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Bidirectional tachycardia in a child. A study using His bundle electrography.

D S Reid, M Tynan, L Braidwood

    British Heart Journal
    |March 1, 1975
    PubMed
    Summary
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    Bidirectional tachycardia in a child, without heart structure issues, was linked to exertion and stress. Effort electrocardiograms are crucial for diagnosing unexplained fainting in children.

    Area of Science:

    • Pediatric Cardiology
    • Electrophysiology
    • Cardiac Arrhythmias

    Background:

    • Bidirectional tachycardia is a rare arrhythmia.
    • Idiopathic ventricular arrhythmias can occur in children without structural heart disease.
    • Unexplained syncope in children warrants thorough cardiac investigation.

    Purpose of the Study:

    • To report a case of bidirectional tachycardia in a pediatric patient.
    • To investigate the origin and triggers of the arrhythmia.
    • To highlight the diagnostic utility of effort electrocardiography in pediatric syncope.

    Main Methods:

    • Case report of a 6-year-old girl.
    • Clinical evaluation including electrocardiography (ECG).
    • Electrophysiological study including His bundle electrography and provocation with atrial pacing and isoprenaline administration.

    Related Experiment Videos

    Main Results:

    • The patient presented with bidirectional tachycardia, not associated with structural heart abnormalities or digitalis use.
    • Arrhythmia was precipitated by physical exertion and emotional stress.
    • His bundle electrography confirmed a ventricular origin of the tachycardia.
    • Arrhythmia was inducible via atrial pacing and isoprenaline.

    Conclusions:

    • Bidirectional tachycardia can occur in children with structurally normal hearts.
    • Effort and emotional stress are potential triggers.
    • His bundle electrography is valuable for determining the ventricular origin.
    • Effort electrocardiography is essential for diagnosing unexplained syncopal episodes in children, even with normal resting ECGs.