title: Impact of transesophageal electrophysiologic study to elucidate the mechanism of arrhythmia on children with supraventricular tachycardia and no preexcitation.
abstract: An electrophysiologic study (EPS) of children and teenagers with paroxysmal supraventricular tachycardia (SVT) and normal electrocardiography (ECG) in sinus rhythm was evaluated. Generally, EPS is performed only before paroxysmal SVT ablation in these patients. In this study, 140 patients (mean age, 15 ± 3 years) with normal ECG in sinus rhythm were studied for SVT by a transesophageal route in baseline state and after isoproterenol. Idiopathic left or right ventricular tachycardia was diagnosed in four patients (3 %). Anterograde conduction over an atrioventricular (AV) left lateral (n = 10) or septal (n = 9) accessory pathway (AP) was noted in 19 patients (13.5 %) at atrial pacing. Orthodromic AV reentrant tachycardia (AVRT) was induced in these children. Five of the patients had a high rate conducted over AP (>240 bpm in baseline state or >290 bpm after isoproterenol). Two of the patients (a 10-year-old girl with well-tolerated SVT and a 17-year-old with syncope-related SVT) had the criteria for a malignant form with the induction of atrial fibrillation conducted over AP at a rate exceeding 290 bpm in baseline state. Of the 140 patients, 74 (53 %) had typical AV node reentrant tachycardia (AVNRT), nine had atypical AVNRT (6 %), 1 had atrial tachycardia (0.7 %), and 33 (23.5 %) had AVRT related to a concealed AP with only retrograde conduction. Electrophysiologic study is recommended for children with paroxysmal SVT and normal ECG in sinus rhythm. The data are helpful for guiding the treatment. Ventricular tachycardia or atrial tachycardia can be misdiagnosed. Masked preexcitation syndrome with anterograde conduction through AP was present in 13.5 % of the patients, and 1.4 % had a malignant preexcitation syndrome.
authors.affiliation: Adult and Paediatric Cardiology, CHU de Brabois, 54500, Vandoeuvre Les Nancy, France, b.brembilla-perrot@chu-nancy.fr.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.forename: A
authors.initials: A
authors.lastname: Moulin-Zinsch
authors.forename: J M
authors.initials: JM
authors.lastname: Sellal
authors.forename: J
authors.initials: J
authors.lastname: Schwartz
authors.forename: A
authors.initials: A
authors.lastname: Olivier
authors.forename: P Y
authors.initials: PY
authors.lastname: Zinzius
authors.forename: C
authors.initials: C
authors.lastname: De Chillou
authors.forename: D
authors.initials: D
authors.lastname: Beurrier
authors.forename: M
authors.initials: M
authors.lastname: Rodermann
authors.forename: G
authors.initials: G
authors.lastname: Goudote
authors.forename: H
authors.initials: H
authors.lastname: Al Amoura
authors.forename: A
authors.initials: A
authors.lastname: Terrier de la Chaise
authors.forename: J
authors.initials: J
authors.lastname: Lemoine
authors.forename: J
authors.initials: J
authors.lastname: Rizk
authors.forename: J P
authors.initials: JP
authors.lastname: Lethor
authors.forename: J L
authors.initials: JL
authors.lastname: Anne Tisserand
authors.forename: S
authors.initials: S
authors.lastname: Taïhi
authors.forename: F
authors.initials: F
authors.lastname: Marçon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D004947:Esophagus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011226:Pre-Excitation Syndromes; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult