Abstract 2134: Transesophageal Pacing as a Predictor for Arrhythmia Recurrence in Infants With Paroxysmal Supraventricular Tachycardia
Introduction: Management of paroxysmal supraventricular tachycardia (PSVT) is challenging in infants as arrhythmia recurrence is often hard to detect after discharge and the efficacy of medical therapy is difficult to ascertain clinically. Transesophageal pacing (TEP) has been used to evaulate PSVT mechanism and to determine drug efficacy. The objective of this study was to evaluate the utility of TEP to predict clinical recurrence following hospital discharge.
Methods: We performed a retrospective chart review of patients with PSVT who presented before age 6 months and also underwent TEP at Vanderbilt Children’s Hospital between 7/1/1998 and 7/1/2008. Inducibility at final pre-discharge TEP, age at presentation, PSVT mechanism, antiarrhythmic therapies used, and number of TEPs performed were noted. Patients with atrial tachycardias were excluded. TEP was usually performed prior to therapy to characterize the arrhythmia and was repeated prior to discharge to assess treatment efficacy. Isoproterenol was used if tachycardia could not be induced at baseline. In most patients, inducibilty of sustained PSVT (>5 min) with TEP prompted escalation or change in therapy before discharge. Recurrence was defined as any sustained confirmed arrhythmia occurring on the prescribed therapy following discharge and through 1 yr of age.
Results: 127 infants with documented PSVT underwent TEP [orthodromic reciprocating tachycardia (92), AV nodal reentrant tachycardia (20), long RP tachycardia (6), multiple mechanisms (4), indeterminant mechanism (5)]. 114 had TEP on the therapy prescribed at discharge. Of 16 patients with a positive discharge TEP, tachycardia recurred clinically in 10. Of 98 patients with a negative discharge TEP, tachycardia recurred clinically in 12 (sensitivity 45%, specificity 93%, positive predictive value 62%, negative predictive value 88%). Patients who recurred were more likley to initially present at a younger age (3 +/− 25 days vs. 26 +/− 53 days, P=0.004), and more likely to have a positive discharge TEP (45% vs. 6.5%, P<0.001).
Conclusions: TEP is useful in predicting PSVT recurrence on therapy in the first year of life and may help guide effective therapy.