Common Supraventricular and Ventricular Arrhythmias in Children

The most common pediatric arrhythmias are tachycardias, and the most common type is supraventricular tachycardia, originating from or above the atrioventricular node and HIS bundle. Ventricular tachycardias are less common but more dangerous. Supraventricular tachycardias usually cause a narrow complex tachycardia unless there is a basal bundle branch block or rate-dependent aberration. A wide QRS tachycardia should be treated as ventricular tachycardias unless proven to be an supraventricular tachycardia with aberration. Diagnosis of both tachyarrhythmia types depends mainly on 12-lead electrocardiography. The most common supraventricular tachycardia type in newborns and infants is atrioventricular reentry tachycardia, related to manifest or concealed accessory pathways and in adolescent atrioventricular nodal reentry tachycardia, whereas focal atrial tachycardias consist of 10%-15% of supraventricular tachycardias during all ages. Supraventricular tachycardias have a low risk of morbidity, and ablation therapy is successful in most types with success rates over 90%. Ventricular tachycardias can be monomorphic or polymorphic, nonsustained or sustained, and can cause more hemodynamic instability than supraventricular tachycardias, requiring more close monitoring and urgent therapies. If hemodynamically unstable, synchronized cardioversion must be performed. Polymorphic ventricular tachycardias are very dangerous and often associated with primary ion channel defects (channelopathies), which can cause sudden cardiac death.