Introduction: Little is known about the real importance of pediatric arrhythmias. Methods: We analyzed the epidemiology, presentation and outcome of all clinically relevant tachyarrhythmias followed up in our pediatric institutions from 1995 to 2006. Results: A total of 250 cases were identified. The mean age ± SD at diagnosis was 4.7 ± 5.3 years, 45 cases were neonatal (18%). Supraventricular arrhythmias were noted in 210 children (84%), ventricular arrhythmias in 40 (16%). The most frequent symptoms were palpitations (n = 71) and syncope (n = 48) in older children, as well as monitoring of diseases (n = 62) and heart failure (n = 49) in younger patients. Recurrence was noted under or after therapy in 75 cases, mostly in cases diagnosed beyond infancy. At long-term follow-up, 169 patients have no recurrence without treatment (of whom 34 had required catheter ablation), 71 are under therapy and 10 died. Conclusion: Supraventricular arrhythmias in younger children are often an incidental diagnosis, respond to antiarrhythmic therapy and have a high incidence of resolution. In older children with supraventricular arrhythmias and in those with ventricular arrhythmias, delayed diagnosis or misdiagnosis is not rare, the arrhythmias are unlikely to resolve spontaneously and long-term antiarrhythmic treatment or catheter ablation is necessary.

The ambulatory paediatric cardiology workload in tertiary academic hospital settings is increasing alarmingly. These data may be helpful in future planning of consultant manpower and in curriculum development for cardiac training of students and residents.

Adenosine or ATP could be the drug of choice for the treatment of junctional tachycardia in infants after vagal manoeuvres have failed. Provided continuous ECG monitoring is performed during injection, adenosine or ATP may be diagnostic in other types of supraventricular tachycardia and even in wide-complex tachycardia. We suggest a bolus injection of 0.5-1.0 mg/kg to be used prior to transport to the paediatric cardiology unit.

Adenosine is an endogenous nucleoside acting on coronary perfusion and myocardial conduction. Although the anti-arrhythmic effects of adenosine have been known for decades, interest in the use of adenosine or adenosine-triphosphate (ATP) (a precursor of adenosine) in termination of supraventricular tachycardia (SVT) has been renewed. We studied the use of striadyne (ATP and a mixture of other nucleosides including adenosine) in 22 infants younger than 6 months in order to evaluate efficiency and safety of the drug in this particular age group. Striadyne stopped SVT in 17 cases and was diagnostic in another 4 cases. Ten out of 17 successfully converted infants showed one or more reinitiations of SVT, which were easily controlled. The results support the efficiency of ATP for the termination of re-entry types of tachycardia, as well as its diagnostic value and its lack of serious side-effects.

Deep abdominal palpation was performed prospectively in 900 newborns. Normal kidneys were felt in all but 8. 2 of these had a normal ultrasonography, 2 had an obstructive hydronephrosis, 1 had bilateral renal hypoplasia and 3 had a previously undiagnosed unilateral renal agenesis. Despite the increasing use of prenatal ultrasonography, careful abdominal examination should be performed in all newborns.