Idiopathic ventricular tachycardia in infancy and childhood - A multicenter study on clinical profile and outcome

OBJECTIVES The present study intended to evaluate the clinical profile and outcome in a large cohort of pediatric patients with idiopathic ventricular tachycardia (VT). BACKGROUND Ventricular tachycardia (VT) without: underlying heart disease is rare in childhood. Limited information is available with regard to outcome and indications for long-term antiarrhythmic treatment. MEHTODS A retrospective multicenter study was conducted. Patient data were obtained from the individual centers using a standardized questionnaire. RESUTLS Ninety-eight pediatric patients with episodes of VT in the absence of structural heart disease were included. Mean age at first manifestation of the arrhythmia was 5.4 years (range 0.1 to 15.1), with 27% of the patients having had VT already in infancy. Clinical symptoms or echocardiographic signs of left ventricular dysfunction were observed initially in 36% of the patients, of which one third (12% of the whole population) presented with severe symptoms (heart failure or syncope). After a mean follow-up of 47 months (range 12 to 182), no patient had died. Twenty-five patients had never been treated with antiarrhythmic drugs. Sixty-three patients were free of VT and did not take antiarrhythmic drugs at last follow-up. Prognosis was better when VT occurred during the first year of life (VT resolution in 89%) compared with VT occurrence beyond the first year of life (VT resolution in 56%: p < 0.01). The A retrospective multicenter study was with VT occurrence beyond the first year patients with presumed right VT (VT resolution in clinical profile was more favorable for patients wi 76%, symptoms in 25% of patients) compared with patients with presumed left VT, where VT resolution occurred in 37% and symptoms in 67% of patients (p < 0.01). CONCLUSIONS VT in children with a normal heart carried a good prognosis. Outcome was better after onset of VT during infancy and when VT originated in the right ventricle. A restrictive use of antiarrhythmic agents might be justified in a largeproportion of these patients. (C) 1999 by the American College of Cardiology.