Pædiatric SVT

Report:

Orthodromic atrioventricular re-entrant tachycardia 333/min

Possible flutter with 1:1 conduction

Left bundle branch block

?Wolff-Parkinson-White syndrome ( see below)

Comment:

The rate is very fast, but an infant’s flutter can be much faster still. In sinus rhythm, the patient has δ waves diagnostic of type ‘B’ preexcitation (115a). This is why I think this is an SVT: flutter would be faster still and would be more likely conducted down the anomalous pathway. The QRS would not look like common or garden LBBB aberrancy. Also (and this is cheating!) I know that the paroxysm was terminated by immersing the baby’s head into ice water.

To my knowledge, osteogenesis imperfecta has no known association with Wolff-Parkinson-White syndrome; its only cardiac complication is occasional aortic incompetence.

115a. Sinus rhythm with WPW ‘B’ conduction. Thus this baby had aberrant, then anomalous conduction. 116. 53 year old man with chronic atrial fibrillation, on sotalol therapy prior to planned cardioversion.