Ventricular arrhythmias in children and adolescents.

The spectrum of ventricular arrhythmias, as observed in adolescents and children, is reviewed. The significance and prognosis of such rhythm disturbances depend to a great extent on the clinical setting in which they occur. Ventricular premature beats (VPBs) are found in a significant percentage of normal adolescents, though usually in very small numbers over 24 h. Frequent unifocal VPBs, even in bigeminy, may occasionally be observed. They are considered benign in the absence of heart disease, especially when they disappear during exercise. Ventricular tachycardia (VT) appears as a complication of some heart lesion in a majority of cases. This may be cardiomyopathy, mitral valve prolapse, sometimes congenital heart defects or occasionally rare anomalies such as long Q-T syndrome, tumors, or right ventricular dysplasia. Idiopathic (primary) VT also occurs in the young, its overall prognosis is more favorable compared to VT with heart disease. The problem of ventricular arrhythmias late after open heart surgery deserves special comment, as it seems to be connected with late sudden death. The investigation and treatment of ventricular arrhythmias in children and adolescents is discussed. The decision on who should be treated is easy in the presence of symptoms, but difficult and controversial in asymptomatic youngsters.