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Complex atrial tachycardias and respiratory syncytial virus infections in infants
R L Donnerstein1, R A Berg, Z Shehab
1Department of Pediatrics, Steele Memorial Children's Research Center, Tucson, AZ.
Insights
Respiratory syncytial virus (RSV) can cause abnormal heart rhythms like supraventricular tachycardia (SVT) in infants. For infants with healthy hearts, these RSV-related heart issues are typically temporary and resolve without long-term treatment.
Area of Science:
- Pediatrics
- Cardiology
- Infectious Diseases
Background:
- Respiratory syncytial virus (RSV) is a common pediatric respiratory pathogen.
- RSV is rarely linked to acquired heart disease.
- Supraventricular tachycardia (SVT) is an abnormal heart rhythm.
Purpose of the Study:
- To investigate the association between acute Respiratory Syncytial Virus (RSV) infections and supraventricular tachycardia (SVT) in infants.
- To characterize the types of SVT and their clinical course in infants with RSV.
- To determine the relationship between RSV, SVT, and underlying cardiac structure.
Main Methods:
- Retrospective review of hospital records, rhythm strips, and electrocardiograms.
- Analysis of 8 infants diagnosed with SVT (>250 beats/min) during acute RSV infection.
- Viral cultures and clinical symptom assessment to confirm RSV infection.
Main Results:
- Six of eight infants had RSV confirmed by viral culture; the other two had typical symptoms during an RSV epidemic.
- Seven infants experienced ectopic atrial tachycardia, chaotic atrial tachycardia, or atrial flutter.
- Five infants had episodes of nonsustained wide-complex SVT; SVT was unrelated to beta-agonist therapy or hypoxia.
Conclusions:
- RSV infections in infants can be associated with unusual atrial tachycardias and wide-complex SVTs.
- SVT in infants with RSV and structurally normal hearts is self-limited and does not require prolonged therapy.
- Recurrence of SVT was observed in infants with pre-existing congenital heart defects.
Abstract:
Respiratory syncytial virus (RSV), a common cause of respiratory infections in children, has only rarely been associated with acquired heart disease. We reviewed hospital charts, rhythm strips, and electrocardiograms of 8 infants with abnormal supraventricular tachycardia (SVT), > 250 beats/min, associated with acute RSV infections. Cultures of nasopharyngeal specimens from six of eight infants grew RSV. Two infants with negative viral culture results had symptoms typical of an RSV infection during a documented RSV epidemic. Two infants had congenital heart defects. Seven of the eight infants had an ectopic atrial tachycardia, chaotic atrial tachycardia, or atrial flutter, and five of eight had episodes of nonsustained wide-complex SVT. One patient was initially treated with intravenously administered lidocaine for an incorrect diagnosis of ventricular tachycardia. SVT was unrelated to either beta-agonist therapy or hypoxic episodes. SVT did not recur after discharge in any infant with a structurally normal heart. Both patients with structural heart disease had recurrences of SVT. We conclude that RSV infections in infants may be associated with unusual atrial tachycardias and that the diagnosis may be complicated by episodes of nonsustained, wide-complex tachycardias. In patients with RSV and structurally normal hearts, chaotic and ectopic atrial tachycardias are self-limited and do not require prolonged drug therapy.