Supraventricular tachycardia in children: AV reentrant tachycardia (including WPW) and AV nodal reentrant tachycardia
- Anne M Dubin, MD
Anne M Dubin, MD
- Professor of Pediatrics
- Stanford School of Medicine
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 . 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".)
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 . 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 . 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 . AVRT and AVNRT accounted for 72 and 9 percent, respectively, with various other arrhythmias comprising the remaining 19 percent.
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- Congenital heart disease
- AV reentrant tachycardia
- - Antegrade versus retrograde
- - Orthodromic versus antidromic
- - Permanent junctional reciprocating tachycardia
- AV nodal reentrant tachycardia
- CLINICAL FEATURES
- Heart failure
- - Neonates
- Syncope and atrial fibrillation
- Ventricular fibrillation
- NATURAL HISTORY
- Ambulatory monitoring
- Exercise testing
- Electrophysiologic evaluation
- SUMMARY AND RECOMMENDATIONS