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Abstract
We reviewed the records of 217 children whose first episode of supraventricular tachycardia
occurred before 18 years (median age 24 months). There were 112 males and 105 females.
Of the 49 with congenital heart disease, SVT began before any operation in 26 and
greater than 2 weeks postoperatively in 23. Wolf-Parkinson-White syndrome was present
on surface ECG in 47/217 (22%). Congestive heart failure accompanied the first episode
of SVT in 38% of the patients who were 4 months of age or younger, and in only 19%
of those over 4 months (P less than 0.001). Treatment was successful in stopping SVT
within 48 hours in 90/142 (63%). Successful short-term treatment included digoxin
57/184 (68%), cardioversion 12/20 (60%), vagal maneuvers 12/19 (63%), phenylephrine
3/9, and overdrive pacing 4/5. SVT recurred at least once in 83% of all patients.
On follow-up (mean 4.6 years), episodes of SVT were still present in 56%. Three patients
died--two from incessant SVT and one from a CVA after VSD repair. We conclude that
long-term status was difficult to predict, but SVT was present in fewer patients whose
age at onset was less than 4 months and in those with unoperated CHD. Early recurrence
was not a poor prognostic sign. We recommended treatment for at least one year in
all patients with SVT, whether or not the first episode terminates spontaneously.