UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Supraventricular tachycardia in children: AV reentrant tachycardia (including WPW) and AV nodal reentrant tachycardia

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 two most common forms of SVT in children are atrioventricular reentrant tachycardia (AVRT), including the Wolff-Parkinson-White (WPW) syndrome, and atrioventricular nodal reentrant tachycardia (AVNRT).

SVT in children including the clinical features and diagnosis of AVRT and AVNRT will be reviewed here. The causes of atrial flutter and atrial fibrillation are discussed separately. (See "Epidemiology of and risk factors for atrial fibrillation" and "Overview of atrial flutter".)

EPIDEMIOLOGY

The prevalence of supraventricular tachycardia (SVT) is not well defined, but is estimated to be between 1 in 250 and 25,000 children, and is the most common rhythm disturbance in children [2,3]. The prevalence is much higher in critically ill children and adults with congenital or acquired heart disease treated in a pediatric cardiac intensive care unit. In one series of 789 admissions of 629 patients aged 1 day to 45 years, arrhythmias occurred in 29 percent [4]. The most common arrhythmias were nonsustained ventricular tachycardia and SVT, occurring in 18 and 13 percent of admissions, respectively.

The majority of patients with SVT have structurally normal hearts. The two most common forms of SVT in children are atrioventricular reentrant tachycardia (AVRT), including the Wolff-Parkinson-White (WPW) syndrome, and atrioventricular nodal reentrant tachycardia (AVNRT). The relative frequency of these arrhythmias was assessed in a report of 137 infants, children, and adolescents who underwent careful electrophysiologic (EP) testing; AVRT accounted for 73 percent and AVNRT for 13 percent [5]. The remaining 14 percent were due to primary atrial tachycardias.

A similar distribution of causes was noted in another report of 346 patients (mean age 14 years) who had undergone radiofrequency catheter ablation for an arrhythmia [6]. AVRT and AVNRT accounted for 72 and 9 percent, respectively, with various other arrhythmias comprising the remaining 19 percent.

                      

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Sep 16 00:00:00 GMT 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Josephson ME, Wellens HJ. Differential diagnosis of supraventricular tachycardia. Cardiol Clin 1990; 8:411.
  2. Keith JD, Rowe RD, Vlad P. Heart Disease in Infancy and Childhood, Macmillan, New York 1967. p.1056.
  3. Ludomirsky A, Garson A Jr. Supraventricular tachycardia. In: Pediatric Arrhythmias: Electrophysiology and Pacing, Gillette PC, Garson, A Jr (Eds), WB Saunders, Philadelphia 1990. p.380.
  4. Hoffman TM, Wernovsky G, Wieand TS, et al. The incidence of arrhythmias in a pediatric cardiac intensive care unit. Pediatr Cardiol 2002; 23:598.
  5. Ko JK, Deal BJ, Strasburger JF, Benson DW Jr. Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardiol 1992; 69:1028.
  6. Tanel RE, Walsh EP, Triedman JK, et al. Five-year experience with radiofrequency catheter ablation: implications for management of arrhythmias in pediatric and young adult patients. J Pediatr 1997; 131:878.
  7. Weindling SN, Saul JP, Walsh EP. Efficacy and risks of medical therapy for supraventricular tachycardia in neonates and infants. Am Heart J 1996; 131:66.
  8. Perry JC, Garson A Jr. Supraventricular tachycardia due to Wolff-Parkinson-White syndrome in children: early disappearance and late recurrence. J Am Coll Cardiol 1990; 16:1215.
  9. Deal BJ, Keane JF, Gillette PC, Garson A Jr. Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up. J Am Coll Cardiol 1985; 5:130.
  10. Giuliani ER, Fuster V, Brandenburg RO, Mair DD. Ebstein's anomaly: the clinical features and natural history of Ebstein's anomaly of the tricuspid valve. Mayo Clin Proc 1979; 54:163.
  11. Smith WM, Gallagher JJ, Kerr CR, et al. The electrophysiologic basis and management of symptomatic recurrent tachycardia in patients with Ebstein's anomaly of the tricuspid valve. Am J Cardiol 1982; 49:1223.
  12. Perry JC. Supraventricular tachycardia. In: Science and Practice of Pediatric Cardiology, 2nd, Garson A Jr, Bricker JT, Fisher DJ, Neish SR (Eds), Williams and Wilkins, Baltimore 1998. p.2059.
  13. Kugler JD, Danford DA, Deal BJ, et al. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. The Pediatric Electrophysiology Society. N Engl J Med 1994; 330:1481.
  14. Kugler JD, Danford DA. Management of infants, children, and adolescents with paroxysmal supraventricular tachycardia. J Pediatr 1996; 129:324.
  15. Krahn AD, Manfreda J, Tate RB, et al. The natural history of electrocardiographic preexcitation in men. The Manitoba Follow-up Study. Ann Intern Med 1992; 116:456.
  16. Sano S, Komori S, Amano T, et al. Prevalence of ventricular preexcitation in Japanese schoolchildren. Heart 1998; 79:374.
  17. Fitzsimmons PJ, McWhirter PD, Peterson DW, Kruyer WB. The natural history of Wolff-Parkinson-White syndrome in 228 military aviators: a long-term follow-up of 22 years. Am Heart J 2001; 142:530.
  18. Gillette PC, Garson A Jr, Kugler JD. Wolff-Parkinson-White syndrome in children: electrophysiologic and pharmacologic characteristics. Circulation 1979; 60:1487.
  19. Dorostkar PC, Silka MJ, Morady F, Dick M 2nd. Clinical course of persistent junctional reciprocating tachycardia. J Am Coll Cardiol 1999; 33:366.
  20. Wren C. Incessant tachycardias. Eur Heart J 1998; 19 Suppl E:E32.
  21. Cruz FE, Cheriex EC, Smeets JL, et al. Reversibility of tachycardia-induced cardiomyopathy after cure of incessant supraventricular tachycardia. J Am Coll Cardiol 1990; 16:739.
  22. Sung RJ, Waxman HL, Saksena S, Juma Z. Sequence of retrograde atrial activation in patients with dual atrioventricular nodal pathways. Circulation 1981; 64:1059.
  23. McGuire MA, Bourke JP, Robotin MC, et al. High resolution mapping of Koch's triangle using sixty electrodes in humans with atrioventricular junctional (AV nodal) reentrant tachycardia. Circulation 1993; 88:2315.
  24. Van Hare GF, Chiesa NA, Campbell RM, et al. Atrioventricular nodal reentrant tachycardia in children: effect of slow pathway ablation on fast pathway function. J Cardiovasc Electrophysiol 2002; 13:203.
  25. Silka MJ, Kron J, Halperin BD, McAnulty JH. Mechanisms of AV node reentrant tachycardia in young patients with and without dual AV node physiology. Pacing Clin Electrophysiol 1994; 17:2129.
  26. Cain N, Irving C, Webber S, et al. Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood. Am J Cardiol 2013; 112:961.
  27. Garson A Jr, Gillette PC, McNamara DG. Supraventricular tachycardia in children: clinical features, response to treatment, and long-term follow-up in 217 patients. J Pediatr 1981; 98:875.
  28. Gilljam T, Jaeggi E, Gow RM. Neonatal supraventricular tachycardia: outcomes over a 27-year period at a single institution. Acta Paediatr 2008; 97:1035.
  29. Paul T, Guccione P, Garson A Jr. Relation of syncope in young patients with Wolff-Parkinson-White syndrome to rapid ventricular response during atrial fibrillation. Am J Cardiol 1990; 65:318.
  30. Harahsheh A, Du W, Singh H, Karpawich PP. Risk factors for atrioventricular tachycardia degenerating to atrial flutter/fibrillation in the young with Wolff-Parkinson-White. Pacing Clin Electrophysiol 2008; 31:1307.
  31. Friedman RA, Walsh EP, Silka MJ, et al. NASPE Expert Consensus Conference: Radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. North American Society of Pacing and Electrophysiology. Pacing Clin Electrophysiol 2002; 25:1000.
  32. Russell MW, Dorostkar PC, Dick M II. Incidence of catastrophic events associated with the Wolff-Parkinson-White syndrome in young patients: diagnostic and therapeutic dilemma (abstract). Circulation 1993; 88:I.
  33. Klein GJ, Bashore TM, Sellers TD, et al. Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med 1979; 301:1080.
  34. Deal BJ, Dick M II, Beerman L, et al. Cardiac arrest in young patients with Wolff-Parkinson-White syndrome (abstract). Pacing Clin Electrophysiol 1995; 18(II):815.
  35. Bromberg BI, Lindsay BD, Cain ME, Cox JL. Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome. J Am Coll Cardiol 1996; 27:690.
  36. Basso C, Corrado D, Rossi L, Thiene G. Ventricular preexcitation in children and young adults: atrial myocarditis as a possible trigger of sudden death. Circulation 2001; 103:269.
  37. Sharma AD, Yee R, Guiraudon G, Klein GJ. Sensitivity and specificity of invasive and noninvasive testing for risk of sudden death in Wolff-Parkinson-White syndrome. J Am Coll Cardiol 1987; 10:373.
  38. Munger TM, Packer DL, Hammill SC, et al. A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 1993; 87:866.
  39. Klein GJ, Prystowsky EN, Yee R, et al. Asymptomatic Wolff-Parkinson-White. Should we intervene? Circulation 1989; 80:1902.
  40. Lundberg A. Paroxysmal atrial tachycardia in infancy: long-term follow-up study of 49 subjects. Pediatrics 1982; 70:638.
  41. Dubin AM, Collins KK, Chiesa N, et al. Use of electrophysiologic testing to assess risk in children with Wolff-Parkinson-White syndrome. Cardiol Young 2002; 12:248.
  42. Benson DW Jr, Dunnigan A, Benditt DG. Follow-up evaluation of infant paroxysmal atrial tachycardia: transesophageal study. Circulation 1987; 75:542.
  43. Cohen MI, Wieand TS, Rhodes LA, Vetter VL. Electrophysiologic properties of the atrioventricular node in pediatric patients. J Am Coll Cardiol 1997; 29:403.
  44. Gallagher JJ, Gilbert M, Svenson RH, et al. Wolff-Parkinson-White syndrome. The problem, evaluation, and surgical correction. Circulation 1975; 51:767.
  45. Reddy GV, Schamroth L. The localization of bypass tracts in the Wolff-Parkinson-White syndrome from the surface electrocardiogram. Am Heart J 1987; 113:984.
  46. Jaeggi ET, Gilljam T, Bauersfeld U, et al. Electrocardiographic differentiation of typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway in children. Am J Cardiol 2003; 91:1084.
  47. Benson DW Jr, Smith WM, Dunnigan A, et al. Mechanisms of regular, wide QRS tachycardia in infants and children. Am J Cardiol 1982; 49:1778.
  48. Klein GJ, Gulamhusein SS. Intermittent preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 1983; 52:292.
  49. Ferdman DJ, Liberman L, Silver ES. A Smartphone Application to Diagnose the Mechanism of Pediatric Supraventricular Tachycardia. Pediatr Cardiol 2015; 36:1452.
  50. Nguyen HH, Van Hare GF, Rudokas M, et al. SPEAR Trial: Smartphone Pediatric ElectrocARdiogram Trial. PLoS One 2015; 10:e0136256.
  51. Gaita F, Giustetto C, Riccardi R, et al. Stress and pharmacologic tests as methods to identify patients with Wolff-Parkinson-White syndrome at risk of sudden death. Am J Cardiol 1989; 64:487.
  52. Kesek M, Sheikh H, Bastani H, et al. The sensitivity of transesophageal pacing for screening in atrial tachycardias. Int J Cardiol 2000; 72:239.
  53. Volkmann H, Kühnert H, Dannberg G. Electrophysiological evaluation of tachycardias using transesophageal pacing and recording. Pacing Clin Electrophysiol 1990; 13:2044.