PEDIATRICS Vol. 76 No. 6 December 1985, pp. 922-926
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Cardiovascular Collapse in Infants: Association With Paroxysmal Atrial Tachycardia

Betty Muthoni Gikonyo MB, ChB, MMed1, Ann Dunnigan MD1, and D. Woodrow Benson Jr MD, PhD1

1 From the Department of Pediatrics, University of Minnesota Hospitals, Minneapolis

Four infants, aged 16 to 28 days (mean 23 days), were seen in the emergency room with acute cardiovascular collapse and with normal heart rate and rhythm. During evaluation for cardiovascular collapse, no infant had sepsis; cardiac assessment revealed normal intracardiac anatomy but global cardiac chamber enlargement and poor left ventricular systolic function, which resolved with supportive treatment. However, three of the four infants demonstrated ventricular preexcitation on their surface electrocardiogram and, subsequently, two infants had transient episodes of tachycardia. During a transesophageal pacing study to evaluate inducibility and electrophysiologic characteristics of tachycardia, sustained tachycardia was initiated in all four infants. Reentrant tachycardia used an accessory atrioventricular connection as evidenced by (1) the presence of preexcitation during sinus rhythm (three infants), (2) the ability to initiate and terminate tachycardia by programmed electrical stimulation (four infants), (3) minimum ventriculoatrial interval recorded in the esophagus (V-Aeso) exceeded 70 ms (four infants), (4) transient bundle branch block during tachycardia prolonged the cycle length and the V-Aaso by 30 to 50 ms (three infants). Findings in these infants suggested prior episodes of prolonged tachycardia as the probable etiology of the cardiovascular collapse.

Key Words: esophageal pacing • infant • shock • cardiovascular collapse • paroxysmal atrial tachycardia

Submitted on November 5, 1984
Accepted on January 11, 1985




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