Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-06T07:11:48.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Tachycardias in children originating in the right ventricular outflow tract: lack of clinical features predicting the presence and severity of the histopathological substrate

Published online by Cambridge University Press:  19 August 2008

Fabrizio Drago ,
Andrea Mazza ,
Maria Giulia Gagliardi ,
Maurizio Bevilacqua ,
Paolo Di Renzi ,
Armando Calzolari ,
Paola Francalanci ,
Renata Boldrini ,
Cesare Bosman  and
Gaetano Di Liso
...Show all authors
Fabrizio Drago*
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
Andrea Mazza
Affiliation:
Department of Cardiology, Santo Spirito Hospital, Rome, Italy
Maria Giulia Gagliardi
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
Maurizio Bevilacqua
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
Paolo Di Renzi
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
Armando Calzolari
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
Paola Francalanci
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
Renata Boldrini
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
Cesare Bosman
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
Gaetano Di Liso
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
Pietro Ragonese
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Ges– Children's Hospital; Rome, Italy
*
Dr Fabrizio Drago, Dipartimento Medico-Chirurgico di Cardiologia Pediacrica, Ospedale Bambino Ges–, Piazza S. Onofrio 4, 1-00165, Rome, Italy. Tel: 39 6 68591; Fax: 39 6 8801931
Get access Rights & Permissions [Opens in a new window]

Abstract

The aim was to determine whether the clinical features of tachycardias originating from the right ventricular outflow tract in children with an apparently normal heart could predict the presence and the severity of the histopathological substrate. Thirteen children (median age 6 years; range 6 months–12 years) with tachycardia originating from the right ventricular outflow tract of apparently normal hearts, were assessed by echocardiography, heart catheterization with angiography, endomyocardial biopsy (13 patients) and magnetic resonance imaging (MRJ) (nine patients). Tachycardia was symptomatic in six and sustained in nine. Endomyocardial biopsy and MRI revealed acute myocarditis in five patients (38%), fatty infiltration of the right ventricle in two (15%), and minor histologic abnormalities in three (23%). Myocarditis was diagnosed in three of nine patients with sustained ventricular tachycardia, as opposed to two of four with non-sustained tachycardia (p = NS); in three of six symptomatic versus two of seven asymptomatic patients (p = NS); and in two of eight patients in whom ventricular tachycardia was induced during exercise testing as opposed to one of three in which it was not inducible (p = NS). A histopathological substrate was found in six of nine patients with sustained ventricular tachycardia, and in all four with non-sustained tachycardia (p = NS); in five of six patients with symptoms versus five of seven asymptomatic patients (p = NS); and in five of eight with inducible ventricular tachycardia during exercise testing versus all three in whom it was not inducible (p = NS). The mean rate of tachycardia was 184 ± 39 beats min−1 in patients with myocarditis, as opposed to 171 ± 48 in patients without myocarditis (p = NS); and 163 ± 33 in patients with a histopathological substrate compared with 210 ± 65 in patients without a histopathological substrate (p = NS). It is concluded that a histopathological substrate is present in the greater majority of children affected by the so-called right ventricular outflow tract tachycardia, but that the clinical features of the tachycardia do not predict the presence and the severity of this histopathological substrate.

Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 3 , May 1999 , pp. 273 - 279
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Lerman, BB, Stein, KM, Markowicz, SM. Idiopathic right ventricular outflow tract tachycardia: a clinical approach. Pace 1996; 19:2120–2137.CrossRefGoogle ScholarPubMed
2.Wiles, HB, Gillette, PC, Harley, RA, Upshur, JK. Cardiomyopathy and myocarditis in children with ventricular ectopic rhythm. J Am Coll Cardiol 1992; 20: 359–362.CrossRefGoogle ScholarPubMed
3.Gagliardi, MG, Bevilacqua, M, Di Renzi, P, Picardo, S, Passariello, R, Marcelletti, C. Usefulness of magnetic resonance imaging for diagnosis of acute myocarditis in infants and children, and comparison with endomyocardial biopsy. Am J Cardiol 1991; 68: 1089–1091.CrossRefGoogle ScholarPubMed
4.Blake, LM, Scheinman, MM, Higgins, LB. MR features of arrhythmogenic right ventricular dysplasia. Am J Roentgenol 1994; 162: 809–812.CrossRefGoogle ScholarPubMed
5.Aretz, HT. Myocarditis: the Dallas criteria. Human Pathol 1987; 18: 619–624.CrossRefGoogle ScholarPubMed
6.Sackett, DL, Haynes, RB, Guyatt, GH, Tugwell, PClinical Epidemiology: A Basic Science for Clinical Medicine. Little, Brown, Boston, 1991, p 55.Google Scholar
7.Proclemer, A, Facchin, D, Miani, D, Feruglio, GA. Tachicardia e fibrillazione ventricolare idiopatiche. Inquadramento, diagnosi, terapia e prognosi. G Ital Cardiol 1994; 24: 1027–1041.Google Scholar
8.Sugrue, DD, Holmes, DR Jr, Gersh, BJ, Edwards, WD, McLaran, CJ, Wood, DL, Osborn, MJ, Hammil, SC. Cardiac histologic findings in patients with life-threatening ventricular arrhythmias of unknown origin. J Am Coll Cardiol 1984; 4: 952–957.CrossRefGoogle ScholarPubMed
9.Strain, JE, Grose, KM, Factor, SM, Fisher, JD. Results of endomyocardial biopsy in patients with spontaneous ventricular tachycardia but without apparent structural heart disease. Circulation 1983; 68: 1171–1181.CrossRefGoogle ScholarPubMed
10.Vignola, PA, Aonuma, K, Swaye, PS, Rozansky, JJ, Blankstein, RL, Benson, J, Grosselin, AJ, Lister, JW. Lymphocy tic myocarditis presenting as unexplained ventricular arrhythmias: diagnosis with endomyocardial biopsy and response to immunosuppression. J Am Coll Cardiol 1984; 4: 812–819.CrossRefGoogle Scholar
11.Morgera, T, Salvi, A, Alberti, E, Silvestri, F, Camerini, F. Morphological findings in apparently idiopathic ventricular tachycardia. An echocardiographic haemodynamic and histologic study. Eur Heart J 1985; 6: 323–334.CrossRefGoogle ScholarPubMed
12.Friedman, RA, Kearney, DL, Moak, JP, Fenrich, AL, Perry, JC. Persistence of ventricular arrhythmia after resolution of occult myocarditis in children and young adults. J Am Coll Cardiol 1994; 24: 780–783.CrossRefGoogle ScholarPubMed
13.Chow, LH, Radio, SJ, Sear, TD, McManus, . Insensitivity of right ventricular endomyocardial biopsy in the diagnosis of myocarditis. J Am Coll Cardiol 1989; 14: 915–920.CrossRefGoogle ScholarPubMed
14.Huack, AJ, Kearney, DL, Edwards, WD. Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for the role of sampling error. Mayo Clin Proc 1989; 64: 1235–1245.CrossRefGoogle Scholar
15.O'Connor, B, Case, CL, Sokoloski, MC, Blair, H, Cooper, K, Gillette, PC. Radiofrequency catheter ablation of right ventricular outflow tachycardia in children and adolescents. J Am Coll Cardiol 1996; 27: 869–874.CrossRefGoogle ScholarPubMed