Diagnosis and Acute Therapy of Supraventricular Tachycardia in Children

Abstract

The clinical characteristics of supraventricular tachycardia (SVT) in children differ from those in adults. SVT has a nonspecific presentation in neonates and infants with symptoms caused by heart failure and sometimes becomes severe because of delayed diagnosis. In older children, palpitations may be a subjective complaint, and most SVTs have a mild presentation. Tachycardia-induced cardiomyopathy secondary to incessant SVT is more often observed in children than in adults. Atrioventricular reciprocating tachycardia and atrioventricular nodal re-entrant tachycardia account for ＞90％ of cases of pediatric SVT, and ectopic atrial tachycardia and other SVTs are less common. The first step in the electrocardiographic diagnosis of SVT involves detection of the P wave, followed sequentially by assessment of P wave morphology and assessment of the time relationship between P waves and QRS complexes. Intravenous administration of adenosine triphosphate is useful for elucidation of the mechanism of SVTs. In hemodynamically unstable children, acute management includes performing immediate synchronized cardioversion. If the child is stable, performing a vagal maneuver and/or intravenous administration of adenosine triphosphate can achieve termination of most SVTs. Administration of second-line antiarrhythmic agents is necessary to treat intractable SVTs. This review discusses a practical approach to electrocardiographic diagnosis of this condition and provides a brief overview of recent information about acute management of pediatric SVT.