Abstract
For young patients with preexcitation syndromes the associated tachycardias and available treatment options are virtually identical to those discussed in other chapters in this book. However, the symptomatic expression of tachycardia may be quite different in young patients with preexcitation syndromes. The role of age-related changes in autonomic tone, morphologic-functional changes in the atrioventricular (AV) node or accessory connection, or changes in the initiating event of tachycardia in serially determining the presence or absence and severity of symptoms in patients with preexcitation syndromes is poorly understood. Nevertheless, age-related differences in symptom expression must be considered in treatment of the young patient. For example, unless associated heart disease is present, an otherwise healthy child may have surprisingly few symptoms from tachycardias even when the rate is rapid. Additionally, death or sudden cardiac arrest in patients with preexcitation syndromes has rarely been documented in the first decade [1–3], possibly because atrial fibrillation (the arrhythmia most closely associated with sudden death in preexcitation syndrome patients) has been reported rarely during the first decade of life [4,5]. Finally, time is often an ally, since young patients may cease having episodes of tachycardia for many years [6–8]. This phenomenon is poorly understood, and emphasizes our incomplete knowledge about the natural history of preexcitation syndromes in affected patients (see Chapter 2 by Dunnigan).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Benson DW, Jr, Gallagher JJ: Electrophysiologic evaluation and surgical correction of WolffParkinson-White Syndrome in children. Clin. Pediat. 19: 575, 1980.
Fasth A: Wolff-Parkinson-White Syndrome. A fatal case in a girl with no other heart disease. Acta Paediatr. Scand 64: 138, 1975.
Brechenmacher C, Courtadon M, Jourde M, Yermia JC, Cheynel J, Voegtlin R: Syndrome de Wolff-Parkinson-White par association de fibres atriohissiennes et de fibres de Mahaim. Arch. Mal Coeur 69: 1275, 1976.
Belhassen B, Pauzner D, Blieden L, Sherez J, Zinger A, David M, Muhlbauer B, Laniado S: Intrauterine and postnatal atrial fibrillation in the Wolff-Parkinson-White syndrome. Circulation 66: 1124, 1982.
Mehta AV, Pickoff AS, Raptoulis A, Wolff GS, Garcia OL, Tamer DF, Ferrer PF, Gelband H: Atrial flutter and atrial fibrillation associated with Wolff-Parkinson-White syndrome in childhood. Pediatr. Cardiol. 1: 197, 1980.
Mantakas ME, McCue CM, Miller WM: Natural history of Wolff-Parkinson-White syndrome discovered in infancy. Am. J. Cardiol. 41: 1097, 1978.
Lundberg A: Paroxysmal atrial tachycardia in infancy: Long-term follow-up study of 49 subjects. Pediatrics 70: 638, 1982.
Benson DW Jr, Dunnigan A, Benditt DG, Schneider SP: Follow-up of infant paroxysmal atrial tachycardia: Transesophageal study. (Abstract.) Circulation 70: I1, 1984.
Giardina ACV, Ehlers KH, Engle MA: WolffParkinson-White syndrome in infants and children: A long term follow-up study. Br. Heart J. 34: 839, 1972.
Benson DW Jr, Smith WM, Dunnigan A, Sterba R, Gallagher JJ: Mechanisms of regular, wide QRS tachycardia in infants and children. Am. J. Cardiol. 49: 1778, 1982.
Dauvignon A, Rautaharju P, Boisselle E, Soumis F, Megelas M, Choquette A. Normal ECG standards for infants and children. Pediatr. Cardiol. 1:123, 1979/80.
Sellers TD Jr, Campbell RFW, Bashore TM, Gallagher JJ: Effects of procainamide and quinidine sulfate in the Wolff-Parkinson-White syndrome. Circulation 55: 15, 1977.
Wellens HJJ, Bar FW, Dassen WRM, Brugada P, Vanagt EJ, Farre J: Effect of drugs in the WolffParkinson-White syndrome: Importance of initial length of effective refractory period of the accessory pathway. Am. J. Cardiol. 46: 665, 1980.
Kerr CR, Prystowsky EN, Smith WM, Cook L, Gallagher JJ: Electrophysiologic effects of disopyramide phosphate in patients with WolffParkinson-White syndrome. Circulation 65: 869, 1982.
Swiryn S, Bauernfeind R, Wyndham CRC, Dhingra RC, Palileo E, Strasberg B, Rosen KM: Effects of oral disopyramide phosphate on induction of paroxysmal supraventricular tachycardia. Circulation 64: 169, 1981.
Soler-Soler J, Sagrista-Sauleda J, Dabrera A, Sauleda-Pares J, Iglesias-Berengue J, PermanyerMiralda G, Roca-Llop J: Effect of verapamil in infants with paroxysmal supraventricular tachycardia. Circulation 59: 876, 1979.
Porter CJ, Gillette PC, Garson A Jr, Hesslein PS, Karpawich PP, McNamara DG: Effects of verapamil on supraventricular tachycardia in children. Am. J. Cardiol. 48: 487, 1981.
Wu D, Keu HC, Yeh SJ, Lin FC, Hung JS: Effects of oral verapamil in patients with atrioventricular tachycardia incorporating an accessory pathway. Circulation 67: 426, 1983.
Gulamhusein S, Ko P, Carruthers SG, Klein GJ: Acceleration of the ventricular response during atrial fibrillation in the Wolff-Parkinson-White syndrome after verapamil. Circulation 65: 348, 1982.
Zipes DP, Prystowsky EN, Heger JJ: Amiodarone: Electrophysiologic actions, pharmacokinetics and clinical effects. J. Am. Coll. Card. 3: 1059, 1984.
Wellens HJJ, Brugada P, Abdolla AH: Effect of amiodarone in paroxysmal supraventricular tachycardia with or without Wolff-ParkinsonWhite syndrome. Am. Heart J. 106: 876, 1983.
Prystowsky EN, Klein GJ, Rinkenberger RL, Hager JJ, Naccarelli GV, Zipes DP: Clinical efficacy and electrophysiologic effects of en- cainide in patients with Wolff-Parkinson-White 37. syndrome. Circulation 69: 278, 1984.
Jackman WM, Zipes DP, Naccarelli GV, Rink- enberger RL, Heger JJ, Prystowsky EN: Elec- 38. trophysiology of oral encanide. Am. J. Cardiol. 49: 1270, 1982.
Nadas AS, Daeschner CW, Roth A, Blumenthal SL: Paroxysmal tachycardia in infants and chil- dren - Study of 41 cases. Pediatics 9: 167, 1952. 39.
Waxman MB, Wald RW, Sharma AD, Huerta F, Cameron DA: Vagal techniques for termination of paroxysmal supraventricular tachycardia Am. J. Cardiol. 46: 655, 1980. 40.
Bissett GS, Gaum W, Kaplan S: The ice bag: A new technique for interruption of supraventricular tachycardia. J. Pediatr. 97: 593, 1980.
Sperandeo V, Pierri D, Palazdo P, Donzelli M, Spataro G: Supraventricular tachycardia in in- 41. fants: Use of the “diving reflex.” Am. J. Cardiol. 51: 286, 1983.
Massumi RA, Kisten AD, Tawakkel AA: Termination of reciprocal tachycardia by atrial stimulation. Circulation 36: 637, 1967.
Durrer D, Schoo L, Schuilenburg RM, Wellens 42. JJ: The role of premature beats in the initiation and the termination of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Circulation 36: 644, 1967. 43.
Sugre DD, McLaran C, Hammill SC, Gersh BJ, Mair DD, Holmes DR Jr: Refractory supra-ventricular tachycardia in the neonate: Treatment with temporary antitachycardia pacing. Mayo Clin. Proc. 60: 169, 1985. 44.
Gallagher JJ, Smith WM, Kerr CR, Kasell J, Cook L, Reiter M, Sterba R, Harte M: Esophageal pacing: A diagnostic and therapeutic 45. tool. Circulation 65: 336, 1982.
Kerr CR, Gallagher JJ, Smith WM, Sterba R, German LD, Cook L, Kasell JH: The induction of atrial flutter and fibrillation and the termina- 46. tion of atrial flutter by esophageal pacing. PACE 6: 60, 1983.
Benson DW Jr, Dunnigan A, Benditt DG, 47. Schneider SP: Transesophageal cardiac pacing: History, application, technique. Clin. Prog. Pac. Electrophysiol. 2: 360, 1984.
Greco R, Musto B, Arienzo V, Alborino A, 48. Garofalo S, Marsico F: Treatment of paroxysmal supraventricular tachycardia in infancy with digitalis, adenosine-5’-triphosphate, and verapamil: A comparative study. Circulation 66: 504, 1982.
Weiss AT, Lewis BS, Halon DA, Hasin Y, Gotsman MS: The use of calcium with verapamil in the management of supraventricular tachyar- 49. rhythmias. Int. J. Cardiol. 4: 275, 1983.
Roguin N, Shapir Y, Blazer S, Zeltzer M, Berant 50.M: The use of calcium gluconate prior to verapamil in infants with paroxysmal supraventricular tachycardia. Clin. Cardiol. 7: 613, 1984.
Yee R, Gulamhusein SS, Klein GJ: Combined verapamil and propranolol for supraventricular tachycardia. Am. J. Cardiol. 53: 757 1984.
Reiter MJ, Shand DG, Aanonsen LM, Wagoner R, McCarthy E, Pritchett ELC: Pharmacokinetics of verapamil: Experience with a sustained intravenous infusion. Am. J. Cardiol. 50: 716, 1982.
Belhassen B, Pelleg A, Shoshani D, Geva B, Laniado S: Electrophysiologic effects of adenosine-5’-triphosphate on atrioventricular reentrant tachycardia. Circulation 68: 827, 1983.
DiMarco JP, Sellers TD, Berne RM, West GA, Belardinelli L: Adenosine: electrophysiologic effects and therapeutic use for terminating paroxysmal supraventricular tachycardia. Circulation 68: 1254, 1983.
Denes P, Cummings JM, Simpson R, Wu D, Amat-Y-Leon F, Dhuigra R, Rosen KM: Effects of propranolol on anomalous pathway refractoriness and circus movement tachycardias in patients with preexciation. Am. J. Cardiol. 41: 1061, 1978.
Barett PH, Jordan JL, Mandel WJ, Yamaguchi I, Laks MM: The electrophysiologic effects of intravenous propranolol in the Wolff-ParkinsonWhite syndrome. Am. Heart J. 98: 213, 1979.
Ponce FE, Williams LC, Webb HM, Riopel DA, Hohn AR: Propranolol palliation of tetralogy of Fallot: Experience with long-term drug treatment in pediatric patients. Pediatrics 52: 100, 1973.
Cumming GR, Mir GH: Heart rate and haemodynamics after autonomic blockade in infants and children. Br. Heart J. 32: 766, 1970.
Benson DW Jr, Dunnigan A, Green TP, Benditt DG, Schneider SP: Periodic procainamide for paroxysmal tachycardia. Circulation. 72: 147, 1985.
Margolis B, De Silva RA, Lown B: Episodic drug treatment in the management of paroxysmal arrhythmias. Am. J. Cardiol. 45: 621, 1980.
Yeh SJ, Lin FC, Chou YY, Hung JS, Wu D: Termination of paroxysmal supraventricular tachycardia with single oral dose of diltiazem and propranolol. Circulation 71: 104, 1985.
Kleinman CS, Donnerstein RL, Jaffe CC, DeVore GR, Weinstein EM, Lynch DC, Talner NS, Berkowitz RL, Hobbins JC: Fetal echocardiography: A tool for evaluation of in utero cardiac arrhythmias and monitoring of in utero therapy: Analysis of 71 patients. Am. J. Cardiol. 51: 237, 1983.
Newburger JW, Keane JF: Intrauterine supra- ventricular tachycardia. J. Pediatr. 95:780, 1979. Given BD, Phillippe M, Sanders SP, Dzau VJ: 478 V. TREATMENT
Procainamide cardioversion of fetal supra-ventricular tachyarrhythmia. Am. J. Cardiol. 53: 1460, 1984.
Spinnato JA, Shaver DC, Flinn GS, Sibai BM, Watson DL, Marin-Garcia J: Fetal supra-ventricular tachycardia: In utero therapy with digoxin and quinidine. Obstet. Gynecol. 64: 730, 1984.
Valerius NH, Jacobson JR: Intrauterine supra-ventricular tachycardia. Acta Obstet. Gynecol. Scand. 57: 407, 1978.
Harrigan JT, Kangos JJ, Sikka A, Spisso KR, Natarajan N, Rosenfeld D, Leiman S, Korn D: Successful treatment of fetal congestive heart failure secondary to tachycardia. N. Engl. J. Med. 304: 1527, 1981.
Dumesic DA, Silverman NH, Tobias S, Golbus MS: Transplacental cardioversion of fetal supra-ventricular tachycardia with procainamide. N. Engl. J. Med. 307: 1128, 1982.
Wolff F, Breuker KH, Schlensker KH, Bolte A: Prenatal diagnosis and therapy of fetal heart rate anomalies: With a contribution on the placental transfer of verapamil. J. Perinat. Med. 8: 203, 1980.
Teuscher A, Bossi E, Imhof P, Erb E, Stocker FP, Weber JW: Effect of propranolol on fetal tachycardia in diabetic pregnancy. Am. J. Cardiol. 42: 304, 1978.
Allan LD, Crawford DC, Anderson RH, Tynan M: Evaluation and treatment of fetal arrhythmias. Clin. Cardiol. 7: 467, 1984.
Crowley DC, Dick M, Rayburn WF, Rosenthal A: Two-dimensional and M-mode echocardiographic evaluation of fetal arrhythmia. Clin. Cardiol. 8: 1, 1985.
Rotmensch HH, Elkayam U, Frishman W: Anti-arrhythmic drug therapy during pregnancy. Ann. Int. Med. 98: 487, 1983.
McKenna WJ, Harris L, Rowland E, Whitelaw A, Storey G, Holt D: Amiodarone therapy during pregnancy. Am. J. Cardiol. 51: 1231, 1983.
Benson DW Jr, Dunnigan A, Benditt DG, Thompson TR, Narayan A, Boros S: Prediction of digoxin treatment failure in infants with supraventricular tachycardia: Role of trans-esophageal pacing. Pediatrics 75: 288, 1985.
Pickoff AS, Zies L, Ferrer PL, Tamer D, Wolff G, Garcia O, Gelband H: High-dose propranolol therapy in the management of supraventricular tachycardia. J. Pediatr. 94: 144, 1979.
Coumel P, Fidelle J: Amiodarone in the treatment of cardiac arrhythmias in children: One hundred thirty-five cases. Am. Heart J. 100: 1063, 1980.
Shahar E, Frand M, Feigel A: Amiodarone in control of sustained tachyarrhythmias in children with Wolff-Parkinson-White Syndrome. Pediatrics 72: 813, 1983.
Benson DW Jr, Dunnigan A, Sterba R, Benditt DG: Atrial pacing from the esophagus in the diagnosis and management of tachycardia and palpitations. J. Pediatr. 102: 40, 1983.
Klein GJ, Gulamhusein S, Prystowsky EN, Carruthers SG, Donner AP, Ko PT: Comparison of the electrophysiologic effects of intravenous and oral verapamil in patients with paroxysmal supraventricular tachycardia. Am. J. Cardiol. 49: 117, 1982.
Alboni P, Shantha N, Pirani R, Baggioni F, Scarfo S, Tomasi AM, Masoni A: Effects of amiodarone on supraventricular tachycardia involving bypass tracts. Am. J. Cardiol. 53: 93, 1984.
Bauernfeind RA, Swiryn S, Petropoulos AT, Coelho A, Gallastegui J, Rosen KM: Concordance and discordance of drug responses in atrioventricular reentrant tachycardia. J. Am. Coll. Cardiol. 2: 345, 1983.
Swiderski J, Lees MH, Nadas AS: The WolffParkinson-White syndrome in infancy and childhood. Br. Heart J. 24: 561, 1962.
Sellers TD Jr, Bashore TM, Gallagher JJ: Digitalis in the pre-excitation syndrome: Analysis during atrial fibrillation. Circulation 56: 260, 1977.
Hastreiter AR, Van der Horst RL, Chow-Tung E: Digitalis toxicity in infants and children. Pediatr. Cardiol. 5: 131, 1984.
Pritchett ELC, Hammill SC, Reiter MJ, Lee KL, McCarthy E, Zimmerman JM, Shand DM: Life-table methods for evaluating antiarrhythmic drug efficacy in patients with paroxysmal atrial tachycardia. Am. J. Cardiol. 52: 1007, 1983.
Singh S, Gelband H, Mehta AV, Kesslerk, Casta A, Pickoff AS: Procainamide elimination kinetics in pediatric patients. Clin. Pharmacol. Ther. 32: 607, 1982.
Ezrin AM, Epstein K, Bassett AL, Myerburg RJ, Gelband H: Effects of procainamide on cellular electrophysiology of neonatal and adult dog myocardium. Dey. Pharmacol. Ther. 1: 352, 1980.
Pickoff AS, Singh S, Flinn CJ, Torres E, Ezrin AM, Gelband H: Dose-dependent electrophysiologic effects of amiodarone in the immature canine heart. Am. J. Cardiol. 52: 621, 1983.
Dunnigan A, Benditt DG, Benson DW Jr: Modes of onset (“initiating events”) of paroxysmal atrial tachycardia in infants and children. Am. J. Cardiol. (In Press, June 1986).
Levy AM, Bonazinga BJ: Sudden sinus slowing with junctional escape: A common mode of initiation of juvenile supraventricular tachycardia. Circulation 67: 84, 1983.
Dreifus LS, Arriaga J, Watanabe Y, Downing D, Haiat R, Morse D: Recurrent Wolff-ParkinsonWhite tachycardia in an infant: Successful treatment by a radio-frequency pacemaker. Am. J. Cardiol. 28: 586, 1971.
Spurrell RAJ, Nathan AW, Bexton RS, Hellestrand KJ, Nappholz T, Camm AJ: Implantable automatic scanning pacemaker for termination of supraventricular tachycardia. Am. J. Cardiol. 49: 753, 1982.
Furman S, Young D: Cardiac pacing in children and adolescents. Am. J. Cardiol. 39: 550, 1977.
Simon AB, Dick M II, Stern AM, Behrendt DM, Sloan H: Ventricular pacing in children. PACE 5: 836, 1982.
Kugler JD, Gillette PC, Duff DF, Cooley DA, McNamara DG: Elective mapping and surgical division of the bundle of Kent in a patient with Ebstein’s anomaly who required tricuspid valve replacement. Am. J. Cardiol. 41: 602, 1978.
Benson DW Jr, Gallagher JJ, Spach MS, Barr RC, Edwards SB, Oldham HN, Kasell J: Accessory atrioventricular pathway in an infant: Prediction of location with body surface maps and ablation with cryosurgery. J. Pediatr. 96: 41, 1980.
Benson DW Jr, Gallagher JJ, Oldham HN, Sealy WC, Sterba R, Spach MS: Corrected transposition with severe intracardiac deformities and Wolff-Parkinson-White syndrome in a child: Electrophysiological investigation and surgical correction. Circulation 61: 1256, 1980.
Byrum CJ, Wahl RA, Behrendt, Dick M: Ven tricular fibrillation associated with the use of digitalis in a newborn infant with WolffParkinson-White syndrome. J. Pediatr. 101: 400, 1982.
Gallagher JJ, Sealy WC: The permanent form of junctional reciprocating tachycardia: Further elucidation of the underlying mechanism. Eur. J. Cardiol. 8: 413, 1978.
Epstein ML, Benditt DG: Long term evaluation of persistent supraventricular tachycardia in children: Clinical and electrocardiographic features. Am. Heart J. 102: 80, 1981.
Cosio FG, Benson DW Jr, Anderson RW, Hession WT, Pritzker MR, Benditt DG: Onset of atrial fibrillation during antidromic tachycardia: Association with sudden cardiac arrest and ventricular fibrillation in a patient with Wolff-Parkinson-White syndrome. Am. J. Cardiol. 50: 353, 1982.
Morady F, Sledge C, Shen E, Sung RJ, Gonzales R, Scheinman MM: Electrophysiologic testing in the management of patients with the WolffParkinson-White syndrome and atrial fibrillation. Am. J. Cardiol. 51: 1623, 1983.
Benson DW Jr, Dunnigan A, Benditt DG, Pritzker MR, Thompson TR: Transesophageal study of infant supraventricular tachycardia: Electrophysiologic characteristics. Am. J. Cardiol. 52: 1002, 1983.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1986 Martinus Nijhoff Publishing
About this chapter
Cite this chapter
Benson, D.W., Dunnigan, A. (1986). Treatment of Pediatric Patients with Preexcitation Syndromes. In: Benditt, D.G., Benson, D.W. (eds) Cardiac Preexcitation Syndromes. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-7526-5_22
Download citation
DOI: https://doi.org/10.1007/978-1-4684-7526-5_22
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4684-7528-9
Online ISBN: 978-1-4684-7526-5
eBook Packages: Springer Book Archive