Belhassen Tachycardia in a 19-Month-Old Child

Huang, Jennifer; Saharan, Sunil; McCammond, Amy N.; Balaji, Seshadri

doi:10.1016/j.jpeds.2014.08.038

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…There are several reports of successful conversion of fascicular VT in young infants with intravenous verapamil 9–12 19. It is interesting to note that in none of these case reports verapamil was used as a first-line agent.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, calcium channel blockers are uniquely effective as the treatment of fascicular VT, to the point that this arrhythmia is also known as ‘verapamil sensitive ventricular tachycardia’. It typically occurs in children and young adults without structural heart disease 9–14. The underlying mechanism is believed to be a re-entry tachycardia involving the Purkinje fibres of the fascicles—typically the left posterior fascicle of the left bundle branch but also has features of an automatic tachycardia, can be incessant, unresponsive to direct current cardioversion and may lead to cardiomyopathy.…”

Section: Introductionmentioning

confidence: 99%

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Fascicular tachycardia in infancy and the use of verapamil: a case series and literature review

et al. 2019

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ObjectiveGuidelines state that verapamil is contraindicated in infants. This is based on reports of cardiovascular collapse and even death after rapid intravenous administration of verapamil in infants with supraventricular tachycardia (SVT). We wish to challenge this contraindication for the specific indication of verapamil sensitive ventricular tachycardia (VSVT) in infants.DesignRetrospective case series and critical literature review.SettingHospitals within New Zealand.PatientsWe present a series of three infants/young children with VSVT or ‘fascicular VT’.ResultsThree children aged between 8 days and 2 years presented with tachycardia 200–220 beats per minute with right bundle brunch block and superior axis. Adenosine failed to cardiovert and specialist review diagnosed VSVT. There were no features of cardiovascular shock. Verapamil was given as a slow infusion over 10–30 min (rather than as a push) and each successfully cardioverted without incident. Critical review of the literature reveals that cardiovascular collapses were associated with a rapid intravenous push in cardiovascularly compromised infants and/or infants given other long-acting antiarrhythmics prior to verapamil.ConclusionsVerapamil is specifically indicated for the treatment of fascicular VT, and for this indication should be used in infancy, as well as in older children, as first-line treatment or after failure of adenosine raises suspicion of the diagnosis. We outline how to distinguish this tachycardia from SVT and propose a strategy for the safe intravenous slow infusion of verapamil in children, noting that extreme caution is necessary with pre-existing ventricular dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fascicular tachycardia in infancy and the use of verapamil: a case series and literature review

et al. 2019

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“…The latter is reported to be potentially fatal in infants younger than one year. Therefore, its use should be restricted to children >1 year of age [63,[87][88][89][90][91][92][93].…”

Section: Class III Antiarrhythmic Drugsmentioning

confidence: 99%

“…Dosage of Vaughn-Williams classification III and IV drugs in children[2,25,27,35,40,63,[87][88][89][90][91][92][93][94][95][96][97][98][99].…”

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confidence: 99%

Antiarrhythmic Drug Dosing in Children—Review of the Literature

Oeffl,

Schober,

Faudon

et al. 2023

Children

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Antiarrhythmic drug therapy represents a mainstay in pediatric arrhythmias. However, official guidelines and consensus documents on this topic remain scarce. There are rather uniform recommendations for some medications (including adenosine, amiodarone, and esmolol), while there are only very broad dosage recommendations for others (such as sotalol or digoxin). To prevent potential mistakes and even uncertainties with regard to dosing, we summarized the published dosage recommendations for antiarrhythmic drugs in children. Because of the wide variations in availability, regulatory approval, and experience, we encourage centers to develop their own specific protocols for pediatric antiarrhythmic drug therapy.

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“…Belhassen tachycardia typically presents in older children, adolescents, and young adults and mimics SVT with aberrancy, right bundle branch block, and left anterior hemiblock [ 2 , 3 ]. There have also been case reports in infants and young children [ 4 ]. Unlike monomorphic ventricular tachycardia where 90% of cases occur in patients with underlying heart disease, patients who present with Belhassen tachycardia typically have no underlying structural heart disease [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Belhassen Tachycardia in a Pediatric Patient: A Simulation for Pediatric Emergency Medicine Fellows

Keilman¹,

Deen²,

Augenstein³

et al. 2022

Cureus

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Ventricular tachycardia in pediatric emergency department patients is a high-risk, low-frequency event well suited for education through simulation. This technical report describes a simulation-based curriculum for Pediatric Emergency Medicine fellows and senior residents involving the evaluation and management of a 10-year-old female presenting with palpitations who is ultimately diagnosed with Belhassen tachycardia. The curriculum highlights the features that differentiate Belhassen tachycardia (idiopathic left posterior fascicular ventricular tachycardia) from supraventricular or other tachycardias, building upon foundational pediatric resuscitation skills and Pediatric Advanced Life Support (PALS) algorithms for advanced learners.

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Belhassen Tachycardia in a 19-Month-Old Child

Cited by 3 publications

References 5 publications

Fascicular tachycardia in infancy and the use of verapamil: a case series and literature review

Fascicular tachycardia in infancy and the use of verapamil: a case series and literature review

Antiarrhythmic Drug Dosing in Children—Review of the Literature

Belhassen Tachycardia in a Pediatric Patient: A Simulation for Pediatric Emergency Medicine Fellows

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