Skip to main content
SpringerLink
Log in

Ventricular arrhythmia in children: Diagnosis and management

  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

With increasing awareness of genetic abnormalities and the aging of patients with structural cardiac disease, particularly those who have had cardiac surgery, primary ventricular tachycardia is being recognized more frequently in children and adolescents and is becoming a larger management issue. The distinction of primary versus secondary is based on whether ventricular tachycardia is the inciting arrhythmia or the end result of a prolonged ischemic event, such as prolonged bradycardia with resultant ventricular tachycardia. This article discusses only primary ventricular tachycardia. The incidence clearly increases with age after cardiac surgery, particularly in specific cardiac abnormalities, such as tetralogy of Fallot post repair, transposition of the great arteries, post atrial switch operation, and hypertrophic obstructive cardiomyopathy. In addition, as genetic abnormalities are becoming better appreciated, conditions such as long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, and Brugada syndrome, with their risk for ventricular tachycardia and fibrillation, are being seen increasingly in the pediatric population. Long-term treatment of ventricular tachycardia includes drug therapy, implantable device therapy, invasive ablation therapy, and combinations of these modalities. To choose the appropriate therapy, the clinician must consider the arrhythmia’s effect on the patient’s hemodynamic status and the potential for sudden cardiac death.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Thiene G, Corrado D, Basso C: Arrhythmogenic right ventricular cardiomyopathy/dysplasia. Orphanet J Rare Dis 2007, 2: 45–61.

    Article  PubMed  Google Scholar 

  2. Eckhardt LL, Farley AL, Rodriguez E, et al.: KCNJ2 mutations in arrhythmia patients referred for LQT testing: a mutation T305A with novel effect on rectification properties. Heart Rhythm 2007, 4: 323–329.

    Article  PubMed  Google Scholar 

  3. Tan HL, Bardai A, Shimizu W, et al.: Genotype-specific onset of arrhythmia in congenital long-QT syndrome: possible therapy implications. Circulation 2006, 114: 1096–1103.

    Article  Google Scholar 

  4. Hayashi M, Takatsuki S, Maison-Blanche P, et al.: Ventricular repolarization restitution properties in patients exhibiting type 1 Brugada electrocardiogram with and without inducible ventricular fibrillation. J Am Coll Cardiol 2008, 51: 1162–1168.

    Article  PubMed  Google Scholar 

  5. London B, Michalec M, Mehdi H, et al.: Mutation in glycerol-3-phosphate dehydrogenase 1-like gene (GPD1-L) decreases cardiac Na+ current and causes inherited arrhythmias. Circulation 2007, 116: 2260–2268.

    Article  PubMed  CAS  Google Scholar 

  6. Ackerman MJ: Cardiac causes of sudden unexpected death in children and their relationship to seizures and syncope: genetic testing for cardiac electropathies. Semin Pediatr Neurol 2005, 12: 52–58.

    Article  PubMed  Google Scholar 

  7. Schwartz PJ, Spazzolini C, Drotti L, et al.: The Jervell and Lange-Nielsen syndrome. Natural history, molecular basis and clinical outcome. Circulation 2006, 113: 783–790.

    Article  PubMed  Google Scholar 

  8. Furushima H, Chinushi M, Sugiura H, et al.: Ventricular tachycardia late after repair of congenital heart disease: efficacy of combination therapy with radiofrequency ablation and class III antiarrhythmic agents and long-term outcome. J Electrocardiol 2006, 39: 219–224.

    Article  PubMed  Google Scholar 

  9. Khairy P, Harris L, Landsberg MJ, et al.: Implantable cardioverter-defibrillators in tetralogy of Fallot. Circulation 2008, 117: 363–370.

    Article  PubMed  Google Scholar 

  10. Byrum C: Ventricular tachycardia. In Clinical Cardiac Electrophysiology in the Young. Edited by Dick M 2nd. New York: Springer; 2006: 139–152.

    Chapter  Google Scholar 

  11. Bradley DJ: Multifocal atrial tachycardia. In Clinical Cardiac Electrophysiology in the Young. Edited by Dick M 2nd. New York: Springer; 2006: 135–138.

    Chapter  Google Scholar 

  12. Knauth AL, Gauvreau K, Powell AJ, et al.: Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 2008, 94: 211–216.

    Article  PubMed  CAS  Google Scholar 

  13. Zipes DP, Camm AJ, Borggrefe M, et al.: ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. J Am Coll Cardiol 2006, 48: 247–346.

    Article  Google Scholar 

  14. DeRosa G, Butera G, Chessa M, et al.: Outcome of newborns with asymptomatic monomorphic ventricular arrhythmia. Arch Dis Child Fetal Neonatal Ed 2006, 91: F419–F422.

    Article  CAS  Google Scholar 

  15. Ralston M, Hazinski MF, Zaritsky AL, et al.: PALS Provider Manual. Dallas: American Heart Association; 2006.

    Google Scholar 

  16. Fischbach PS: Pharmacology of antiarrhythmic agents. In Clinical Cardiac Electrophysiology in the Young. Edited by Dick M 2nd. New York: Springer; 2006: 267–288.

    Chapter  Google Scholar 

  17. Hoshino K, Ogawa K, Hishitani T, et al.: Successful uses of magnesium sulfate for torsades de pointes in children with long QT syndrome. Pediatr Int 2006, 48: 112–117.

    Article  PubMed  CAS  Google Scholar 

  18. McBride BF, Min B, Kluger J, et al.: An evaluation of the impact of oral magnesium lactate on the corrected QT interval of patients receiving sotalol or dofetilide to prevent atrial or ventricular tachyarrhythmia recurrence. Ann Noninvasive Electrocardiol 2006, 11: 163–169.

    Article  PubMed  Google Scholar 

  19. Kim JR, Juriansz GJ, Jones DR, et al.: Comparison of a standard versus accelerated dosing regimen for D,L-sotalol for the treatment of atrial and ventricular dysrhythmias. Pacing Clin Electrophys 2006, 29: 1219–1225.

    Article  Google Scholar 

  20. Connolly SJ, Dorian P, Roberts RS, et al.: Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC study: a randomized trial. JAMA 2006, 295: 165–171.

    Article  PubMed  CAS  Google Scholar 

  21. Rosso R, Kaman JM, Rogowski O, et al.: Calcium channel blockers versus beta blockers alone for preventing exercise-induced arrhythmias in catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm 2007, 4: 1149–1154.

    Article  PubMed  Google Scholar 

  22. Goldschlager N, Epstein AE, Naccarelli GV, et al.: A practical guide for clinicians who treat patients with amiodarone. Heart Rhythm 2007, 4: 1250–1259.

    Article  PubMed  Google Scholar 

  23. Fukumoto K, Kobayashi T, Tachibana K, et al.: Pitfalls of testing and summary of guidance on safety monitoring with amiodarone and digoxin. BMJ 2007, 334: 312–315.

    Article  Google Scholar 

  24. Nelli N, Stewart-Teixeira L, Dipchand AI: Amiodaronesirolimus/tacrolimus interaction in a pediatric heart transplant patient. Pediatr Transplant 2006, 10: 736–739.

    Article  Google Scholar 

  25. Epstein AE, DiMarco JP, Ellenbogen KA, et al.: ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. Circulation 2008, 117: e350–e408.

    Article  PubMed  Google Scholar 

  26. Costa R, Silva KR, Mendonca RC, et al.: Incidence of shock and quality of life in young patients with implantable cardioverter-defibrillator. Arg Bras Cardiol 2007, 88: 258–264.

    Google Scholar 

  27. Kreibel T, Saul JP, Schneider H, et al.: Noncontact mapping and radiofrequency ablation of fast and hemodynamically unstable ventricular tachycardia after surgical repair of tetralogy of Fallot. J Am Coll Cardiol 2008, 50: 2162–2168.

    Article  Google Scholar 

  28. Baksiene D, Sileikiene R, Sileikis V, et al.: Idiopathic ventricular tachycardia in children: curative therapy with radiofrequency ablation. Medicina (Kaunas) 2007, 43: 803–807.

    Google Scholar 

  29. Yao Y, Zhang S, He DS, et al.: Radiofrequency ablation of the ventricular tachycardia with arrhythmogenic right ventricular cardiomyopathy using non-contact mapping. Pacing Clin Electrophysiol 2007, 30: 526–533.

    Article  PubMed  Google Scholar 

  30. Schwartz PJ, Priori SG, Cerrone M, et al.: Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome. Circulation 2004, 109: 1826–1833.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Michigan Congenital Heart Center, Department of Pediatrics, University of Michigan Health System, Box 5204, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Gerald Serwer

Authors
  1. Gerald Serwer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerald Serwer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Serwer, G. Ventricular arrhythmia in children: Diagnosis and management. Curr Treat Options Cardio Med 10, 442–447 (2008). https://doi.org/10.1007/s11936-008-0036-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-008-0036-7

Keywords

Search

Navigation