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Incessant Infant Ventricular Tachycardia


Presentation

  • The most common clinical presentation is VT with congestive heart failure.[orpha.net]
  • This report describes 21 patients with incessant ventricular tachycardia present greater than 90% of the day and night; the age at diagnosis ranged from birth to 30 months (mean 10.5 months).[ncbi.nlm.nih.gov]
  • Presents a new chapter on recording and interpreting heart rhythms in patients with pacemakers. Includes new material on interpreting ECG findings associated with implantable cardioverter-defibrillators.[books.google.com]
  • A previously healthy, 7-month-old male infant weighing 7 kg presented to our institution with a 2-day history of incessant ventricular tachycardia (VT) unresponsive to defibrillation and medication.[circ.ahajournals.org]
  • In this case, the presentation and management of a neonate with SVT, whose arrhythmia was first detected in utero and later confirmed postpartum is presented.[nigjcardiol.org]
Congestive Heart Failure
  • The most common clinical presentation was cardiac arrest (11 patients, in 5 after digitalis for presumed supraventricular tachycardia); another 6 patients had congestive heart failure and 4 were asymptomatic.[ncbi.nlm.nih.gov]
  • The most common clinical presentation is VT with congestive heart failure.[orpha.net]
  • Conclusion From a practical standpoint, the presence of a tachycardiomyopathy should be suspected in any patient with congestive heart failure and persistent or incessant tachycardia.[elsevier.es]
  • heart failure from atrial flutter 7.)[quizlet.com]
  • Patients with shock, congestive heart failure, or cardiac arrest: -Drug clearance may be reduced in these patient populations and a continuous infusion when treating ventricular arrhythmias should not exceed 20 mcg/kg/min Precautions Consult WARNINGS[drugs.com]
Physician
  • Widely considered the optimal electrocardiography reference for practicing physicians, and consistently rated as the best choice on the subject for board preparation, this is an ideal source for mastering the fundamental principles and clinical applications[books.google.com]
  • We are indebted to the following physicians for referral of the patients: Ramon Canent, Charles Cooper, Carl Gumbiner, Henry Gelband, Sudhir Mehta, Garth Orsmond, and Juan Villafane.[nejm.org]
  • Recognition, diagnosis, and treatment are important skills for emergency physicians because of the distinct differences in diagnosis and treatments for each type of SVT.[ahcmedia.com]
  • J, Ichikawa R, Shibuya A, Maeda Y, Hishiki T, Kondo Y PloS one 13(9) e0203985 Sep 2018 [Refereed] Psychometric validation of a new measurement instrument for time-oriented patient information in electronic medical records: A questionnaire survey of physicians[researchmap.jp]
Anemia
  • Stay current on the developments and research surrounding neonatal anemia from the entirely new chapter on Blood and Hematopoietic System highlights.[books.google.com]
  • Differential Diagnosis Sinus Tachycardia secondary to dehydration/hypovolemia (most common), fever, hypoxia, anemia, shock, MI, pulmonary edema, hyperthyroidism, hypocalcemia, or medications Supraventricular Tachycardia (AV re-entry, junctional, or atrial[learn.pediatrics.ubc.ca]
  • The rapid proliferation of blood vessels in your bosom needs the constant boost from the heart as well Diseases like thyroid and anemia also put you at the risk of tachycardia In addition, the hormonal changes, side effects of pregnancy medications, and[beingtheparent.com]
  • SINUS TACHYCARDIA • The sinus node sends out impulses faster than usual HR • In response to body’s need for CO : exercise,anxiety, fever, hypovolemia or circulatory shock, anemia, CHF, administration of catecholamines, thyrotoxicosis & myocardial disease[slideshare.net]
Collapse
  • Digoxin and verapamil are best avoided as they may worsen the tachycardia and lead to cardiovascular collapse. Prognosis Tachycardia usually resolves before the age of five years and drug treatment can be withdrawn. Late recurrence is unusual.[orpha.net]
  • In each case antiarrhythmic drug therapy caused haemodynamic collapse, requiring emergency ECMO support. Drug therapy on ECMO was not successful.[europace.oxfordjournals.org]
  • Repeated ECHO after several hours showed a diffusely hypocontractile left ventricle with significantly reduced ejection fraction of around 20% with hemodynamic collapse in terms of refractory hypotension.[signavitae.com]
  • Bradyarrhythmias - Symptoms • General: altered consciousness,fatigue,dizziness,syncope • Hemodynamic instability: hypotension, poor end-organ perfusion, respiratory distress/failure, sudden collapse 51.[slideshare.net]
  • Cardiovascular instability is unlikely when the heart rate is [6] The resulting cardiovascular collapse in cases with unstable rhythm draws attention to the presence of the condition.[nigjcardiol.org]
Surgical Procedure
  • A pacemaker is a small battery-operated device implanted into the body (near the collarbone) through a surgical procedure.[kidshealth.org]
  • Surgical procedures in the vicinity of the AV node: - tetralogy of Fallot repair - closure of VSDs - AVSD repair - other complex surgical procedures are at increased risk of developing JET 2.)[quizlet.com]
  • Precipitating events may include the following: Use of prescription or recreational drugs (eg, cocaine) Skeletal myopathy Recent surgical procedures Central lines (eg, direct mechanical ectopy) Recent illnesses (eg, potential for myocarditis); fever may[emedicine.medscape.com]
Regurgitation
  • Echocardiography demonstrated a structurally normal heart and mild mitral regurgitation. Percutaneous catheter mapping identified that the VT originated in the posterobasal left ventricle.[circ.ahajournals.org]
  • The bedside ECHO showed normal dimensions of heart chambers with the preserved ejection fraction of the left ventricle measuring 60-70%, with normal function of the right ventricle and with only trivial triuspid regurgitation.[signavitae.com]
  • Two-dimensional and Doppler echocardiography showed bi-ventricular dilatation, left ventricle dimensions: end-diastolic 60 mm; end-systolic 52.5 mm, severe global hypokinesis with mild mitral and tricuspid regurgitation, pulmonary arterial pressure 54[elsevier.es]
  • The progression to hydrops in utero seems to follow right heart failure, with tricuspid regurgitation and right ventricular dilation signifying impending decompensation.[glowm.com]
  • Other causes of atrial fibrillation include: - tricuspid atresia - rheumatic heart disease - AV valve regurgitation 6.)[quizlet.com]
Tachycardia
  • Incessant ventricular tachycardia in an infant treated with transmural radiofrequency ablation. Circulation, 105 (23), 2797-2798.[okayama.pure.elsevier.com]
  • Differential diagnosis The differential diagnosis includes other types of ventricular tachycardia and supraventricular tachycardia with a wide QRS.[orpha.net]
  • Increased dose of amiodarone, with the use of verapamil, landiolol and lidocaine transiently controlled her tachycardia. She was transferred to our hospital for RFCA of her tachycardia when she was 9-month-old.[jstage.jst.go.jp]
  • Abstract Infants with incessant ventricular tachycardia (occurring greater than 10% of the day) have generally been described in pathologic studies.[ncbi.nlm.nih.gov]
  • Stay current on timely topics like contemporary cardiac mapping and imaging techniques, atrial tachycardia and flutter, atrial fibrillation, atrioventricular nodal reentrant tachycardia, tachycardias related to accessory atrioventricular connections,[books.google.com]
Heart Failure
  • Features new chapters on pediatric electrocardiography that explore rhythm problems associated with pediatric obesity, heart failure, and athletic activity.[books.google.com]
  • The most common clinical presentation was cardiac arrest (11 patients, in 5 after digitalis for presumed supraventricular tachycardia); another 6 patients had congestive heart failure and 4 were asymptomatic.[ncbi.nlm.nih.gov]
  • The most common clinical presentation is VT with congestive heart failure.[orpha.net]
  • However, despite being clinically silent, these lesions can provoke arrhythmias and heart failure (Pediatrics 118:1146-1151, 2006; Eur J Pediatr 153:155-7, 1994).[bmcpediatr.biomedcentral.com]
  • Supraventricular tachycardia (SVT) is a common mode of presentation which could cause heart failure. [1] This is particularly important in fetus where they could become hydropic from heart failure and suffer stillbirth.[nigjcardiol.org]
Suggestibility
  • Etiology The physiopathology of this type of VT is unknown but it has been suggested that microscopic tumors such as myocardial hamartomas, also known as histiocytoid cardiomyopathy (see this term), are responsible.[orpha.net]
  • Careful examination of the 12-lead electrocardiogram suggested ventricular tachycardia, which was confirmed by electrophysiological studies.[ncbi.nlm.nih.gov]
  • Patients whose findings on subsequent investigation suggest benign VT often may resume their full activities.[emedicine.medscape.com]
  • This observation was among the first to suggest that marijuana may be related to the incidence of ventricular tachyarrhythmias in certain patients.[sanraffaele.it]
  • Conclusion The patient’s clinical course suggests that careful life-long disease management is important, even in TSC patients without apparent symptoms.[bmcpediatr.biomedcentral.com]
Withdrawn
  • Prognosis Tachycardia usually resolves before the age of five years and drug treatment can be withdrawn. Late recurrence is unusual. The documents contained in this web site are presented for information purposes only.[orpha.net]
  • Treatment can usually be withdrawn by the age of five years without recurrence(3,4).[indianpediatrics.net]
  • After further testing revealed no spontaneous or inducible arrhythmia the catheters were withdrawn, though femoral lines were kept until after transfer to the neonatal intensive care unit (NICU).[innovationsincrm.com]
  • In case 2, ablation was undertaken because the tachycardia recurred when extracorporeal support was withdrawn.[europace.oxfordjournals.org]
Stroke
  • Keep current with the latest developments in palliative care, mass casualty/epidemic disease, acute respiratory failure, non-invasive ventilation, neurocritical care, neuroimaging, hypoxic-ischemic encephalopathy, stroke and intracerebral hemorrhage,[books.google.com]
  • STROKE WORK: The area of the Pressure-Volume Loop. Mathematically, that means: Stroke Work (Stroke Volume) x (Mean Arterial Pressure) STROKE WORK is equivalent to stroke volume, but it is normalized for differences in blood pressure.[kumc.edu]
  • Actions Shares 0 Downloads 751 Comments 3 Likes 36 No notes for slide obeying the “all or none” law.enabling it to function as a single unit Site of origin Pathophysiology of tachyarrhythmias Insufficient time for diastolic filling leads to decreased stroke[slideshare.net]
  • Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke 1991;22(8):983-988. Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation.[ahcmedia.com]
  • Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation. Eur Heart J. 2010 Apr;31(8):967-75.[textbookofcardiology.org]
Encephalopathy
  • Keep current with the latest developments in palliative care, mass casualty/epidemic disease, acute respiratory failure, non-invasive ventilation, neurocritical care, neuroimaging, hypoxic-ischemic encephalopathy, stroke and intracerebral hemorrhage,[books.google.com]

Workup

Left Axis Deviation
  • The most common electrocardiographic (ECG) pattern (10 of 21) was right bundle branch block with left axis deviation, but other right and left bundle branch block patterns were observed.[ncbi.nlm.nih.gov]
  • Anything negative of -30 is left axis deviation, as occurs from left ventricular hypertrophy. Anything positive of 110 is right axis deviation, as occurs from right ventricular hypertrophy.[kumc.edu]
Nodal Tachycardia
  • Atrioventricular nodal tachycardia a. AV nodal re-entry tachycardia (AVNRT) b. Junctional (automatic) tachycardia 3. Primary atrial tachycardia a. Sinus tachycardia b. Atrial flutter c. Atrial re-entry tachycardia d. Automatic atrial tachycardia e.[quizlet.com]
  • AV-NODAL TACHYCARDIA : Tachycardia, plus the P-Wave is insignificant or absent. This is tachycardia, where the impulse originates from the AV-Node. The inherent pacemaker of the AV-Node is faster than the SA-Node.[kumc.edu]
Right Bundle Branch Block
  • The most common electrocardiographic (ECG) pattern (10 of 21) was right bundle branch block with left axis deviation, but other right and left bundle branch block patterns were observed.[ncbi.nlm.nih.gov]
  • Diagnostic methods The electrocardiogram (ECG) usually shows a type of right bundle branch block morphology and a superior axis, predicting a tachycardia origin in the posterior or inferior left ventricle.[orpha.net]
  • A 12-lead electrocardiogram showed a right bundle branch block, normal QT and no signs of ischaemia.[signavitae.com]
  • The dominant R wave in lead V1 may be misinterpreted as right bundle branch block. Type B: the delta wave and QRS complex are predominantly negative in leads V1 and V2 and positive in the other precordial leads, resembling left bundle branch block.[patient.info]
  • bundle branch block (RBBB) configuration with left superior axis deviation (LSAD), VT usually occurs in young individuals with structurally normal hearts and generally carries a good prognosis. 10 Idiopathic incessant VT leading to a tachycardia-mediated[elsevier.es]
Myocardial Fibrosis
  • In four, only myocardial fibrosis was found; results of one biopsy were normal.(ABSTRACT TRUNCATED AT 250 WORDS).[ncbi.nlm.nih.gov]
  • fibrosis. 26 TMC is a curable disease and should be suspected in any patient with decreased ventricular function in the setting of incessant tachycardia.[elsevier.es]
Abnormal ECG
  • Comprehensively and expertly describes how to capture and interpret all normal and abnormal ECG findings in adults and children.[books.google.com]

Treatment

  • Management and treatment Immediate treatment involves control of tachycardia and general support or resuscitation as required. Intravenous lidocaine (1-2 mg/kg) will usually slow or stop the tachycardia leading to rapid symptomatic improvement.[orpha.net]
  • Transluminal treatment of arteriosclerotic obstruction. Description of a new technique and a preliminary report of its application. ‎ Page 90 - Age-related changes in normal human hearts during the first 10 decades of life.[books.google.com]

Prognosis

  • Prognosis Tachycardia usually resolves before the age of five years and drug treatment can be withdrawn. Late recurrence is unusual. The documents contained in this web site are presented for information purposes only.[orpha.net]
  • Prognosis Prognosis is usually very good once treated. [ 16 ] Catheter ablation may be curative.[patient.info]
  • Ventricular tachycardia disappears during exercise and is usually refractory to drugs with a good long-term prognosis.[af-ablation.org]
  • Specialist evaluation is required to define the prognosis and treatment(3,4). Atrioventricular reentry is also the commonest tachycardia encountered in children of school age.[indianpediatrics.net]

Etiology

  • Etiology The physiopathology of this type of VT is unknown but it has been suggested that microscopic tumors such as myocardial hamartomas, also known as histiocytoid cardiomyopathy (see this term), are responsible.[orpha.net]
  • Ninety-eight patients from 13 centers were found to have either sustained or non-sustained VT of undetermined etiology while 29 patients with long QT syndrome, catecholaminergic VT, or accelerated ventricular rhythm were excluded.[aapgrandrounds.aappublications.org]
  • This arrhythmia may be either of congenital etiology or may occur after cardiac surgery. Sudden death is uncommon in children with arrhythmias but when it occurs, is frequently caused by ventricular arrhythmias.[af-ablation.org]
  • Chronic therapy is based on the underlying etiology of the arrhythmia with the use of beta-blockers and class 1A, 1B, 1C, and 3 antiarrhythmic drugs.[uscjournal.com]

Epidemiology

  • Summary Epidemiology The incidence of incessant infant VT is estimated to be 1/333,300 live births in the United Kingdom. Males are more commonly affected than females.[orpha.net]
  • Print version SUMMARY Non-invasive diagnostic methods along with the clinical epidemiology of supraventricular arrhythmias are vital elements for the differential diagnosis and management of such arrhythmias, however they not always allow us to reach[fac.org.ar]
  • Petronis et al. [27] using age-matched controls in the survey data from the National Institute of Mental Health Epidemiologic Catchment Area Program reported that marijuana was associated with an age- and race-adjusted relative risk of 1.5 (95% CI 1.1[sanraffaele.it]
  • Epidemiology WPW syndrome is relatively common and found in 2 to 4 people per 1,000 population. In adults, it is more common in males. [ 2 ] WPW syndrome is found in all ages, although it is most common in young, previously healthy people.[patient.info]
  • Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology[bmcpediatr.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of septic cardiomyopathy is mediated by cytokines and NO.[signavitae.com]
  • Likes Statistics Notes Views Total views 7,725 On SlideShare 0 From Embeds 0 Number of Embeds 25 Actions Shares 0 Downloads 751 Comments 3 Likes 36 No notes for slide obeying the “all or none” law.enabling it to function as a single unit Site of origin Pathophysiology[slideshare.net]
  • Ventricular tachycardia: Pathophysiology and radiofrequency catheter ablation. PACE 1997; 20: 534-551. 7. Kugler JD, Danford DA, Houston K, Felix G.[indianpediatrics.net]
  • This review will provide a basic understanding of the pathophysiology, management strategies, and clinical presentations of SVT.[clinicaladvisor.com]
  • Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev. 2011 Jan;91(1):265-325. DOI: 10.1152/physrev.00031.2009 PubMed ID: 21248168 HubMed Cox JL. The surgical treatment of atrial fibrillation. IV.[textbookofcardiology.org]

Prevention

  • Medication may be used to convert ventricular tachycardia to a normal rhythm, slow down the heart rate or prevent recurrences.[ucsfbenioffchildrens.org]
  • Stay informed about the developments in treatments or prevention techniques available for abnormal heart rate or rhythm.[momjunction.com]
  • Shibuya A, Misawa J, Maeda Y, Ichikawa R, Kamata M, Inoue R, Morimoto T, Nakayama M, Hishiki T, Kondo Y Journal of evaluation in clinical practice 23(6) 1459-1465 Dec 2017 [Refereed] An approach for preventive healthcare for elderly people in Japan using[researchmap.jp]
  • ., a family practitioner specializing in nutrition and preventive surgery in Torrance, California. Come to for the right carotid artery. Softly massaging the right carotid artery is another vagal maneuver.[ventriculartachycardiatreatment.com]
  • Sim I, MacDonald K, Lavori P, Norbutas C, Hlatky M (1997) Quantitative overview of randomised trials of amiodarone to prevent sudden cardiac death. Circulation 96: 2823–2829 PubMed Google Scholar 11.[link.springer.com]

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