0047: Follow-up of children or teenagers with paroxysmal supraventricular tachycardia but without preexcitation syndrome

• Published in: Archives of Cardiovascular Diseases Supplements Vol. 7; no. 1; pp. 94 - 95
• Main Authors: Brembilla-Perro, Béatrice, Moulin-Zinsch, Anne, Lethor, Jean Paul, Nrecaj-Jager, Carole, Tisserant, Anne, Cloez, Jean Louis, Marchal, Cécile, Marçon, François
• Format: Journal Article
• Language: English
• Published: Elsevier France 01.01.2015
• ISSN: 1878-6480
• DOI: 10.1016/S1878-6480(15)71757-X

Paroxysmal supraventricular tachycardia’s (SVT) are considered of benign if ECG in sinus rhythm (SR) is normal, but their occurrence in children/teenagers is always associated with an anxiousness of parents, child and doctors. The purpose of study was to report the clinical and electrophysiological data of children with SVT, their follow-up and management. 147 children and teenagers aged from 5 to 19 years (mean 15±3) with a normal ECG in SR were studied for spontaneous SVT. Transesophageal electrophysiological study was systematic. Children were followed from 1 month to 13 years (mean 2±2 years). SVT was poorly-tolerated in 26 patients (18%). SVT was related to atrioventricular (AV nodal re-entrant tachycardia (RT) (AVNRT) in 107 children, either typical in 95 children or atypical AVNRT in 12 children, to an AVRT related to a concealed accessory pathway (AP) in 40 patients (27%). Radiofrequency (RF) of the slow pathway (n=50) or AP (n=32) was performed in absence of general anaesthesia in 82 patients (56%) from 1 month up to 13 years after initial evaluation (mean 2±2 years). Failure of ablation (frequently for refuse to continue) was frequent and occurred in 15 children (26%), 7 with AVNRT (14%), 9 with AP (28%) (0.08). Recurrence of SVT occurred in 4 patients (5%) and 14 (17.5%) have still sinus tachycardia-related symptoms. In 13 children treated by antiarrhythmic drug (AAD) or betablockers, SVT recurred in 4 children; 2 children presented AAD-related syncope. In 52 untreated patients one death was noted after AAD infusion used to stop SVT, but other patients remained asymptomatic or had short and well-tolerated SVT’s. The management of SVT in children remains difficult despite the development of RF ablation of SVT. Failure of ablation remains higher than in adults for several reasons. Child remains symptomatic in 17.5% of cases after ablation. One third of them had a spontaneous favourable evolution. However in symptomatic children with frequent SVT’s despite antiarrhythmic drugs or betablockers, ablation should be indicated to avoid drugsrelated adverse effects.