Right ventricular outflow tract tachycardia in children
Received 10 April 2006; received in revised form 5 July 2006; accepted 30 August 2006.
Objective
To assess the clinical spectrum of right ventricular outflow tract tachycardia and its management in children.
Study design
Five centers identified patients for retrospective review. Patients (age <18 years) demonstrating ventricular tachycardia with an inferior axis and left bundle branch block were included. Patients with structural heart disease, myocarditis, cardiomyopathy, or long QT syndrome were excluded. Demographics, clinical presentation, investigations, and treatment were analyzed. Holter data were used to quantify ectopy.
Results
Patients (n = 48) were referred for evaluation of incidental findings (39/48), near syncope or syncope (7/48), or other (2/48). Investigations included magnetic resonance imaging (51%), endomyocardial biopsy (25%), and angiography (23%). Medical treatment was initiated in 26 of the 48 patients. The most common indications for treatment were frequent ectopy and symptoms. Medical treatment (P <.007) and observation alone (P <.02) were both associated with a reduction in ectopy. Symptoms persisted in 3 of 13 patients who were treated medically and in all untreated patients. At follow-up, there were no deaths and no difference in ectopy (P <.46) between patients who were treated medically and patients who were observed. Ablation was attempted in 6 of the 48 patients (successful in 4/6).
Conclusion
The clinical spectrum and management of right ventricular outflow tract tachycardia in children are diverse. Both medical therapy and observation alone were associated with a reduction in ectopy.
BC Children’s Hospital, Vancouver, British Columbia, Canada; Sainte Justine Hospital, Montreal, Quebec, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada; Stollery Children’s Centre, Edmonton, Alberta, Canada; and Centre Hopitalier de l’Universite Laval, Laval, Quebec, Canada.
Reprint requests: Dr Shubhayan Sanatani, Division of Cardiology, Department of Pediatrics, BC Children’s Hospital, 4480 Oak St, Vancouver, BC V6H 3V4, Canada.
ABSTRACT