PEDIATRICS Vol. 9 No. 2 February 1952, pp. 167-181
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PAROXYSMAL TACHYCARDIA IN INFANTS AND CHILDREN

Study of 41 Cases

ALEXANDER S. NADAS M.D.1, C. WILLIAM DAESCHNER M.D.1, ARTHUR ROTH M.D.1, and STANLEY L. BLUMENTHAL M.D.1

1 The Sharon Cardiovascular Unit and the Children's and Infants' Hospital of the Children's Medical Center, and from the Department of Pediatrics, Harvard Medical School, Boston.

Forty-one cases of paroxysmal tachycardia in infants and children were studied. Male infants under four months of age with idiopathic tachycardia seem to represent a separate group among these children and can be contrasted with the group of patients over four months of age where males and females with tachycardia of known or unknown etiology are equally represented.

Congestive failure develops in the majority of the young infants with paroxysmal tachycardia but only in a minority of the older children.

Two factors which have a bearing on the development of congestive failure are duration of tachycardia at rates more than 180/min. and the age of the patient.

Twenty-nine patients showed electrocardiographic characteristics of supraventricular tachycardia; nine children had paroxysmal auricular flutter; three showed ventricular tachycardia.

The recommended drug for termination of supraventricular tachycardia and auricular flutter is digitalis nativelle or its equivalent. The optimal digitalizing dose corresponds to 1.0 to 1.2 mg./M2 of body surface or .02 to .03 mg./0.5 kg. body weight. This amount should be administered in 12 to 24 hours. Ventricular tachycardia, it was found, responds well to quinidine.

As a maintenance dose for supraventricular tachycardia and auricular flutter, the authors recommend one-tenth of the digitalizing dose daily for at least one week, possibly longer. Quinidine is probably useful in preventing recurrences of ventricular tachycardia and of the tachycardias of the Wolff-Parkinson-White syndrome.

The prognosis for life is good. Recurrences within the first year are likely; beyond that period, only the older children and those representing the Wolff-Parkinson-White syndrome have further attacks.

Submitted on August 20, 1951




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