2014 Volume 30 Issue 6 Pages 651-658
Background: Ectopic Atrial Tachycardia (EAT) in pediatric patients without structural heart disease is not frequent with an incidence of 10% to 15% of pediatric patients referred for catheter ablation, and its clinical manifestation is diverse. The aim of this study is to clarify the clinical manifestation and appropriate management in these patients.
Methods: A retrospective review identified 22 children with EAT without structural heart disease at the Chiba Cardiovascular Center from April 1998 to March 2013. Patients were classified into three groups according to the duration of EAT; those were Group A (EAT eventually ceases spontaneously by 6 years old), Group B1 (EAT is persistent with permanent or incessant tachycardia), and Group B2 (EAT is persistent with paroxysmal tachycardia), and we compared clinical features among these groups. Patients with a genetic abnormality were excluded.
Results: Age at diagnosis was significantly younger in Group A than Group B1 and B2 (p = 0.002) (Group A; median 0.3 years: range 0-1.8 years, Group B1; median 10.4 years: range 0.9-15.4 years, Group B2; median 10.4 years: range 4.4-13.5 years). Both Group A and Group B2 showed a favorable response to drug therapy. Group B1 was more refractory to drug therapy than the others. All 15 children with persistent tachycardia received radiofrequency catheter ablation (RFCA) with a success rate of 93% (14/15).
Conclusion: EAT is expected to generate spontaneous resolution; therefore, antiarrhythmic drug therapy should be the first choice in patients with non-structured heart disease and early onset EAT, especially for a fetus, neonate, and infant. The indication is to show different clinical manifestations according to type of tachycardia in cases with persistent EAT. In cases with sustained or recurrent EAT, in those tachycardia-induced cardiomyopathy (TIC) could develop, meticulous follow-up and management including RFCA is necessary.
