[Ventricular tachyarrhythmia in childhood. Syncope, differential diagnosis of epilepsy]

In recent years we have noticed an increased number of severe ventricular tachyarrhythmias in children with structurally normal hearts. It is necessary to search for this condition specifically. Fainting fits caused by ventricular fibrillation or flutter with or without lengthening of the QT interval in the electrocardiogram are triggered by shock, fear or physical exertion. Distinguishing the condition from epilepsy can sometimes be difficult. Diagnosis in the case of a 14 year old boy with no history of genetic disorder could only be established with the aid of a 24-hour-ECG. Extended QT-times were observed here only in the higher heart frequency area. A 7 year old boy, initially given anti-convulsion therapy, showed QT-lengthening with ventricular extrasystoles only after repeated ECGs. His mother died suddenly following acoustic trauma. A 10 year old girl with no history of genetic disorder exhibited similar symptoms. On the basis of our observations we are of the opinion that a clear distinction into a genetically homogenous group with long QT-times, and one with a normal QT-interval, is not possible. Investigation of presumed epileptic cases by means of 24-hour-EEG-ECG in combination and ergometrics is recommended. Our patients were treated successfully with beta-blockers (propranolol).