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Pediatric Heart (Expert Forum)
SVT Causes and Treatment
Answered by
Jeffrey R Boris, M.D. - Pediatric Cardiology, Ambulatory Cardiology
The Children’s Hospital of Philadelphia
Philadelphia - PA
Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.
SVT Causes and Treatment
by Umar_Khan, Oct 27, 2009 04:00AM
My daughter is 9 years old. She has been diagnosed with SVT two days ago. She has had 3-4 episodes of high heart rate prior to this over the past year and was fine after resting for a few hours. Due to our ignorance we never thought that this was due to a medical condition because she is other wise is perfect health, active and in fact amongst the tallest and healthiest children in her class.
Currently the cardiologist has attached a Holter on her chest for two days to monitor her heart condition and is going to suggest treatment after analyzing the results. We have been told that this may be a congenital condition which is now expressing itself. I would appreciate if you could tell me the reasons for this condition and what options do i have for treatment.
Many Thanks
Currently the cardiologist has attached a Holter on her chest for two days to monitor her heart condition and is going to suggest treatment after analyzing the results. We have been told that this may be a congenital condition which is now expressing itself. I would appreciate if you could tell me the reasons for this condition and what options do i have for treatment.
Many Thanks
Doctor's Answer
by Jeffrey R Boris, M.D., Oct 28, 2009 11:56AM
, Oct 28, 2009 11:56AMTo: Umar_Khan
Dear Umar Khan,
Supraventricular tachycarda (SVT) occurs when 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. It causes a fast abnormal heartrate, called a dysrhythmia; SVT is just one of many kinds of dysrhythmias. 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. We need to think about her initial management, evaluation, and subsequent management. 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. Typically, a few hours of SVT is not dangerous to her as long as her heart is structurally normal—it is a nuisance, though, and can be somewhat scary.
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. A Holter monitor will demonstrate how frequently she is having SVT. Next, after evaluating this information, she can be put on medications to prevent her from going into this arrhythmia. Since the likelihood of spontaneous resolution of SVT is quite low at this point, subsequent management needs to be considered. As part of this, you may eventually want 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 around 8-12 years of age. That said, there are several approaches to this. As mentioned previously, since SVT with a structurally normal heart is typically a nuisance and is not life-threatening, it can be treated and either prevented with lifelong medications to prevent its occurrence, or ablated and completely eliminated.
Supraventricular tachycarda (SVT) occurs when 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. It causes a fast abnormal heartrate, called a dysrhythmia; SVT is just one of many kinds of dysrhythmias. 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. We need to think about her initial management, evaluation, and subsequent management. 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. Typically, a few hours of SVT is not dangerous to her as long as her heart is structurally normal—it is a nuisance, though, and can be somewhat scary.
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. A Holter monitor will demonstrate how frequently she is having SVT. Next, after evaluating this information, she can be put on medications to prevent her from going into this arrhythmia. Since the likelihood of spontaneous resolution of SVT is quite low at this point, subsequent management needs to be considered. As part of this, you may eventually want 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 around 8-12 years of age. That said, there are several approaches to this. As mentioned previously, since SVT with a structurally normal heart is typically a nuisance and is not life-threatening, it can be treated and either prevented with lifelong medications to prevent its occurrence, or ablated and completely eliminated.
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The presence of the extra pathway, also known as an accessory pathway, allows for SVT to occur, as electricity goes down the normal electrical connection (through the A-V node) and back up through the accessory pathway. Wolff-Parkinson-White syndrome, or WPW, is associated with a certain kind of accessory pathway that allows forward electrical conduction from the atria to the ventricles, with evidence of this seen on the electrocardiogram. Thus, it is certainly able to cause SVT. It is associated with greater risk than typical SVT (sometimes also referred to as a "concealed pathway"), as any atrial tachyarrhythmias (fast heart rhythms originating in the atria, such as atrial flutter or fibrillation) can potentially go down this pathway into the ventricles and cause the ventricles to beat so fast as to be incompatible with life. This causes sudden cardiac death.