Sustained tachyarrhythmia in children younger than 1 year of age: Six
year single-center experience
Gulhan Tunca Sahin, Erkut Ozturk, Taner Kasar, Alper Guzeltas and Yakup Ergul
Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and
Research Hospital, Istanbul Saglik Bilimleri University, Istanbul, Turkey.
Abstract Background: The aim of this study was to evaluate the results of non-operational sustained tachyarrhythmia in
patients <1 year of age at the present center.
Methods: Between November 2010 and November 2016, the demographic characteristics, type and localization of
the tachyarrhythmia, echocardiographic ﬁndings, and medical and/or ablation therapy for patients <1 year of age
with sustained tachyarrhythmia were evaluated.
Results: Of 99 patients, 91 had sustained supraventricular tachycardia, and eight had sustained ventricular tachycar-
dia. The median age was 30 days (range, 1–350 days), and the median weight was 4.2 kg (range, 2–13 kg). The
common symptoms were palpitation and restlessness (n = 49, 49.5%), or the tachycardia was detected during
routine inspection (n = 25, 25.3%) or fetal echocardiography (n = 11, 11.1%). Nineteen individuals (19%) had left
ventricular (LV) dysfunction on ﬁrst echocardiography. Twenty individuals had congenital heart disease. Common
diagnoses were Wolff-Parkinson-White syndrome (n = 27), focal atrial tachycardia (n = 10), permanent junctional
reciprocating tachycardia(n = 6), and atrial ﬂutter (n = 6). Seventeen patients underwent medical therapy combined
with cardioversion. The most commonly used abortive and acute therapy agents were adenosine, esmolol, and amio-
darone. The most common combination therapy was propranolol and amiodarone, followed by a propranolol and
propafenone combination. Nine individuals were treated with catheter ablation due to either resistance to medical
therapy or LV dysfunction.
Conclusions: Tachyarrhythmias in children <1 year of age are mostly caused by accessory pathways and require
multidrug therapy. Catheter ablation is an effective alternative therapy in the case of resistance to medical therapy
and/or LV dysfunction.
Key words accessory pathway, infant, medical therapy, newborn, tachyarrhythmia.
Tachyarrhythmias are common cardiac arrhythmias in newborns
The majority of tachyarrhythmias presenting in
infancy depend on the presence of an accessory pathway. In
one-third of patients, tachyarrhythmia never recurs after 1 year
of age, but heart failure may develop more easily in neonates
and infants depending on the duration, mechanism, and rate of
Patients usually present with non-speciﬁc symptoms, such
as pallor, difﬁculty feeding, tachypnea, and excessive sweat-
ing. It is diagnosed either during routine physical examination
or evaluation for dilated cardiomyopathy. Occasionally, it is
detected during follow up for fetal tachycardia.
The majority of sustained tachyarrhythmias in children
<1 year were treated with a single anti-arrhythmic drug or a
combination of such drugs depending on the spontaneous
Although it is more risky in those under
1 year than in other age groups, radiofrequency ablation
(RFA) or cryoablation can be applied successfully in a limited
number of patients refractory to medical treatment. In this
study, we report on sustained tachyarrhythmia patients aged
<1 year age in terms of presentation, clinical ﬁndings, tach-
yarrhythmia type, and treatment modality.
The study was conducted retrospectively in a tertiary cardiac
center between November 2010 and November 2016, involving
all patients <1 year of age who presented with sustained tach-
yarrhythmia. All postoperative tachyarrhythmia cases were
excluded. Age at time of diagnosis, presentation signs and
symptoms, sex, bodyweight, tachyarrhythmia type, electrocar-
diogram (ECG) ﬁndings, echocardiography, 24 h Holter ECG
monitoring, anti-arrhythmia medications, whether trans-
esophageal (TEEPS) or transvenous electrophysiological study
was performed, and the ablation procedure details were recorded
on a study chart. Presentation signs and symptoms were catego-
rized as (i) restlessness and palpitation; (ii) dyspnea; or
Correspondence: Yakup Ergul, MD,
Istanbul Mehmet Akif Ersoy
gitim Arasßtırma Hastanesi,
ukcßekmece, Istanbul, Turkey.
Received 28 May 2017; revised 13 October 2017; accepted 20
© 2017 Japan Pediatric Society
Pediatrics International (2018) 60, 115–121 doi: 10.1111/ped.13445