Electrophysiological characteristics of idiopathic ventricular tachycardia in children
Junji Fukuhara1, Naokata Sumitomo, Takahiro Nakamura
1Department of Pediatrics and Child Health, Nihon University, School of Medicine, Tokyo, Japan.
Insights
Idiopathic ventricular tachycardia (VT) in children can be triggered by exercise, especially polymorphic VT. Some cases involve non-verapamil sensitive re-entry mechanisms.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Idiopathic ventricular tachycardia (VT) in children, while generally having a good prognosis, carries a risk of sudden death.
- Understanding the characteristics and triggers of pediatric idiopathic VT is crucial for risk stratification and management.
Purpose of the Study:
- To investigate the inducibility, mechanisms, and adenosine triphosphate (ATP) sensitivity of idiopathic ventricular tachycardia (VT) in a pediatric cohort.
- To differentiate between right ventricular VT (RVVT) and left ventricular VT (LVVT) in children.
Main Methods:
- Retrospective analysis of 46 children diagnosed with idiopathic VT.
- Induction of VT through exercise and programmed ventricular stimulation.
- Assessment of VT termination with adenosine triphosphate (ATP).
Main Results:
- Monomorphic VT occurred in 39 patients, polymorphic VT in 7. VT originated from the right ventricle (RV) in 22 and left ventricle (LV) in 17.
- Exercise induced VT in 68% of RVVT, 41% of LVVT, and 100% of polymorphic VT. ATP terminated VT in 60% of tested patients.
- Mechanisms included triggered activity (36.4% RVVT, 52.9% LVVT), automaticity (40.9% RVVT, 5.9% LVVT), and re-entry (22.7% RVVT, 41.2% LVVT).
Conclusions:
- Polymorphic VT showed higher exercise inducibility than RVVT and LVVT. Non-verapamil sensitive re-entry was observed in some idiopathic VT patients, more frequently in those with underlying heart conditions.
Background:
Idiopathic ventricular tachycardia (VT) has been reported to have a good prognosis, but there still might be the potential risk of sudden death.
Methods And Results:
The 46 consecutive children (mean age 11.7 ± 3.4 years) with idiopathic VT were enrolled in this study. Monomorphic VT was detected in 39 patients and polymorphic VT in 7 patients. The VT originated from the right ventricle (RV) in 22 patients, and left ventricle (LV) in 17 patients. The VT was induced by exercise in 68% of the RVVT, 41% of the LVVT, and 100% of the polymorphic VT. The VT was induced by programmed ventricular stimulation in 41% of the RVVT, 35% of the LVVT, and none of the polymorphic VT. Adenosine tri-phosphate terminated the VT in 9 of 15 patients (60%). The mechanism of the VT was suspected to be triggered by activity in 36.4%, automaticity in 40.9%, and re-entry in 22.7% of the RVVT, whereas it was 52.9%, 5.9%, and 41.2% of the LVVT, respectively.
Conclusions:
The exercise inducibility was higher in polymorphic VT than the RVVT and LVVT, but no difference in the programmed stimulation. The sensitivity to adenosine tri-phosphate was not different between the RVVT and LVVT. In some patients with idiopathic VT, a non-verapamil sensitive re-entry was documented, which was more common in patients with ischemic heart disease or cardiomyopathy.
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