The optimal approach for duration of antiarrhythmic medication remains unknown..What is New:• Shortening the duration of antiarrhythmic medication in infants with supraventricular tachycardia does not seem to increase the risk of subsequent recurrence.• Infants whose arrhythmia was successfully controlled with monotherapy were the group least likely to have recurrence after discontinuation of antiarrhythmic medication.

Ectopic Atrial Tachycardia in Infants Following Congenital Heart Disease Surgery.

Although ectopic atrial tachycardia (EAT) is common following surgery for congenital heart disease (CHD), there are limited data regarding this arrhythmia. This study assessed risk factors and outcomes for patients less than one year of age with post-operative EAT. This was a retrospective analysis of infants undergoing CHD surgery from 2007 to 2020. Patients and surgeries with EAT were compared to controls without EAT. Out of 5372 infant CHD surgeries, EAT developed in 129 (2.5%). Compared to controls, the EAT cohort was younger (median 7 vs 85days, p < 0.01), weighed less at time of surgery (3.3 vs 4.2kg, p < 0.01), and was more likely to have DiGeorge syndrome (7.7% vs 3.0%, p < 0.01). Multivariate analysis revealed total anomalous venous connection (TAPVC) repair (odds ratio [OR] 2.8; 95% confidence interval 1.5-5.2), DiGeorge syndrome (OR 2.4; 1.1-5.2), Society of Thoracic Surgeons-European Association for Cardio-Thoracic surgery (STAT) category ≥ 4 (OR 2.1; 1.0-4.4), and longer cardiopulmonary bypass times (OR 1.1; 1.0-1.2) as independent risk factors for EAT. The onset of EAT occurred a median of 9days (IQR 5-14days) after CHD surgery. Antiarrhythmic treatment was initiated in 109/129 patients (84%) with propranolol (71%) and amiodarone (24%) the most commonly used medications. Although 15 (11.6%) patients did not survive to hospital discharge, EAT was not directly implicated in any deaths. EAT occurred after 2.5% of infant CHD surgeries. In addition to TAPVC repair, longer and more complex surgeries were associated with an increased the risk for the development of post-operative EAT.

Left ventricular dysfunction in a child with asymptomatic pre-excitation: Cure with catheter ablation

Wolff-Parkinson-White syndrome, is known to cause left ventricular dysfunction or dilated cardiomyopathy secondary to sustained tachycardia in infants and children. However, left ventricular dysfunction secondary to pre-excitation related abnormal ventricular activation has been reported in a limited number of cases. This condition should be recognized early, as catheter ablation of the accessory pathway can permit rapid ventricular function improvement. In this paper, we present a 2.5-year-old patient diagnosed with tachycardia-free Wolff-Parkinson-White syndrome with a right free wall accessory pathway and depressed cardiac function, whose left ventricular function is completely restored after successful catheter cryoablation.

Permanent Junctional Reciprocating Tachycardia in Infants from Myocarditis-like Presentation to Simple Tachycardia: A Case Series

Permanent Junctional Reciprocating Tachycardia (PJRT) is a rare type of supraventricular tachycardia. It can be misdiagnosed and hence under-treated in infants and children, leading to significant cardiac morbidities and mortalities. We describe four cases of young infants who presented with a wide range of clinical scenarios from neonatal tachycardia to overtly decompensated heart failure, all caused by PJRT. All cases showed complete recovery with appropriate medical treatment. In this case series, we aim to discuss the diversity of clinical presentations, and the challenges surrounding the diagnosis, management, and prognosis. To achieve this aim, we have also performed a detailed literature review and reflected on our cases presented to our center between 2016 to 2020. PJRT is rare; it is often missed or diagnosed late in the presentation. Hence, the key is to keep it in mind in infants presenting with acute cardiac problems from simple tachycardia to a myocarditis-like presentation. Anti-arrhythmic medications are safe and effective as first-line therapy for PJRT in neonates and infants. They can prevent or delay the need for invasive cardiac ablation, which is more challenging in these age groups and should be considered in cases refractory to medical treatment.

Incidence and Related Risk Factors of Junctional Ectopic Tachycardia in Infants after Cardiac Surgery for Congenital Heart Disease

Objective: Junctional ectopic tachycardia is common after cardiac surgery for congenital heart disease. However, its incidence and related risk factors in infants after cardiac surgery are not well known. The objective of this study was to determine the overall incidence and related risk factors for junctional ectopic tachycardia in neonates and infants. Methods: We enrolled a total of 271 patients aged

Radiofrequency catheter ablation for supraventricular tachycardia in a paediatric population: characteristics of tachycardia mechanisms in a subpopulation with early onset.

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. 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. 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. 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.

224 Ivabradine, a Safe and Effective Monotherapy in the Treatment of Congenital Junctional Tachycardia in Infancy

224 Ivabradine, a Safe and Effective Monotherapy in the Treatment of Congenital Junctional Tachycardia in Infancy

Junctional ectopic tachycardia in infants and children.

Tachyarrhythmias originating in the atrioventricular (AV) node and AV junction including the bundle of His complex (BH) are called junctional tachycardia (JT) or junctional ectopic tachycardia (JET). Congenital JET (CJET) is a rare arrhythmia that occurs in patients without a preceding cardiac surgery and can be refractory to medical therapy and associated with high morbidity and mortality. CJET has a high rate of morbidity and mortality with death occurring in 35% of cases. JET occurring within 72 hours after cardiac surgery is referred to as postoperative JET (POJET) and caused by direct trauma, ischemic, or stretch injury to the AV conduction tissues during surgical repair of congenital heart defects. Focal junctional tachycardia (FJT) is also known as automatic junctional tachycardia and includes paroxysmal or non‐paroxysmal forms. We discuss a staged approach to therapy with improved pharmacological therapies and the use of catheter‐based therapies.

New therapeutic option for junctional ectopic tachycardia in infants following congenital heart surgery: ivabradine, a case report

Junctional ectopic tachycardia (JET) is the most common tachyarrhythmia that appears mostly during the immediate postoperative period of congenital heart surgery. Patients who develop JET have increased mortality and morbidity. Despite the availability of different antiarrhythmic treatments, management of JET is still challenging. We report a case of reversing of malignant JET following congenital heart surgery with the use of oral Ivabradine, after the failure of all the others treatment options of JET. Ivabradine is a drug used in adult practice to lower heart rate in heart failure and angina. Our case report may provide hope that Ivabradine may be a new therapeutic option for JET in infants following congenital heart surgery.

Fascicular tachycardia in infancy and the use of verapamil: a case series and literature review

ObjectiveGuidelines state that verapamil is contraindicated in infants. This is based on reports of cardiovascular collapse and even death after rapid intravenous administration of verapamil in infants with supraventricular tachycardia...

Permanent junctional reciprocating tachycardia in infants and Children.

Permanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular tachycardia (SVT). It generally presents in infants but can be difficult to diagnose. The characteristic EKG findings, response to Adenosine and persistence or frequent recurrences are helpful in making the diagnosis. It is usually difficult to manage with the initial and single medications used in SVT. Many patients are misdiagnosed and not treated effectively and end up having end stage cardiomyopathy and are diagnosed in patients referred for transplant. Hence all patients referred for a cardiac transplant with dilated cardiomyopathy need to be evaluated for this arrhythmia. If appropriate treatment is started early in the course, the failure can be ameliorated, and the cardiomyopathy can be resolved.

Nadolol for Treatment of Supraventricular Tachycardia in Infants and Young Children.

Supraventricular tachycardia (SVT) is a common infant arrhythmia, for which beta-blockers are frequently chosen as therapy. Propranolol is a common choice though it is dosed every 6-8h. We reviewed the clinical results of treating infant SVT with an extemporaneous preparation of nadolol. Retrospective cohort study of patients under 2years old receiving nadolol for SVT at a single center. Patients were ascertained by patient and pharmacy databases. Twenty-eight infants received nadolol, of whom 25 had regular narrow complex tachycardia, 2 atrial flutter, and 1 focal atrial tachycardia. Patient age at initiation was a median 54days (range 10-720). The final dose was 1mg/kg/day in 22/28 patients (range 0.5-2). Once-daily dosing was used in 20 patients (71.4%); dosing was BID in 7, TID in 1. Among regular narrow complex tachycardia patients, 18/25 received nadolol monotherapy and 7 required additional agents; flecainide in 6, digoxin in 1. The median age of tachyarrhythmia onset was 18days (range 1-180) with a median age of nadolol initiation of 30days (range 11-390). Of the 20 regular narrow complex tachycardia patients initiated on nadolol monotherapy, 85% had no recurrences as of 1-year follow-up. Side effects were suspected in 3 of 28 (10.7%), including wheezing (n=1, 3.5%), irritability and diarrhea (n=1, 3.5%), and bradycardia (n=1, 3.5%). Oral nadolol suspension was a successful treatment for SVT in 85% of patients with minimal adverse effects. Single daily dosing was used in the majority of patients.

Radiofrequency Catheter Ablation of Accessory Atrioventricular Pathways in Infants and Toddlers≤15kg.

Accessory atrioventricular pathways (AP) are the most common substrate for paroxysmal supraventricular tachycardia in infants and small children. Up-to-date data on AP ablation in infants and small children are limited. The aim of the present study was to gain additional insight into radiofrequency (RF) catheter ablation of AP in infants and toddlers focusing on efficacy and safety in patients with a body weight of≤15kg. Since 10/2002, RF ablation of AP was performed in 281 children in our institution. Indications, procedural data as well as success and complication rates in children with a body weight≤15kg (n=22) were compared with children>15kg (n=259). Prevalence of structural heart anomalies was significantly higher among children≤15kg (27 vs. 5.7%; p=0.001). Procedure duration (median 262 vs. 177min; p=0.001) and fluoroscopy time (median 20.6 vs. 14.0min; p=0.007) were significantly longer among patients≤15kg. Procedural success rate did not differ significantly between the two groups (82 vs. 90%). More RF lesions were required for AP ablation in the smaller patients (median 12 vs. 7; p=0.019). Major complication rate was significantly higher in children≤15kg (9 vs. 1.1%; p=0.05) with femoral vessel occlusion being the only major adverse event in patients≤15kg. Catheter ablation of AP in children was effective irrespective of body weight. In children≤15kg, however, procedures were more challenging and time-consuming. Complication rate and number of RF lesions in smaller children were higher when compared to older children.

Retraction Note: Adenosine triphosphate treatment for supraventricular tachycardia in infants.

Retraction Note to: Eur J Pediatr (1994) 153:668-671 DOI 10.1007/BF02190689. This article, "Adenosine triphosphate treatment for supraventricular tachycardia in infants", published in the European Journal of Pediatrics (1994) 153/9: 668-671, Springer-Verlag 1994, has been retracted at the request of the Publisher as it is a duplicate of the paper "Adenosine-tri-phosphate treatment for supraventricular tachycardia in infants", that has been published with further corrections in Vol. 153/11: 793-796, of the same journal.

Clinical study of idiopathic left ventricular tachycardia in infants and young children

Objective To analyze the clinical manifestations, diagnosis and treatment of idiopathic left ventricular tachycardia(ILVT) in infants and young children. Methods The clinical data, including manifestations, lab results and treatments of 37 cases of ILVT in infants and young children were analyzed retrospectively. Results ILVT were seen more in young children older than 1 year old and male infants.A total of 37 cases with ILVT showed diverse clinical manifestations, 5 children had cardiac insufficiency with oliguria and edema, 2 children had syncope.There were 8 children without any symptoms, and 22 children had some symptoms, which mainly included agitation and crying, weakness and sweaty, vomitting and pale complexion.Holter showed incessant ILVT in 20 cases(54.1%), and paroxysmal in 17 cases(45.9%). Of the 37 cases, 9 cases presented tachycardia-induced cardiomyopathy(TIC), 8 of them were secondary to the incessant ILVT.Children with TIC compared with those without TIC, the ventricular rate were faster[(206.2±38.7) beats/min vs.(171.8±38.7)beats/min, P<0.05], the duration were longer[(22.6±15.3)days vs.(9.8±6.0)days, P<0.05]. A total of 34 cases were given by antiarrhythmic drugs, verapamil was higher effective in reversion to sinus rhythm.Radiofrequency ablations were conducted in 8 cases, resulting in ventricular tachycardia elimination.All of children were fine during following up periods.After successful control of tachycardia, left ventricular end-diastolic diameter and left ventricular ejection fraction in patients with TIC gradually recovered[(35.4±7.2)mm vs.(28.9±5.6)mm, P<0.05; (46.7±4.0)% vs.(70.1±1.5)%, P<0.01]. Conclusion ILVT in infants and young children are rare, and present different manifestions.An incessant ILVT with faster ventricular rate and longer duration are more frequently complicated by TIC.Radiofrequency ablation is the effective way of radical cure of the disease.The diagnosis and treatment for the tachycardia are particularly important in early time, and the prognosis are good. Key words: Children; Idiopathic left ventricular tachycardia; Tachycardia-induced cardiomyopathy; Treatment,

Treatment of supraventricular tachycardia in infants: Analysis of a large multicenter database

ObjectiveSupraventricular tachycardia (SVT) is the most common arrhythmia in infants. Infants are typically treated with antiarrhythmic medications, but there is a lack of evidence guiding management, thus exposing infants to risks of both inadequate therapy and medication adverse events. We used data from a large clinical database to better understand current practices in SVT management, safety of commonly used medications, and outcomes of hospitalized infants treated for SVT. MethodsThis retrospective data analysis included all infants discharged from Pediatrix Medical Group neonatal intensive care units between 1998 and 2012 with a diagnosis of SVT who were treated with antiarrhythmic medications. We categorized infants by the presence of congenital heart disease other than patent ductus arteriosus. Medications were categorized as abortive, acute, or secondary prevention therapies. We used descriptive statistics to describe medication use, adverse events, and outcomes including SVT recurrence and mortality. ResultsA total of 2848 infants with SVT were identified, of whom 367 (13%) had congenital heart disease. Overall, SVT in-hospital recurrence was high (13%), and almost one fifth of our cohort (18%) experienced an adverse event. Mortality was 2% in the overall cohort and 6% in the congenital heart disease group (p<0.001). Adenosine was the most commonly used abortive therapy, but there was significant practice variation in therapies used for acute treatment and secondary prevention of SVT. Conclusion and practice implicationSignificant variation in SVT treatment and suboptimal outcomes warrant future clinical trials to determine best practices in treating SVT in infants.

A case of resistant supraventricular tachycardia in infancy period

Supraventricular tachycardia is the most common cause of symptomatic tachycardia in infancy and childhood. The most commonly occurs due to accessory pathway. Clinical symptoms are more severe in the neonatal period than childhood period, and sign of heart failure may be seen. Therefore urgent treatment is required. Most of these cases can be controlled with medical therapy; catheter ablation may be very rarely required. A 34 days old patient with supraventricular tachycardia which cannot be controlled with classical therapy is presented.

Radiofrequency Catheter Ablation for Dyssynchrony-induced Dilated Cardiomyopathy in an Infant

The relationship between accessory pathway-mediated ventricular preexcitation and left ventricular dyssynchrony-induced dysfunction has been described in patients with Wolff-Parkinson-White (WPW) syndrome in the absence of sustained supraventricular tachycardia (SVT). Supraventricular tachycardia in infants is usually successfully suppressed with antiarrhythmic medications, but catheter ablation has ultimately been required as definitive treatment in medically resistant cases. Catheter ablation has not been described in young infants for dyssynchrony-related dilated cardiomyopathy in the absence of SVT. We describe a case of an infant with WPW who did not have sustained supraventricular tachycardia, but who developed rapid progression of ventricular dysfunction after birth. Preexcitation could not be medically suppressed but was successfully ablated. This was followed by complete resolution of ventricular dysfunction within 2 months.