Permanent junctional reciprocating tachycardia in children: a multicenter experience.
BACKGROUND
Permanent junctional reciprocating tachycardia (PJRT) is an uncommon form of supraventricular tachycardia in children. Treatment of this arrhythmia has been considered difficult because of a high medication failure rate and risk of cardiomyopathy. Outcomes in the current era of interventional treatment with catheter ablation have not been published.


OBJECTIVE
To describe the presentation and clinical course of PJRT in children.


METHODS
This is a retrospective review of 194 pediatric patients with PJRT managed at 11 institutions between January 2000 and December 2010.


RESULTS
The median age at diagnosis was 3.2 months, including 110 infants (57%; aged <1 year). PJRT was incessant in 47%. The ratio of RP interval to cycle length was higher with incessant than with nonincessant tachycardia. Tachycardia-induced cardiomyopathy was observed in 18%. Antiarrhythmic medications were used for initial management in 76%, while catheter ablation was used initially in only 10%. Medications achieved complete resolution in 23% with clinical benefit in an additional 47%. Overall, 140 patients underwent 175 catheter ablation procedures with a success rate of 90%. There were complications in 9% with no major complications reported. Patients were followed for a median of 45.1 months. Regardless of treatment modality, normal sinus rhythm was present in 90% at last follow-up. Spontaneous resolution occurred in 12% of the patients.


CONCLUSIONS
PJRT in children is frequently incessant at the time of diagnosis and may be associated with tachycardia-induced cardiomyopathy. Antiarrhythmic medications result in complete control in few patients. Catheter ablation is effective, and serious complications are rare.
Department of Pediatrics, Division of Cardiology, British Columbia Children's Hospital, Vancouver, BC, Canada.
Kristopher T
KT
Kang
Department of Pediatrics, Division of Cardiology, British Columbia Children's Hospital, Vancouver, BC, Canada.
James E
JE
Potts
Vanderbilt University Medical Center, Nashville, Tennessee.
Andrew E
AE
Radbill
University of Michigan, Ann Arbor, Michigan.
Martin J
MJ
La Page
Mitera Children's Hospital, Athens, Greece.
John
J
Papagiannis
Primary Children's Hospital, Salt Lake City, Utah.
Jason M
JM
Garnreiter
Children's Heart Centre, University Hospital Motol, Prague, Czech Republic.
Petr
P
Kubus
Stollery Children's Hospital, Edmonton, AB, Canada.
Michal J
MJ
Kantoch
University of Iowa Children's Hospital, Iowa City, Iowa.
Nicholas H
NH
Von Bergen
CHU Mère-Enfant Sainte-Justine, University of Montreal, Montreal, QC, Canada.
Anne
A
Fournier
Centre Mère-Enfant, CHUQ, Quebec, QC, Canada.
Jean-Marc
JM
Côté
University Children's Hospital, Georg-August University, Go¨ttingen, Germany.
Thomas
T
Paul
Providence Sacred Heart Children's Hospital, Spokane, Washington.
Charles C
CC
Anderson
Mayo Clinic, Rochester, Minnesota.
Bryan C
BC
Cannon
Lucile Packard Children's Hospital, Palo Alto, California.
Christina Y
CY
Miyake
Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York.
Andrew D
AD
Blaufox
Children's Heart Centre, University Hospital Motol, Prague, Czech Republic.
Susan P
SP
Etheridge
Department of Pediatrics, Division of Cardiology, British Columbia Children's Hospital, Vancouver, BC, Canada. Electronic address: ssanatani@cw.bc.ca.
Shubhayan
S
Sanatani
D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D054139:Tachycardia, Reciprocating / Q000453:epidemiology / Q000503:physiopathology*; D014481:United States / Q000453:epidemiology
Antiarrhythmic medications ok; Catheter ablation; Pediatrics; Permanent junctional reciprocating tachycardia