Kristopher T Kang1, James E Potts1, Andrew E Radbill2, Martin J La Page3, John Papagiannis4, Jason M Garnreiter5, Petr Kubus6, Michal J Kantoch7, Nicholas H Von Bergen8, Anne Fournier9, Jean-Marc Côté10, Thomas Paul11, Charles C Anderson12, Bryan C Cannon13, Christina Y Miyake14, Andrew D Blaufox15, Susan P Etheridge6, Shubhayan Sanatani16. 1. Department of Pediatrics, Division of Cardiology, British Columbia Children's Hospital, Vancouver, BC, Canada. 2. Vanderbilt University Medical Center, Nashville, Tennessee. 3. University of Michigan, Ann Arbor, Michigan. 4. Mitera Children's Hospital, Athens, Greece. 5. Primary Children's Hospital, Salt Lake City, Utah. 6. Children's Heart Centre, University Hospital Motol, Prague, Czech Republic. 7. Stollery Children's Hospital, Edmonton, AB, Canada. 8. University of Iowa Children's Hospital, Iowa City, Iowa. 9. CHU Mère-Enfant Sainte-Justine, University of Montreal, Montreal, QC, Canada. 10. Centre Mère-Enfant, CHUQ, Quebec, QC, Canada. 11. University Children's Hospital, Georg-August University, Go¨ttingen, Germany. 12. Providence Sacred Heart Children's Hospital, Spokane, Washington. 13. Mayo Clinic, Rochester, Minnesota. 14. Lucile Packard Children's Hospital, Palo Alto, California. 15. Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York. 16. Department of Pediatrics, Division of Cardiology, British Columbia Children's Hospital, Vancouver, BC, Canada. Electronic address: ssanatani@cw.bc.ca.
Abstract
BACKGROUND: Permanent junctional reciprocating tachycardia (PJRT) is an uncommon form of supraventricular tachycardia in children. Treatment of this arrhythmia has been considered difficult because of a high medication failure rate and risk of cardiomyopathy. Outcomes in the current era of interventional treatment with catheter ablation have not been published. OBJECTIVE: To describe the presentation and clinical course of PJRT in children. METHODS: This is a retrospective review of 194 pediatric patients with PJRT managed at 11 institutions between January 2000 and December 2010. RESULTS: The median age at diagnosis was 3.2 months, including 110 infants (57%; aged <1 year). PJRT was incessant in 47%. The ratio of RP interval to cycle length was higher with incessant than with nonincessant tachycardia. Tachycardia-induced cardiomyopathy was observed in 18%. Antiarrhythmic medications were used for initial management in 76%, while catheter ablation was used initially in only 10%. Medications achieved complete resolution in 23% with clinical benefit in an additional 47%. Overall, 140 patients underwent 175 catheter ablation procedures with a success rate of 90%. There were complications in 9% with no major complications reported. Patients were followed for a median of 45.1 months. Regardless of treatment modality, normal sinus rhythm was present in 90% at last follow-up. Spontaneous resolution occurred in 12% of the patients. CONCLUSION: PJRT in children is frequently incessant at the time of diagnosis and may be associated with tachycardia-induced cardiomyopathy. Antiarrhythmic medications result in complete control in few patients. Catheter ablation is effective, and serious complications are rare.
BACKGROUND: Permanent junctional reciprocating tachycardia (PJRT) is an uncommon form of supraventricular tachycardia in children. Treatment of this arrhythmia has been considered difficult because of a high medication failure rate and risk of cardiomyopathy. Outcomes in the current era of interventional treatment with catheter ablation have not been published. OBJECTIVE: To describe the presentation and clinical course of PJRT in children. METHODS: This is a retrospective review of 194 pediatric patients with PJRT managed at 11 institutions between January 2000 and December 2010. RESULTS: The median age at diagnosis was 3.2 months, including 110 infants (57%; aged <1 year). PJRT was incessant in 47%. The ratio of RP interval to cycle length was higher with incessant than with nonincessant tachycardia. Tachycardia-induced cardiomyopathy was observed in 18%. Antiarrhythmic medications were used for initial management in 76%, while catheter ablation was used initially in only 10%. Medications achieved complete resolution in 23% with clinical benefit in an additional 47%. Overall, 140 patients underwent 175 catheter ablation procedures with a success rate of 90%. There were complications in 9% with no major complications reported. Patients were followed for a median of 45.1 months. Regardless of treatment modality, normal sinus rhythm was present in 90% at last follow-up. Spontaneous resolution occurred in 12% of the patients. CONCLUSION: PJRT in children is frequently incessant at the time of diagnosis and may be associated with tachycardia-induced cardiomyopathy. Antiarrhythmic medications result in complete control in few patients. Catheter ablation is effective, and serious complications are rare.
Authors: Rakesh Gopinathannair; Susan P Etheridge; Francis E Marchlinski; Francis G Spinale; Dhanunjaya Lakkireddy; Brian Olshansky Journal: J Am Coll Cardiol Date: 2015-10-13 Impact factor: 24.094