Atrioventricular Nodal Reentrant Tachycardia in Children

Abstract

The purpose of this study was to identify the clinical and electrophysiological characteristics of children with atrioventricular reentry tachycardia (AVNRT) and to define the prognosis and the treatment strategy. Sixty-two children (28 males and 34 females mean age, 10.2 +/- 3.2 years) with AVNRT ("slow-fast" type) were included in the study. Patients were divided into two groups: 47 patients with severe symptoms (group A) and 15 with mild symptoms (group B). The severity of the symptoms was not related to the electrophysiological parameters. Females were more symptomatic than males. Patients in group B did not receive any treatment (except 1 because of parents' choice) nor did they develop symptoms, and 5 patients had resolution of palpitations. Forty-one of 46 patients in group A were successfully treated with medical therapy as initial treatment. Thirty-one patients in group A underwent slow pathway ablation. There were late recurrences of AVNRT in 6 patients. Typical AVNRT in young patients does not appear to be life threatening. Patients with mild or no symptoms do well without therapy. Medical therapy and slow pathway ablation appear to be effective in the more symptomatic patients. Age and electrophysiological variables are not related to the symptoms or response to treatment. Females with AVNRT are more symptomatic and more likely to present with syncope.

Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Infants and Toddlers

“…Because of the relatively narrow safety zone in small children, it is not suggested that RFCA for AVNRT or para-Hisian accessory pathway be performed in young patients. 30 Cryoablation, instead of radiofrequency ablation, may be a good alternative to avoid such complications. 31 We also had another patient who developed profound bradycardia during ablation of a left lateral accessory pathway, which was attributed to Bezold-Jarisch reflex.…”

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary

“…18 In comparison with AVRT, patients with AVNRT are more likely to be female, with an age of onset >30 years. 16,[19][20][21] SVT has an impact on quality of life, which varies according to the frequency of episodes, the duration of SVT, and whether symptoms occur not only with exercise but also at rest. 18,22 In 1 retrospective study in which the records of patients <21 years of age with WPW pattern on the ECG were reviewed, 64% of patients had symptoms at presentation, and an additional 20% developed symptoms during follow-up.…”

“…It is usually seen in young adults without structural heart disease or ischemic heart disease, and >60% of cases are observed in women. 16 The ventricular rate is often 180 bpm to 200 bpm but ranges from 110 bpm to >250 bpm (and in rare cases, the rate can be <100 bpm). 19 The anatomic substrate of AVNRT is dual AV nodal physiology (Table 2).…”

“…16 Atypical atrial flutter and macroreentrant AT are on the rise as consequences of increasing AF ablation in this patient population, yet there are limited outcome data from RCTs for this segment of the population. Therapeutic decisions should be balanced between the overall risks and benefits of the invasive nature of ablation versus long-term commitment to pharmacological therapy.…”

Arrhythmias in Children and Young Adults

“…6.2.4 Natural history: AVNRT is not life-threatening and patients with minimal symptoms do well without therapy. Female patients are more symptomatic and tend to present with syncope (Drago et al 2006). 6.2.5 Clinical presentation: Symptoms include palpitations, chest pain, heart failure, and shock, and rarely syncope, dependent on the duration of the AVNRT.…”