Treatment of Permanent Junctional Reciprocating Tachycardia in a Preterm Neonate: Case Report

Abstract

Permanent junctional reciprocating tachycardia (PJRT) is most often observed in infants and children and can lead to incessant tachycardia. PJRT is usually refractory to medical treatment. Tachycardia may infrequently occur in the fetus in which case fetal tachycardia transplacental treatment should be started immediately. Term delivery is recommended for fetuses with tachycardia in the absence of significant clinical compromise to avoid complications of preterm birth. Herein, a 36-week preterm neonate presented with PJRT. He had tachycardia in the fetal period and was treated with digoxin, amiodaron, and esmolol therapy after birth without undergoing the catheter ablation procedure.

Conservative Treatment of Permanent Junctional Reciprocating Tachycardia

“…The slow retrograde conduction properties of the accessory pathway facilitate the initiation and maintenance of the tachycardia. The arrhythmia, accounting for 1% of supraventricular tachycardias (SVTs) in children, typically presents at young age with incessant palpitation and heart failure symptoms (fatigue, exercise intolerance, dyspnea) due to tachycardia induced cardiomyopathy [2,3,7]. The paroxysmal form of PJRT appears to be more frequent in adults and less associated with heart failure.…”

“…Therefore, the ECG findings are not able to differentiate definitively between PJRT and atypical fast/slow AVNRT. However, the clinical presentation with repetitive occurrence of the tachycardia and development of systolic heart failure was highly suggestive for a PJRT [1][2][3].…”

Coumel tachycardia in children

“…It has also been described rarely in the fetal and neonatal period 6,7 . Coumel tachycardia is usually incessant from birth or infancy, although it may not be recognized until adolescence.…”