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Management of supraventricular tachycardia in children

Author
Anne M Dubin, MD
Section Editor
John K Triedman, MD
Deputy Editor
Carrie Armsby, MD, MPH

INTRODUCTION

Supraventricular tachycardia (SVT) can be defined as an abnormally rapid heart rhythm originating above the ventricles, often (but not always) with a narrow QRS complex; it conventionally excludes atrial flutter and atrial fibrillation [1].

The management of SVT in children will be reviewed here. Two major issues will be addressed: acute management to terminate the arrhythmia, and chronic therapy to prevent recurrence. The clinical features of the different types of SVT are discussed separately. (See "Supraventricular tachycardia in children: AV reentrant tachycardia (including WPW) and AV nodal reentrant tachycardia".)

ACUTE MANAGEMENT

Acute management of the child who presents with SVT can be a challenge because the exact mechanism of the tachycardia often is unknown. The treatment strategy depends upon the patient's presentation and clinical status (hemodynamically stable or unstable). The approach consists of initiating therapy while continuing to assess the patient's condition (table 1). The following discussion is generally in agreement with the 2010 Pediatrics Advanced Life Support (PALS) guidelines developed by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) (algorithm 1) [2]. The AHA/ILCOR guidelines were updated in 2015; however, the guidelines for tachyarrhythmias remained unchanged [3].

Hemodynamic assessment and monitoring — An infant or child who presents with a tachyarrhythmia should have an immediate hemodynamic assessment and a 15-lead electrocardiogram (ECG) (12 standard leads plus leads V3R and V4R [right sided leads analogous to V3 and V4 on the left] and V7 [left posterior axillary line at V4 level]). Continuous ECG monitoring during therapeutic maneuvers provides insight into the cause of tachycardia and helps in the planning of chronic therapy.

The most important initial clinical determination to make in children presenting with a tachyarrhythmia is whether signs and symptoms related to the rapid heart rate are present. These include hypotension, heart failure, and signs of shock, pallor, or decreased level of consciousness. Signs in infants may include irritability, tachypnea, and poor feeding.

                             

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Literature review current through: Nov 2016. | This topic last updated: Fri Aug 26 00:00:00 GMT 2016.
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