Supraventricular tachycardia in children: Clinical features, response to treatment, and long-term follow-up in 217 patients

doi:10.1016/S0022-3476(81)80578-1

The Journal of Pediatrics

Volume 98, Issue 6, June 1981, Pages 875-882

https://doi.org/10.1016/S0022-3476(81)80578-1 Get rights and content

We reviewed the records of 217 children whose first episode of supraventricular tachycardia occurred before 18 years (median age 24 months). There were 112 males and 105 females. Of the 49 with congenital heart disease, SVT began before any operation in 26 and >2 weeks postoperatively in 23. Wolf-Parkinson-White syndrome was present on surface ECG in 47/217 (22%). Congestive heart failure accompanied the first episode of SVT in 38% of the patients who were 4 months of age or younger, and in only 19% of those over 4 months (P<0.001). Treatment was successful in stopping SVT within 48 hours in 90/142 (63%). Successful short-term treatment included digoxin 57/84 (68%), cardioversion 12/20 (60%), vagal maneuvers 12/19 (63%), phenylephrine 3/9, and overdrive pacing 4/5. SVT recurred at least once in 83% of all patients. On follow-up (mean 4.6 years), episodes of SVT were still present in 56%. Three patients died—two from incessant SVT and one from a CVA after VSD repair. We conclude that long-term status was difficult to predict, but SVT was present in fewer patients whose age at onset was <4 months and in those with unoperated CHD. Early recurrence was not a poor prognostic sign. We recommended treatment for at least one year in all patients with SVT, whether or not the first episode terminates spontaneously.

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To describe the prevalence of Owlet Smart Sock (OSS) use in infants with supraventricular tachycardia (SVT) and associated demographic and clinical characteristics of users and to analyze the association of OSS use on medical resource use and clinical outcomes from emergency department (ED) encounters for SVT.
This was a single-center, retrospective cohort study of infants with confirmed SVT from 2015 to 2022. OSS users and nonusers were compared across clinical and demographic parameters. Medical resource use (phone calls, office visits, ED visits) and outcomes (need for intensive care, length of stay, echocardiographic function, clinical appearance) were compared between OSS users and nonusers.
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Citation Excerpt :
Patients with reported symptoms but without cardiac evaluation, documentation, or modification in antiarrhythmic management were not considered an SVT recurrence. Study design and candidate predictors of recurrence were chosen a priori based on clinical experience and prior historical data. 3-5,10,11,16 The only risk factor decided after data collection (and before data analysis) were cutoffs for age category.
Data regarding recurrence risk among infants with supraventricular tachycardia (SVT) are limited.
The purpose of this study was to determine incidence and factors associated with SVT recurrence.
This was a retrospective single-center study (1984-2020) with prospective phone follow-up of infants with structurally normal hearts diagnosed at age ≤1 year with re-entrant SVT. Primary outcome was first SVT recurrence after hospital discharge. Classification and regression tree analysis was performed to determine a risk algorithm.
Among 460 infants (62% male), 87% were diagnosed at ≤60 days of age (median 13 days; IQR: 1-31 days). During a median follow-up of 5.2 years (IQR: 1.8-11.2 years), 33% had recurrence. On multivariable analysis, factors associated with recurrence included: fetal or late (>60 days) diagnosis (HR: 1.90; 95% CI: 1.26-2.86; and HR: 1.73; 95% CI: 1.07-2.77, respectively), Wolff-Parkinson-White (WPW) syndrome (HR: 2.46; 95% CI: 1.75-3.45), and need for multi-antiarrhythmic or second-line therapy (HR: 2.08; 95% CI: 1.45-2.99). Based on the classification and regression tree analysis, WPW incurred the highest risk. Among those without WPW, age at diagnosis was the most important factor predicting risk. Fetal or late diagnosis incurred higher risk, and if multi-antiarrhythmic or second-line therapy was also required, risk nearly doubled. Infants without WPW, who were diagnosed early (0-60 days), and who were discharged on propranolol were at lowest recurrence risk.
Infants with SVT are most likely to be diagnosed at ≤60 days and be male. Risk factors for recurrence (occurred in 33%), present at time of diagnosis, include WPW, fetal or late diagnosis, and multi-antiarrhythmic or second-line therapy. Infants with early diagnosis, without WPW, and discharged on first-line monotherapy are at lowest recurrence risk.
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This study aims to describe the current burden of primary and comorbid pediatric HF in the United States.
International Classification of Diseases, Clinical Modification codes were used to identify HF cases and comorbidities from the Kids’ Inpatient Database, National Inpatient Sample, National Emergency Department (ED) Sample, and National Vital Statistics System for 2012 and 2016. To describe HF events, all visits/events among pediatric and adult subjects were included in the analysis. HF events were classified into 1 of 3 groups: 1) no HF; 2) primary HF; or 3) comorbid HF. We compared patients with and without HF and calculated unique event rates with age and sex standardization.
Congenital heart disease, conduction disorders/arrhythmias, and cardiomyopathy were responsible for the majority of pediatric HF-related ED visits and hospitalizations. Compared to 2012, in 2016, there was an increase in comorbid HF ED visits (rate ratio: 1.93; P < 0.001) and primary HF hospitalizations (rate ratio: 1.14; P = 0.002). Pediatric HF burden was lower compared to adult HF; however, deaths in the ED and in-hospital were significantly more likely in children presenting with HF than adults.
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Detection of Tachyarrhythmias in a Large Cohort of Infants Using Direct-to-Consumer Heart Rate Monitoring
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Current estimates of the incidence of tachyarrhythmias in infants rely on clinical documentation and may not reflect the true rate in the general population. Our aim was to describe the epidemiology of tachyarrhythmia detected in a large cohort of infants using direct-to-consumer heart rate (HR) monitoring.
Data were collected from Owlet Smart Sock devices used in infants in the US with birthdates between February 2017 and February 2019. We queried the HR data for episodes of tachyarrhythmia (HR of ≥240 bpm for >60 seconds).
The study included 100 949 infants (50.8% male) monitored for more than 200 million total hours. We identified 5070 episodes of tachyarrhythmia in 2508 infants. The cumulative incidence of tachyarrhythmia in our cohort was 2.5% over the first year of life. The median age at the time of the first episode of tachyarrhythmia was 36 days (range, 1-358 days). Tachyarrhythmia was more common in infants with congenital heart disease (4.0% vs 2.4%; P = .015) and in females (2.7% vs 2.0%; P < .001). The median length of an episode was 7.3 minutes (range, 60 seconds to 5.4 hours) and the probability of an episode lasting longer than 45 minutes was 16.8% (95% CI, 15.4%-18.3%).
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⁺: Supported in part by Grant HL-07190 from the National Institutes of Health United States Public Health Services and by USPH Grant RR-00188 from General Clinical Research Branch National Institutes of Health.

^*: Recipient of a National Institutes of Health Young Investigator Research Award HL-24916.

^**: Recipient of a National Institutes of Health Research Career Development Award HL-00571.

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Original articleSupraventricular tachycardia in children: Clinical features, response to treatment, and long-term follow-up in 217 patients+

Lancet

Am Heart J

Pediatrics

Am Heart J

Heart disease in infancy and childhood

Paroxysmal tachycardia in infants and children. Study of 41 cases

Pediatrics

Paroxysmal tachycardia in infancy

Acta Paediatr Scand Suppl

Paroxysmal tachycardia in infancy: follow-up study of 47 subjects ranging in age from 10 to 26 years

Pediatrics

Paroxysmal tachycardia in infancy and childhood

Acta Paediatr Scand

Original article
Supraventricular tachycardia in children: Clinical features, response to treatment, and long-term follow-up in 217 patients+