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Ventricular tachycardia and accelerated ventricular rhythm presenting in the first month of life
1Department of Pediatrics, University of California-San Francisco School of Medicine.
Insights
Infants with accelerated ventricular rhythm and structurally normal hearts often resolve spontaneously. Withholding antiarrhythmic therapy is a reasonable approach, given the excellent long-term outcomes and lack of hemodynamic compromise.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Neonatal Medicine
Background:
- Ventricular tachycardia (VT) and accelerated ventricular rhythm (AVR) are rare in neonates.
- Structurally normal hearts are typically associated with a better prognosis.
Purpose of the Study:
- To evaluate the long-term outcomes of infants presenting with VT or AVR and structurally normal hearts.
- To determine the efficacy and necessity of antiarrhythmic therapy in this population.
Main Methods:
- Retrospective review of 14 infants (<1 month old) with VT or AVR and normal cardiac structure over 22 years.
- Analysis of clinical presentation, electrophysiologic characteristics, treatment, and long-term follow-up.
Main Results:
- Twelve infants had AVR; 10 survived with a median follow-up of 4 years, free of AVR and medications.
- Two infants with VT had long QT syndrome; both are alive on beta-blockers, one with a pacemaker.
- AVR in infants did not cause hemodynamic compromise, with rates only slightly above sinus rhythm.
Conclusions:
- Infants with AVR and structurally normal hearts have an excellent long-term prognosis.
- Withholding antiarrhythmic therapy and awaiting spontaneous resolution is a reasonable strategy for neonatal AVR.
- VT in the context of long QT syndrome requires ongoing management, typically with beta-blockers.
Abstract:
Fourteen infants aged less than 1 month presented to our institution during the last 22 years with ventricular tachycardia (VT) or accelerated ventricular rhythm and a structurally normal heart. In 2, VT was associated with long QT syndrome. Both are alive on beta-blocker therapy, 1 with an implanted pacemaker. Twelve infants had accelerated ventricular rhythm, and 2 of these died in the first 2 months of life of unrelated conditions. The other 10 are alive at a median age of 4 years (range 2 months to 11 years), and none were lost to follow-up. Hemodynamic compromise did not occur with accelerated ventricular rhythm. The ventricular rate was very close to the sinus rate in all 12, less than 12% above the sinus rate. The mean QRS duration during accelerated ventricular rhythm was 92.5 ms, and averaged twice the QRS duration during sinus rhythm. Fusion beats were seen in all 12, and there was atrioventricular dissociation with capture beats in 10. In 2, ventriculoatrial conduction was present. Treatment was attempted in 5 of the 10 survivors with accelerated ventricular rhythm, and was thought to be successful in 4. Treatment was later successfully withdrawn in all 5, so that all 10 survivors were free of accelerated ventricular rhythm and were not receiving antiarrhythmic medications at last follow-up. Because of the excellent long-term outcome and the lack of hemodynamic compromise during the rhythm, it seems reasonable to withhold antiarrhythmic therapy in infants with accelerated ventricular rhythm and await resolution of the rhythm.