Paroxysmal tachycardia in children and teenagers with normal sinus rhythm and without heart disease

The purpose of this study was to evaluate the value of esophageal programme d stimulation in children and teenagers with normal sinus rhythm ECG and no rmal noninvasive studies, having palpitations and syncope, and no documente d tachycardias. Paroxysmal tachycardias are frequent in children and are of ten related to accessory connection. These tachycardias are sometimes diffi cult to prove. Transesophageal atrial pacing was performed at rest and duri ng infusion of isoproterenol in 31 children or adolescents aged 9-19 years (16 +/- 3 years) with normal sinus rhythm ECG and suspected or documented e pisodes of paroxysmal tachycardia. Sustained tachycardia tvas induced in 27 patients, at rest in 13 patients, and after isoproterenol in 14 remaining patients. Atrioventricular nodal reentrant tachycardia was found as the mai n cause of paroxysmal tachycardia (22 cases). Six patients were followed by a vagal reaction and dizziness. These patients had spontaneous tachycardia with syncope. In three other patients, atrial fibrillation was also induce d. Concealed accessory pathway reentrant tachycardia was identified in thre e patients. In two patients, a regular wide tachycardia with right bundle b ranch block morphology was induced; the diagnosis of verapamil-sensitive ve ntricular tachycardia was made in a second study by intracardiac study. In conclusion, atrioventricular nodal reentrant tachycardia was found as the m ain cause of symptoms in children with normal sinus rhythm EGG. Syncope is frequently associated and provoked by a vagal reaction. This diagnosis coul d be underestimated in adolescents frequently considered as hysterical beca use noninvasive studies are negative.