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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
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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

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