Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children <3 or ≥3 years of age

• Published in: Journal of the American College of Cardiology Vol. 43; no. 3; pp. 438 - 444
• Main Authors: Salerno, Jack C, Kertesz, Naomi J, Friedman, Richard A, Fenrich, Arnold L
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 04.02.2004; Elsevier Science; Elsevier Limited
• Subjects: Adolescent; Age; Age Factors; Anti-Arrhythmia Agents - therapeutic use; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiac Surgical Procedures - methods; Cardiology; Cardiology. Vascular system; Cardiomyopathy; Cardiovascular disease; Catheter Ablation - methods; Child; Child, Preschool; Children & youth; Female; Heart; Heart rate; Humans; Infant; Infant, Newborn; Male; Medical sciences; Pediatrics; Remission, Spontaneous; Retrospective Studies; Sinuses; Substance abuse treatment; Success; Tachycardia, Ectopic Atrial - physiopathology; Tachycardia, Ectopic Atrial - therapy; Variables; AET; SVT; ECG; RFA; LA; RA; Human; Arrhythmia; Cardiovascular disease; Atrial tachycardia; Phlebology; Excitability disorder; Result; Treatment; Heart disease; Circulatory system; Ectopia; Cardiology; Child; Age
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2003.09.031

We assessed the clinical presentation, natural history, and treatment response of atrial ectopic tachycardia (AET) in children <3 years of age (group 1) compared with those ≥3 years of age (group 2). Atrial ectopic tachycardia is a common cause of chronic supraventricular tachycardia in children and can be resistant to pharmacologic therapy. Radiofrequency ablation (RFA) can eliminate AET arising from a single focus. A retrospective review identified all children at Texas Children's Hospital diagnosed with AET from March 1991 to November 2000. Data obtained included clinical presentation, echocardiographic evaluation, response to antiarrhythmic therapy, spontaneous resolution, and outcomes of radiofrequency and surgical ablation. Sixty-eight children were identified (22 children <3 years and 46 children ≥3 years of age). Control of AET with antiarrhythmic therapy was achieved in 91% of the younger children but only 37% of the older children (p < 0.001). There was a higher rate of spontaneous resolution in the younger group (78%) compared with the older group (16%) (p < 0.001). Radiofrequency ablation was performed in 35 of the older children, with ultimate success in 74%. Surgical intervention was required for six children. Younger children respond to antiarrhythmic therapy and have a high incidence of AET resolution, thus warranting a trial of antiarrhythmic therapy. In children ≥3 years, AET is unlikely to resolve spontaneously, and antiarrhythmic medications are frequently ineffective. Thus, RFA should be considered early in the course of treatment for these children; however, surgical intervention may be necessary.