Permanent junctional reciprocating tachycardia in children: a multicenter experience

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Cardiac Arrhythmias

Background:

• Permanent junctional reciprocating tachycardia (PJRT) is a rare supraventricular tachycardia in children.
• Historically, treatment has been challenging due to medication failure and cardiomyopathy risk.
• Current outcomes with catheter ablation in pediatric PJRT are not well-documented.

Purpose of the Study:

• To characterize the presentation and clinical course of pediatric PJRT.
• To evaluate the effectiveness and safety of different treatment modalities for pediatric PJRT.

Main Methods:

• Retrospective review of 194 pediatric patients diagnosed with PJRT.
• Data collected from 11 institutions between January 2000 and December 2010.
• Analysis of clinical presentation, treatment strategies, and outcomes.

Main Results:

• Median age at diagnosis was 3.2 months, with 57% being infants.
• 47% of cases were incessant tachycardia, associated with a higher RP interval/cycle length ratio.
• Tachycardia-induced cardiomyopathy occurred in 18%; medication success was 23% (complete resolution).
• Catheter ablation success rate was 90% (175 procedures in 140 patients), with 9% complications (no major ones).
• At follow-up (median 45.1 months), 90% achieved normal sinus rhythm, and 12% experienced spontaneous resolution.

Conclusions:

• Pediatric PJRT is often incessant at diagnosis and linked to tachycardia-induced cardiomyopathy.
• Antiarrhythmic medications provide complete control in a minority of patients.
• Catheter ablation is an effective treatment for pediatric PJRT with a low rate of serious complications.