S U P R AV E N T R I V U L A R T A C H Y C A R D I A I N

C H I L D R E N / I N FA N T S
BY ANDHINI
INTRODUCTION

• Supraventricular tachyarrhythmia (SVT) is the most common tachyarrhythmia in

pediatric patients and accounts for more than 90% of paediatric arrhythmias.
• Neonates and infants with paroxysmal supraventricular tachycardias generally present
with signs of subsequent development of cardiac dysfunction, heart failure, and
multiorgan shock.

• .
 S U P R AV E N T R I C U L A R T A C H Y C A R D I A I N
Y O U N G PAT I E N T
• Supraventricular tachycardia is the most frequent form of symptomatic dysrhythmia in
infants, children and adolescents.
• Most episodes of tachycardia are characterised by a rapid and regular heart rate due to
an abnormal electrophysiological mechanism.
• Involvement of cardiac structures above the bifurcation of the bundle of His in the
mechanism of tachycardia separates supraventricular tachycardia from ventricular
tachycardia.
 S U P R AV E N T R I C U L A R T A C H Y C A R D I A
O R G A N I Z E D B Y A N AT O M I C O R I G I N

Supraventricular Atrioventricular Ectopic Atrial Permanent

Tachycardia Nodal Tachycardia Form of
Caused by an
Accessory
Reentrant Junctional
Atrioventricular Tachycardia Reciprocating
Pathway Tachycardia
 S U P R AV E N T R I C U L A R TA C H Y C A R D I A C A U S E D B Y A N
A C C E S S O RY AT R I V E N T R I C U L A R PAT H WAY
most common anatomical
substrate for the occurrence of
supraventricular tachycardia in
young patients
Because of the activation
sequence, depolarisation f the
atria occurs > 60 msec after
ventricular activation on the
surface ECG.
The activation wave front is
conducted via the
atrioventricular node down to
the ventricles and via the
accessory pathway back to the
atria, with the typical features of
a macro-reentrant circuit.
Treatment  Transesophageal
electrocardiography and pacing
are very sophisticated and
elegant techniques for
management and differential
diagnosis SVT in infant and
children
ATRIOVENTRICULAR NODAL
REENTRANT TACHYCARDIA

• A typical form of this tachycardia is established

when the electrical impulse is conducted
antegradely over the slow conducting pathway to
the bundle of His and retrogradely over the fast
pathway, resulting in an extremely short interval
from the beginning of the QRS complex to atrial
activation.
• Therefore, P waves are typically not visible on
the surface ECG during episodes of tachycardia of
the ‘slow-fast’ type.
• the uniform picture of a supraventricu- lar
tachycardia with deep-negative P waves in the
inferior ECG leads, which seem to precede the
fol- lowing QRS complex, allows diagnosis of this
long-RP tachycardia by a single glance at the sur-
face ECG
 E C TO P I C AT R I A L TA C H Y C A R D I A

• an atrial pacemaker other than the sinus node depolarises with abnormally enhanced
automaticity
• On the surface ECG, a P wave with non-sinus morphology precedes the QRS
complexes
• The tachycardia is present for >80% of the day. In contrast to atrioventricular
reentrant tachycardias, the atrioventricular node is not a sub- stantial part of the
mechanism of tachycardia
 PERMANENT FORM OF JUNCTIONAL
R E C I P R O C AT I N G TA C H Y C A R D I A
• This tachycardia is based on an accessory atrioventricular pathway that is located in
the posteroseptal space at the tricuspid valve annulus, often in the vicinity of the
mouth of the coronary venous sinus.
• the uniform picture of a supraventricular tachycardia with deep-negative P waves in
the inferior ECG leads, which seem to precede the following QRS complex, allows
diagnosis of this long-RP tachycardia by a single glance at the surface ECG
EPIDEMIOLOGY AND GENETIC

EPIDEMIOLOGY • 1 in 250 to 1 in 1000 children

• 50% present in first episode in the first years of life

• In infants with paroxysmal SVT, the heart rate is usually 220 to 320 beats/minute ; in older children, it is
160 to 280 beats/minutes

HISTORY • n infants, symptoms are usually non- specific and include poor feeding, irritability, vomiting, cyanosis, and
pallid spells.
• bal children with SVT, palpitations and fluttering in the chest are the usual presenting symptoms.

Physical
• Most patients presenting with episodic palpitations have a structurally normal heart and will have normal
findings on the physical examination, particularly older children.
• Infants are more likely to present with signs of heart failure because the tachycardia may have gone

examination unrecognized for longer periods.

S H O RT M A N A G E M E N T

Stable Condition Unstable condition

• Stable condition  (elder • Heart failure  Cardioversion

children) vagal manuver (Slow • starting with 2-4 J/kg is
down the conduction in AV recommended
node and broke reentry circuits
mechanism SVT)
• Adenosin  Child 100 mcg/kg
• Infant 150 mcg or 200 mcg/kg
• Side effect : AV block , sinus
pause
LONG TERM MANAGEMENT
• For children with rare and mildly symptomatic episodes in whom SVT is easily
terminated, the SVT may not merit treatment.
• For children with episodes that are difficult to terminate, occur frequently, or occur
during athletic participation, it may be advisable to offer medical therapy or
transcatheter ablation as therapeutic options.
• Infants with SVT deserve special recognition in regard to treatment options. Most
infants will undergo spontaneous resolution of SVT.
LONG TERM MANAGEMENT

• catheter-based ablative techniques that serve

to eliminate the abnormal electrical
connections that allow SVT to occur.
Ablation • The risk of ablation catheterization is age
Therapy. dependent and the location of the arrhythmic
substrate focus, total AV block ablation.
• This risk can be reduced by the use of
cryoablation (age > 3 years old)