Related Experiment Videos
Clinical and evolutive aspects in ventricular preexcitation syndromes in child
A G Dimitriu1, C Iordache, I Nicolau
11st Clinic of Pediatrics, University of Medicine and Pharmacy, Iaşi.
Insights
Ventricular preexcitation syndromes (VPS) in children, including Wolff-Parkinson-White syndrome, often present with tachycardia. Effective medical management, avoiding surgical ablation, is crucial for these pediatric cardiac rhythm disturbances.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Clinical Pediatrics
Background:
- Ventricular preexcitation syndromes (VPS) significantly impact pediatric cardiac rhythm disturbances, altering clinical and ECG presentations.
- VPS diagnosis and management in children present unique challenges due to varying clinical manifestations.
Purpose of the Study:
- To analyze the clinical characteristics, diagnostic methods, and therapeutic outcomes of ventricular preexcitation syndromes in a pediatric population.
- To evaluate the efficacy of medical management strategies for supraventricular tachycardia in children with VPS.
Main Methods:
- Retrospective study of 58 pediatric cases (2 weeks-15 years) with VPS over 3 years.
- Surface ECG analysis to identify VPS types (WPW, Mahaim, Lown-Ganong-Levine).
- Review of clinical symptoms, diagnostic tools (ECG, Holter, electrophysiology), and treatment regimens.
Main Results:
- Wolff-Parkinson-White (WPW) syndrome type B observed in 30% of cases; others included Mahaim pathways and Lown-Ganong-Levine syndrome.
- Paroxysmal supraventricular tachycardia was the most common symptom; 4 cases presented with wide QRS complex.
- Intravenous digoxin + propranolol for infants/young children; propranolol/quinidine, disopyramide, or amiodarone for older children, with satisfactory results and no need for surgical ablation.
Conclusions:
- VPS in children require careful diagnosis and management to prevent severe ventricular arrhythmias.
- Medical therapy, including digoxin, propranolol, quinidine, disopyramide, and amiodarone, is effective for managing tachyarrhythmias in pediatric VPS.
- Further investigation with Holter monitoring and electrophysiology studies is recommended for unclear tachyarrhythmias, especially those with wide QRS complexes.
Abstract:
Ventricular preexcitation syndromes (VPS) are very important between cardiac rhythm disturbances in childhood, because their presence can change the clinical and ECG picture and thus the treatment can be very difficult. The authors studied 58 cases of VPS in children (2 weeks-15 years old) admitted in a period of 3 years. The surface ECG showed VPS aspects: in 30% of cases we noticed WPW syndrome type B and the rest presented VPS with Mahaim pathways and Lown-Ganong-Levine syndrome. 4 cases were familial and 1 child a hidden WPW syndrome. In 65% of cases the cardiac symptoms put the diagnosis and 1/3 of cases were discovered by common ECG. The most important cardiac sign of the children with WPW syndrome was the paroxysmal supraventricular tachycardia, 4 cases presenting wide QRS complex. Others types of VPS were without clinical symptoms. The intravenous administration of digoxin + propranolol was the therapy of choice for paroxysmal supraventricular tachycardia in infants and children until 2-3 years old, and propranolol and chinidine after this age. The children older than 2-3 years and/or those with ineffective preventive for recurrent treatment received dysopiramide and specially amiodarone with satisfactory results; it was not necessary the surgical ablation of the aberrant pathway. Ventricular preexcitation syndromes and wrong treatment can induce severe ventricular arrhythmia, so all the tachyarrhythmias with unknown etiology and especially those with wide QRS complex must be investigated very carefully, using and Holter test and the endocavitary electrophysiology, for a correct medical and/or surgical treatment.