Paroxysmal Supraventricular tachycardia (PSVT) is a regular, narrow complex, supraventricular tachycardia (SVT) with sudden episodic onset and termination (Hafeez, n.d.). PSVT occurs in all age groups but it is the second most common arrhythmia in children after sinus tachycardia (Neroni et al., (2014). The incidence and prevalence of PSVT remain controversial. A literature review indicates a range of occurrence from 1 in 250 children (Salerno, 2009), 1 in 750 children (Mayo Clinic, 2019), and one in every 2,500 children (Ellis & Marcin, 2019).
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The most common cause of PSVT is a cardiac conduction reentry phenomenon. Reentry occurs when a normal electrical impulse depolarizes the atria, then the ventricles, and continues back (retrograde) to the atria via an abnormal accessory pathway. The accessory pathway acts as a short circuit that allows the impulse to re-enter the atrium causing a rapid depolarization cycle.
Cyclic conduction reentry speeds up the heart rate. While PSVT can cause discomfort, it is usually not life-threatening. Many children do not need treatment, but medications and procedures may be necessary in some cases. If the heart rate is fast enough, the ventricles won't have adequate time to fill with blood, and symptoms of shock, hypotension, signs of heart failure, lightheadedness, or exercise intolerance may occur.
This course will include information on ECG characteristics of pediatric PSVT, common mechanisms of initiation of PSVT including the Wolff-Parkinson-White (WPW) Syndrome, the clinical presentation of PSVT in the infant, child and adolescent and medications and procedures used to treat PSVT.
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SVT is usually not life threatening.
References
Ellis, M. E. & Marcin, J. (2019). Paroxysmal supraventricular tachycardia (PSVT). Healthline. https://www.healthline.com/health/paroxysmal-supraventricular-tachycardia-psvt.
Hafeez Y, Quintanilla Rodriguez BS, Ahmed I, et al. Paroxysmal Supraventricular Tachycardia. [Updated 2021 Apr 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507699/
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
Patti L, Ashurst JV. Supraventricular Tachycardia. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441972/
Salerno, J.C. & Seslar, S.P.. Supraventricular Tachycardia. (2009). Arch Pediatr Adolesc Med. 163(3), 268–274. doi:10.1001/archpediatrics.2008.547
Strasburger, J. F., Cheulkar, B., & Wichman, H. J. (2007). Perinatal arrhythmias: diagnosis and management. Clinics in perinatology, 34(4), 627–viii. https://doi.org/10.1016/j.clp.2007.10.002