Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T18:29:42.045Z Has data issue: false hasContentIssue false
  • English
  • Français

Pharmacological treatment of young children with permanent junctional reciprocating tachycardia

Published online by Cambridge University Press:  24 May 2005

Margriet van Stuijvenberg ,
Gertie C. M. Beaufort-Krol ,
Jaap Haaksma  and
Margreet Th. E. Bink-Boelkens
Margriet van Stuijvenberg
Affiliation:
Beatrix Children's Hospital, Division of Pediatric Cardiology, University Hospital Groningen, The Netherlands
Gertie C. M. Beaufort-Krol
Affiliation:
Beatrix Children's Hospital, Division of Pediatric Cardiology, University Hospital Groningen, The Netherlands
Jaap Haaksma
Affiliation:
Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands
Margreet Th. E. Bink-Boelkens
Affiliation:
Beatrix Children's Hospital, Division of Pediatric Cardiology, University Hospital Groningen, The Netherlands
Get access Rights & Permissions [Opens in a new window]

Abstract

Our objective was to assess the efficacy of pharmacological treatment in reducing the incidence of permanent junctional reciprocating tachycardia in young children, or to bring the mean heart rate over 24 h to a normal level.

We included 21 children with a median age of 0.05 year seen with permanent junctional reciprocating tachycardia over the period 1990 through 2001. Of these children, two had abnormal left ventricular function. Follow-up visits were made at least every 6 months. We registered the presence of the tachycardia over 24 h, the mean heart rate over 24 h, and cardiac function. Treatment was started with propafenone alone, or in combination with digoxin as the first choice. Treatment was effective in 14 cases (67%), with either complete disappearance of the tachycardia after discontinuation of medication, or continuation in sinus rhythm with medication; partially effective in 4 cases (20%) when the mean heart rate over 24 h on the last Holter recording was less than 1 standard deviation above the normal for age; but was not effective in the remaining 3 cases (14%). In 3 patients treated with propafenone, or 13 given propafenone and digoxin, treatment was effective in 12 (75%), partially effective in 2 (13%), and ineffective in the other 2 (13%).

All 21 children had a normal left ventricular function at the end of follow-up. The median duration of follow-up was 2.4 years. Permanent junctional reciprocating tachycardia had disappeared spontaneously in one-third of the children, 5 being less than 1 year old. Adverse effects, seen in 5 cases, were mild or asymptomatic. No signs of proarrhythmia were registered.

Pharmacological treatment, either with propafenone alone, or in combination with digoxin, is safe and effective in young children with permanent junctional reciprocating tachycardia. The mean heart rate is normalized, and cardiac function is restored and preserved. Radiofrequency ablation may be delayed to a safer age, with the arrhythmia disappearing spontaneously in one-third.

Keywords

Arrhythmiacatheter ablationdrug treatmentpropafenone
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 5 , October 2003 , pp. 408 - 412
Copyright
© 2003 Cambridge University Press

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

Coumel P, Cabrol C, Fabiato A, Gourgon R, Slama R. Tachycardie permanente par rhythme reciproque. Arch Mal Coeur 1967; 60: 1830–1864.Google Scholar
Packer DL, Bardy GH, Worley SJ, et al. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol 1986; 57: 563–570.Google Scholar
Kugler JD, Danford DA, Deal BJ, et al. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. N Engl J Med 1994; 330: 1481–1487.Google Scholar
Goldberg CS, Caplan MJ, Heidelberger KP, Dick II M. The dimensions of the triangle of Koch in children. Am J Cardiol 1999; 83: 117–120.Google Scholar
Kugler JD, Danford DA, Houston K, Felix G. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Am J Cardiol 1997; 80: 1438–1443.Google Scholar
Blaufox AD, Felix GL, Saul JP. Radiofrequency catheter ablation in infants ≤18 months old. When is it done and how do they fare? Short-term data from the Pediatric Ablation Registry. Circulation 2001; 104: 2803–2808.Google Scholar
Saul JP, Hulse JE, Papagiannis J, Van Praag R, Walsh EP. Late enlargement of radiofrequency lesions in infant lambs: implications for ablation procedures in small children. Circulation 1994; 90: 492–499.Google Scholar
Friedman RA, Walsh EP, Silka MJ, et al. NASPE Expert Consensus Conference: Radiofrequency Catheter Ablation in children with and without congenital heart disease. Report of the writing committee. PACE 2002; 25: 1000–1017.Google Scholar
Lindinger A, Heisel A, Von Bernuth G, et al. Permanent junctional re-entry tachycardia: a multicentre long-term follow-up study in infants, children and young adults. Eur Heart J 1998; 19: 936–942.Google Scholar
Fish FA, Gillette PC, Benson DW. Proarrhythmia, cardiac arrest and death in young patients receiving encainide and flecainide. J Am Coll Cardiol 1991; 18: 356–365.Google Scholar
Dorostkar PC, Silka MJ, Morady F, Dick II M. Clinical course of persistent junctional reciprocating tachycardia. J Am Coll Cardiol 1999; 33: 366–375.Google Scholar
Critelli G. Recognizing and managing permanent junctional reciprocating tachycardia in the catheter ablation era. J Cardiovasc Electrophysiol 1997; 8: 226–236.Google Scholar
Aguinaga L, Primo J, Anguera I, et al. Long-term follow-up in patients with the permanent form of junctional reciprocating tachycardia treated with radiofrequency ablation. PACE 1998; 21: 2073–2078.Google Scholar
Drago F, Silvetti MS, Mazza A, et al. Permanent junctional reciprocating tachycardia in infants and children: effectiveness of medical and non-medical treatment. Ital Heart J 2001; 2: 456–461.Google Scholar
Perry JC, McQuinn RL, Smith RT, Gothing C, Fredell P, Garson A. Flecainide acetate for resistant arrhythmias in the young: efficacy and pharmacokinetics. J Am Coll Cardiol 1989; 14: 185–191.Google Scholar
Lucet V, Do Ngoc D, Sidi D, Batisse A, Fidelle J, Coumel P. Traitement medical et evolution a long terme des tachycardies reciproque permanentes de l'enfant à propos de 10 cas suivis durant 11 ans. Arch Mal Coeur 1985; 2: 210–216.Google Scholar
Janousek J, Paul T. Safety of oral propafenone in the treatment of arrhythmias in infants and children (European Retrospective Multicenter Study). Am J Cardiol 1998; 81: 1121–1124.Google Scholar