Permanent junctional reciprocating tachycardia in children: A multi-center experience: Permanent junctional reciprocating tachycardia.

Heart rhythm : the official journal of the Heart Rhythm Society

PubMedID: 24769425

Kang KT, Potts JE, Radbill AE, La Page MJ, Papagiannis J, Garnreiter JM, Kubus P, Kantoch MJ, Von Bergen NH, Fournier A, Côté JM, Paul T, Anderson CC, Cannon BC, Miyake CY, Blaufox AD, Etheridge SP, Sanatani S. Permanent junctional reciprocating tachycardia in children: A multi-center experience: Permanent junctional reciprocating tachycardia. Heart Rhythm. 2014;.
BACKGROUND
Permanent junctional reciprocating tachycardia (PJRT) is an uncommon form of supraventricular tachycardia in children. Treatment of this arrhythmia has been considered difficult due to 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
Median age at diagnosis was 3.2 months, including 110 infants (57%) (age <1 year). PJRT was incessant in 47%. The ratio of RP interval to cycle length was higher with incessant compared to non-incessant 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 patients.

CONCLUSION
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.