My three year old has had three episodes of what her doc suspects is PVST over the last 2 years or so. From what I have read on this site, she is very young for this. Through an EKG, it was determined she does not have wolf-parkinson-white. It's great to have ruled one diagnosis out but what are the other things it could be? And what can I expect for her future? What can I do to help her feel comfortable or get her heart to convert back to normal? Each time it has happened at night, and has been associated with fever. Her heart rate was 160 during the most recent episode. She sleeps through it but in checking on her throughout the night, I know it goes on for several hours. I'm pretty sure we would have time to get her to the kids care for an EKG next time it occurs, which is good for diagnosis but how dangerous is it that it goes so long? Which should I shoot for, getting her heart to convert (and by the way, how do I do that? "ok, bear down, sweetie") or letting it go on for the EKGs sake?
Is my little girl going to be ok?
Actually, paroxysmal supraventricular tachycardia (also called supraventricular tachycardia, or SVT), is not unusual for this age. It is seen in infants, children, and teenagers. Typically, in about 2/3 of infants, it disappears by age 1 year. However, it sounds like your daughter had it develop subsequent to that. All SVT means is that there is an extra electrical pathway that connects the top and the bottom of the heart, so that electricity goes down the normal pathway, then comes back up the extra pathway quickly. Although I am not evaluating her myself, so I can’t tell you everything about her prognosis for sure, there are a few things that I can say. First, you will not be able to get her heart to be normal; that is, not have the capability of going into SVT. However, if she does go into SVT, you can do what are called “vagal maneuvers”, which your cardiologist can show you how to do. These can sometimes break an episode of SVT. One of these is having her blow really hard into a straw whose end is squeezed tightly. There are others that are similar. Second, fever and infections can certainly lower the threshold for going into SVT, so this is something that we do see. Third, a few hours of SVT is not dangerous to her as long as her heart is structurally normal. And, if your cardiologist already has the diagnosis of SVT, then there is no need for it to continue for EKG proof. If the cardiologist does not have direct proof of a diagnosis, then he or she can order an event recorder for you to keep at home for a month, which is a device that can record your daughter’s heart rhythm during an event. As an aside, a heart rate of 160 is most likely less than the heart rate that she achieves when she runs around for a while, so this shouldn’t be a concern.
Overall, if your daughter has not been seen by a pediatric cardiologist, then that should be your first step. Have her evaluated and get a diagnosis of SVT, if that’s what it is. As part of the evaluation, the cardiologist will likely perform an echocardiogram to evaluate for certain structural defects that can be associated with SVT, such as Ebstein’s anomaly of the tricuspid valve. Next, if your daughter is diagnosed with SVT, then she can be put on medications to prevent her from going into this arrhythmia. The likelihood of spontaneous resolution of SVT is quite low at this point, though, so you may eventually need to consider an electrophysiology study with radiofrequency ablation. This is an elective procedure performed with several catheters to electrically map the heart. During this, the extra pathway is found. Then, a special ablation catheter can burn the pathway and make it go away. This is routinely done when the children are closer to 8-12 years of age. That said, SVT with a structurally normal heart is typically a nuisance and is not life-threatening. It can be easily treated and either prevented with lifelong medications or ablated and completely eliminated.
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