Prognosis in Primary Ventricular Tachycardia in the Pediatric Patient

SUMMARY Five male pediatric patients with primary ventricular tachycardia are described. Although three were initially in congestive heart failure due to the tachycardia and were extremely difficult to manage, all have completely recovered, are not taking medication, and are free of arrhythmia. Three of the patients re-quired long-term management with quinidine, with a therapeutic goal of controlling the heart rate rather than abolishing the arrhythmia. No growth disturbances were found in those three patients. A review of reported cases revealed 71 infants and children with ventricular tachycardia not associated with heart disease or systemic disorders; only four deaths were reported (5.6%). In the primary form of ventricular tachycardia in children, complete pharmacologic suppression may not be achieved without seriously endangering the normal electrophysiologic functions. Controlling the rate to an asymptomatic level with pharmacologic means is safer for a problem that may be self-limited. PRIMARY ventricular tachycardia (VT) is an un-common cardiac arrhythmia in childhood, and the choice of treatment may be influenced by experience with VT in the adult. In adults, this arrhythmia is life-threatening because of rapid deterioration to ven-tricular fibrillation, and emergency steps to convert to sinus rhythm are justified. Similarly, VT in children with profound hypoxia, or severe congenital heart dis-ease may be a terminal event and cardioversion is urgent, although not necessarily effective. Primary or idiopathic VT in children, by contrast, is less grave; the dangers of an unplanned assault with the goal of complete suppression of the ectopic mechanism may prove more dangerous than the arrhythmia. In this report we present our experience with primary VT in infants and children to clarify the prognosis of this arrhythmia when managed conservatively