Idiopathic Left Ventricular Tachycardia in Children
Monnipa Suesaowalak MD*, Apichai Khongphatthanayothin MD*, Buncha Sunsaneewitayakul MD**, Tosaporn Sirisopikun MD***, Worakan Promphan MD****, Yaowalak Jariyapongpaiboon MD*****, Surapun Sitthisook MD******
Affiliation : * Division of Cardiology, Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok ** The Heart Center, King Chulalongkorn Memorial Hospital, Bangkok *** Pediatric Cardiology Division, Department of Pediatrics, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima **** Queen Sirikit National Institute of Child Health, Bangkok ***** Department of Pediatrics, Chiangrai Regional Hospital, Chiang Rai ****** Division of Cardiology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok
Background : Idiopathic left ventricular tachycardia (ILVT) is a rare but well-recognized clinical entity. The
clinical characteristics and prognosis of this form of ventricular tachycardia (VT) in Thai children is not
known.
Objective : To define clinical presentations, drug therapies, roles of radiofrequency (RF) catheter ablation,
and the short-term outcome of these children in Thailand.
Patients and Method: From April 1999 to June 2007, 10 patients were diagnosed as ILVT by specific electro-
cardiographic features and therapeutic response. All patients had a structurally normal heart. Data were
collected retrospectively. Baseline clinical information, 12-lead electrocardiography (ECG) during VT,
responses to drug therapy, results of RF catheter ablation therapy, and outcome were determined.
Results : Median age at presentation was 9.5 years (range, 3.8 to 14.0 years). Three patients (30%) were male.
Eight patients (80%) were diagnosed as supraventricular tachycardia (SVT) before ILVT diagnosis. Median
duration from SVT diagnosis to the correct diagnosis was 1.5 years (range, 0 to 6.0 years). Palpitation and
chest pain were usual clinical manifestations while congestive heart failure was the presentation in one due
to incessant tachycardia. Two patients had recurrent VT episodes during acute febrile illnesses. The majority
of patients responded to intravenous verapamil. RF catheter ablation was performed in 3 patients with
recurrence of the VT in one.
Conclusion : Prompt recognition of the ILVT especially in the emergency department is very important. Verapamil
is effective for acute termination as well as prevention of VT recurrence. When VT is refractory to medical
therapy, RF catheter ablation is safe and effective. The short-term prognosis was good.
Keywords : Ventricular tachycardia, Pediatrics, Children, Arrhythmia
