Supraventricular tachyarrhythmia associated with left ventricular dysfunction in neonates & infants: Experience from a Tertiary Care Children’s Hospital in Dhaka, Bangladesh

Abstract

Introduction: Supraventricular Tachyarrhythmia (SVT) in neonates & infants may results in left ventricular (LV) dysfunction if persists for long time. Sometimes it may result into cardiomyopathy & symptomatic heart failure. Left ventricular systolic function improves or normalizes and symptoms resolve if rhythm is corrected or rate controlled is achieved. The purpose of the study is to observe clinical features, management & outcome of various SVT associated with left ventricular dysfunction admitted at cardiac centre of Bangladesh Shishu Hospital & Institute. Methodology: This prospective cross-sectional study was conducted in all the neonates & infants admitted with confirmed SVT with LV dysfunction. SVT was confirmed by ECG criteria & LV dysfunction was confirmed by Echocardiography. All the patient underwent treatment according to unit SVT management protocol for different types of SVT. Presenting complaints, ECG findings, Echo findings, Antiarrhythmic medicine with which the SVT is reverted to sinus rhythm, duration required for reversion, any complication during management was recorded. These patient was followed up at centre’s arrhythmia clinic 1 month, 3 months, 6 months and 1 year after discharge from hospital. During follow up the ongoing antiarrhythmic medicine dose, duration & discontinuation, any side effects, ECG & ECHO findings was recorded. Result: Total 18 neonates & infants were admitted with confirmed SVT with LV dysfunction during the study period. Median age was 43 days & median ventricular rate was 250 BPM. One third of patient presented with symptoms & signs of heart failure, 22% presented with circulatory shock, 44% presented without heart failure or shock. The most frequent SVT was Atrio-ventricular re-entry tachycardia (AVRT) 39%(7), Atrial ectopic tachycardia (AET) focal & multifocal constitute 33.3% (6), Two patient (11.1) each diagnosed as Congenital junctional ectopic tachycardia(JET) & Permanent junctional reciprocating tachycardia (PJRT). Only one infant diagnosed as Atrial flutter. Five patient (27.8%) has severe left ventricular (LV) dysfunction with ejection fraction of less than 35%. Median duration for reversion to sinus rhythm was 26 hours. Median duration of maintenance therapy was 7 months. Recurrence of SVT happened in 8 patients (44.4%) during maintenance therapy & median duration of antiarrhythmic medicine free period was 36 months. Conclusion: Supraventricular tachycardia with LV dysfunction is an under appreciated, but treatable condition in pediatric patients with structurally normal hearts. It shows complete normalization of cardiac function and generally has an excellent prognosis once the arrhythmia is controlled.