Dataset Information

Age makes a difference: Symptoms in pediatric supraventricular tachycardia.

ABSTRACT:

Background

Supraventricular tachycardia is a group of rhythm disturbances that affect 1 in 300-1200 Australian children annually. The differentiation of supraventricular tachycardia (SVT) symptoms and age of onset according to their subtype is not well understood in the pediatric population. Most studies rely on ECG criteria only to characterize the subtype of the SVT, which is not applicable to all subtypes. The purpose of this study was to identify the symptoms and ages of onset of SVT subtypes, and to analyze whether ethnicity or severity correlated with the SVT subtype confirmed in an invasive Electrophysiology (EP) study.

Methods

A retrospective analysis and prospective survey evaluated 364 patients who underwent an EP study at The Royal Children's Hospital, Melbourne between 2009 and 2015. Age of onset, symptoms, and ethnicity were collected by phone survey or medical records in addition to EP study diagnostic data, medication status, and follow-up information about their symptom status following EP procedure. Patients were grouped according to their SVT subtype. Data analysis was performed using chi-squared, Fisher's exact, and ANOVA statistical tests to determine associations between SVT substrates.

Results

Two hundred and thirty-three suitable cases of SVT were identified (131 men, 102 women) aged between 0 and 18 years. Atrioventricular Reentrant Tachycardia (AVRT) (n = 153) was the most common SVT subtype, followed by Atrioventricular Nodal Reentrant Tachycardia (AVNRT) (n = 55), Atrial Tachycardia (AT) (n = 17), and other SVT subtypes (n = 8) which included Atrial Fibrillation, Atrial Flutter, and Junctional Tachycardia. There was a male predominance in all subtypes, except for AVNRT. AVNRT patients had palpitations, dyspnoea, dizziness, and anxiety more than any other group, AVRT patients complained of vomiting most and patients with AT had the most fatigue. The mean age of symptom onset varied among groups, being earlier in AVRT, later in AVNRT with a significant difference between AVRT with unidirectional retrograde accessory pathway (URAP) and AVNRT subtypes (P < 0.01).

Conclusion

Some specific symptoms were strong discriminators between different SVT subtypes. Ethnicity did not have strong correlations with SVT subtype incidence. This study was able to show clinical differences among children with SVT due to AVRT (URAP) compared to AVNRT, allowing the prognosis and intended management of pediatric SVT to be anticipated by less invasive means.

SUBMITTER: Quattrocelli A

PROVIDER: S-EPMC6174476 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Publications

Age makes a difference: Symptoms in pediatric supraventricular tachycardia.

Quattrocelli Amanda A Lang Janet J Davis Andrew A Pflaumer Andreas A

Journal of arrhythmia 20180813 5

<h4>Background</h4>Supraventricular tachycardia is a group of rhythm disturbances that affect 1 in 300-1200 Australian children annually. The differentiation of supraventricular tachycardia (SVT) symptoms and age of onset according to their subtype is not well understood in the pediatric population. Most studies rely on ECG criteria only to characterize the subtype of the SVT, which is not applicable to all subtypes. The purpose of this study was to identify the symptoms and ages of onset of SVT ...[more]

PMID: 30327703

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Project description:OBJECTIVES:Supraventricular tachycardia is the most common arrhythmia in infants, and antiarrhythmic medications are frequently used for prophylaxis. The optimal prophylactic antiarrhythmic medication is unknown, and prior randomized trials have been underpowered. We used data from a large clinical registry to compare efficacy and safety of digoxin and propranolol for infant supraventricular tachycardia prophylaxis. We hypothesized that supraventricular tachycardia recurrence is less common on digoxin when compared with propranolol. DESIGN:Retrospective cohort study. SETTING:Pediatrix Medical Group neonatal ICUs. PATIENTS:Infants discharged from 1998 to 2012 with supraventricular tachycardia who were treated with digoxin or propranolol. We excluded infants discharged before completing 2 days of therapy, those with Wolff-Parkinson-White syndrome, structural heart defects (except atrial/ventricular septal defects and patent ductus arteriosus), and those started on multidrug therapy. MEASUREMENTS AND MAIN RESULTS:We used Cox proportional hazards to evaluate supraventricular tachycardia recurrence, defined as need for adenosine or electrical cardioversion while exposed to digoxin versus propranolol, controlling for infant characteristics, inotropic support, supplemental oxygen, and presence of a central line. We identified 342 infants exposed to digoxin and 142 infants exposed to propranolol. The incidence rate of treatment failure was 6.7/1,000 infant-days of exposure to digoxin and 15.4/1,000 infant-days of exposure to propranolol. On multivariable analysis, treatment failure was higher on propranolol when compared with that on digoxin (hazard ratio, 1.97; 95% CI, 1.05-3.71). Hypotension was more frequent during exposure to digoxin versus propranolol (39.4 vs 11.1/1,000 infant-days; p < 0.001). There was no difference in frequency of other clinical adverse events. CONCLUSIONS:Digoxin was associated with fewer episodes of supraventricular tachycardia recurrence but more frequent hypotension in hospitalized infants relative to propranolol.

Project description:BackgroundVagal maneuvers (VagMs) are recommended as the first-line treatment of supraventricular tachycardia (SVT). However, the optimal type of VagMs remains unproven.AimThis study aims to compare the effectiveness and adverse events amongst VagMs on SVT via network meta-analyses (NMAs).MethodsWe systematically searched randomized controlled trials (RCTs) that involved adults with SVT and compared VagMs without language restrictions. We determined the initial and final responses of conversion rate to sinus rhythm and adverse events. Risk of bias (RoB) was appraised by Cochrane revised tool, and contribution matrix was calculated. NMAs were synthesized using frequentist random-effects model and presented as relative risk (RR) with 95% CI. The order of probability was presented as surface under the cumulative ranking curve analysis (SUCRA). Sensitivity analysis was performed using both Bayesian and frequentist approach with fixed- or random-effects models. Certainty of evidence (CoE) was rated by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology.ResultsFourteen RCTs with 2,180 patients were enrolled. Small portion of mixed estimates was contributed from high overall RoB studies. Compared with carotid sinus massage (CSM), the modified Valsalva maneuver (MVM) was the most effective VagM after initial performance [SUCRA: 0.9992, RR: 5.47 (1.77-16.93)] and at the end of study [SUCRA: 1.0000, RR: 3.62 (2.04-6.39), CoE: high]. The standard VM did not elicit better conversion rate to the sinus rhythm than CSM at the initial response [SUCRA: 0.4395, RR: 1.97 (0.63-6.15)] and at the end of the study [SUCRA: 0.4795, RR: 1.64 (0.94-2.87), CoE: moderate]. The SUCRA value of CSM at the initial and final responses was the least one amongst three VagMs (0.0613 and 0.0205, respectively). Adverse events amongst three VagMs were similar (CoE: low). Sensitivity analyses yielded consistent results.ConclusionWe recommended MVM as the first choice of VagM for rhythm conversion before the pharmacological management of SVT.

Dataset Information

Age makes a difference: Symptoms in pediatric supraventricular tachycardia.

Background

Methods

Results

Conclusion

Publications

Age makes a difference: Symptoms in pediatric supraventricular tachycardia.

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