Vignati G, Drago F, Mauri L, Guccione P, Ragonese P, Figini A
Dipartimento Cardiologico de Gasperis, Ospedale Niguarda, Milano.
G Ital Cardiol. 1996 Jul;26(7):747-55.
The aim of this study was to assess the prognosis and the clinical course of incessant idiopathic ventricular tachycardia (VT) with left bundle branch morphology, in a group of 14 children consecutively evaluated in our institutions between 1983 and 1994.
Mean age of these patients was 8 +/- 2 years, and they were followed for 56 +/- 32 months. In all the children, VT was present for more than 80% of the day, in non sustained runs. The mean rate of VT was of 142 +/- 30 beats/min. Four children were symptomatic. The evaluation of these children was obtained by treadmill stress test (12/14), cardiac catheterization (13/14), electrophysiologic study (10/14), nuclear magnetic resonance (7/14), and serial echocardiographic and Holter examinations.
Right ventricular dysplasia was suspected in 2 cases on the basis of nuclear magnetic resonance and angiographic data. In both these cases VT was not suppressed by exercise. Medical treatment was started in 9/14 patients (69%), it was completely effective in 4 (44%) and partially effective in 2 further cases (22%). Thirteen out of fourteen patients had a regular follow-up. No patient died. All patients remained asymptomatic and in 6 (46%) VT disappeared. In 4 of these last 6 patients therapy has been previously effective. Two children, one with right ventricle dysplasia, continue antiarrhythmic treatment.
Incessant VT is well tolerated in pediatric age. The frequency of spontaneous remissions is relatively high (46% of cases). In few patients this arrhythmia is associated with evident cardiac abnormalities. In our opinion, medical treatment is necessary in symptomatic patients and in those with heart abnormalities.
