Epidemiology and Natural History
Epidemiological studies have suggested that the prevevalence of SVT is 2-2.5 cases/ 1000 people, with an incidence of 35 cases/100,000 person-years (1). SVTs are as common among children as adults with otherwise anatomically normal hearts, and thus this pediatric problem is not uncommon. The types of SVT encountered in children and their underlying mechanisms are generally similar to those seen in adults, but the relative frequency of specific arrhythmia types differs. Common SVTs that may require diagnosis and treatment in these age groups include: accessory pathway-mediated tachycardias such as Wolff-Parkinson-White syndrome (WPW), concealed accessory pathway, Mahaim fiber tachycardia, and permanent junctional reciprocating tachycardia (PJRT), atrioventricular nodal reentrant tachycardia (AVNRT), and ectopic atrial tachycardias. Rarely, children with anatomically normal hearts may also present with atrial reentrant arrhythmias, such as atrial flutter and AF, but these are more commonly encountered in patients with underlying congenital or acquired heart disease.
Several features of the natural history of SVT in children affect clinical decision-making related to acute and chronic management of the tachycardia. Age-based changes in prevalence have been documented in WPW (2) and AVNRTs (3). Younger patients with supraventricular arrhythmia are more likely to have an accessory pathway-mediated tachycardia than either AVNRT or primary atrial tachycardia. AVNRT is particularly uncommon in infancy, and does not begin to increase in frequency until children reach
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