Treatment of PSVT

Children who have brief or infrequent bouts of SVT may not need treatment but should receive regular supervision (Mayo Clinic, 2019).

Treatment of a child with PSVT will depend on a number of factors which include:

• Cardiovascular stability of the patient with this episode.
  
• Underlying medical or cardiac conditions.
  
• The length of time this tachyarrhythmia has been occurring.
  
• Severity of symptoms
  
• Frequent bouts of rapid heart beats (Mayo Clinic, 2019)

Initial at home approaches

• Breath-holding while incorporating a Valsalva maneuver.
  
• Performing a Valsalva maneuver in the supine position, which may be more successful than if the child is standing.
  
• Assisted deep bending. Mouse-over to view video demonstration.
  
• While sitting, child may bend over as if to pick up something off of the floor Mouse-over for video demonstration.
  
• Stimulation of the ‘diving reflex’ by applying ice to a newborn’s face near the mouth or nose for 15-20 seconds.

Contraindicated

Eyeball compression is contraindicated in children because of the risk of eyeball-retina damage.

Medications

According to Neroni et al (2014), these are the recommended medications:

• Antiarrhythmic prophylaxis recommend in the first year of life
  
• Adenosine – drug of choice for tachycardias involving the atrioventricular node.
  
• Digoxin for PSVT atrioventricular node except for patients with Wolff-Parkinson-White syndrome below one year of age.
  
• Patients with atrioventricular reentrant PSVT should be treated with class lc drugs (propaphenone and flecainide)
  
• Amiodarone has the best antiarrhytyhmic effect but has multiple side effects.

Not recommended for children

Verapamil – risk of electromechanical dissociation

Ablation therapy

Ablation therapy is usually reserved for patients who do not respond to anti- arrhythmic treatment and are in heart failure.

Cardiac ablation works by destroying abnormal fiber in the heart that triggers or perpetuates tachycardia. This prevents abnormal electrical signals from creating arrhythmia.

This is a description of a typical ablation procedure:

• Initiation of an electrophysiology study to monitor heart activity
• Insertion of a small, specialized catheter from the patient's legs to the heart
• Detection of the cause of the tachycardia in the heart
• Insertion of another specialized catheter that can deliver hot or cold energy to destroy the abnormal fiber
• Can take three to four hours (Saul, 2016; Dubin, 2019)

The ablation studies have a higher risk below the age of 5. Physicians typically will only carry out this procedure in childre under 5 who are extremely ill. By the age of 5 there is little risk for the child. The Mayo Clinic reports a 95% to 98% success rate with a less than 1% complication rate with a two day recovery. Usual this procedure results in a permanent cure. https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/managing-pediatric-supraventricular-tachycardia/mac-20474690

Outlook

The outlook for children with SVT is excellent. The problem is usually not life- threatening plus the current treatments are highly effective. Successful ablation procedures lead to a cure. With no increased incidence of long term effents. https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/managing-pediatric-supraventricular-tachycardia/mac-20474690

References

Dubin, A.M. et al. (2019). Pediatric and congenital electrophysiology society initiative on device needs in pediatric electrophysiology. Heart Rhythm 16:493.
https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/managing-pediatric-supraventricular-tachycardia/mac-20474690

Fanos, V., Mussap, M., Faa, G. & Papageorgiou, A. (2015). Paroxysmal supraventricular tachycardia: physiopathology and management.  Proceedings of the 10th International Workshop on Neonatology. https://worldwidescience.org/topicpages/s/supraventricular+tachycardia+vagal.html.

Mayo Clinic, 2019 https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/managing-pediatric-supraventricular-tachycardia/mac-20474690.

Neroni, P., Ottonello, G., Manus, D., Atzei, A., Trudu, E., Floris, S. & Fanos, V. (2014). Paroxysmal supraventricular tachycardia: physiopathology and management. J Pediatr Neonat Individual Med. 3(2). e030243. doi: 10.7363/030243.

Saul, J.P. et al. (2016). PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 13:e251.

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