Permanent junctional reciprocating tachycardia in children: a multicenter experience
Abstract
Background Permanent junctional reciprocating tachycardia (PJRT) is an uncommon form of supraventricular tachycardia in children. Treatment of this arrhythmia has been considered difficult because of a high medication failure rate and risk of cardiomyopathy. Outcomes in the current era of interventional treatment with catheter ablation have not been published.Objective To describe the presentation and clinical course of PJRT in children.Methods This is a retrospective review of 194 pediatric patients with PJRT managed at 11 institutions between January 2000 and December 2010.Results The median age at diagnosis was 3.2 months, including 110 infants (57%; aged <1 year). PJRT was incessant in 47%. The ratio of RP interval to cycle length was higher with incessant than with nonincessant tachycardia. Tachycardia-induced cardiomyopathy was observed in 18%. Antiarrhythmic medications were used for initial management in 76%, while catheter ablation was used initially in only 10%. Medications achieved complete resolution in 23% with clinical benefit in an additional 47%. Overall, 140 patients underwent 175 catheter ablation procedures with a success rate of 90%. There were complications in 9% with no major complications reported. Patients were followed for a median of 45.1 months. Regardless of treatment modality, normal sinus rhythm was present in 90% at last follow-up. Spontaneous resolution occurred in 12% of the patients.Conclusion PJRT in children is frequently incessant at the time of diagnosis and may be associated with tachycardia-induced cardiomyopathy. Antiarrhythmic medications result in complete control in few patients. Catheter ablation is effective, and serious complications are rare.
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PJRT is a rare form of atrioventricular reciprocating tachycardia using a concealed accessory pathway, usually located in the posteroseptal region, with retrograde decremental conduction properties.
“Permanent Junctional Reciprocating Tachycardia (PJRT) represents a rare form of atrioventricular reciprocating tachycardia using a concealed accessory pathway, usually located in the posteroseptal region, with retrograde decremental conduction properties.328”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [328]
Incessant PJRT may result in tachycardia-induced cardiomyopathy that usually resolves after successful treatment by radiofrequency catheter ablation.
“The incessant nature of PJRT may result in tachycardia-induced cardiomyopathy that usually resolves after successful treatment by radiofrequency catheter ablation.328”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [328]
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- Authors
- Kang, K. T., Potts, J. E., Radbill, A. E., La Page, M. J., Papagiannis, J., Garnreiter, J. M., Kubus, P., Kantoch, M. J., Von Bergen, N. H., Fournier, A., Côté, J.-M., Paul, T., Anderson, C. C., Cannon, B. C., Miyake, C. Y., Blaufox, A. D., Etheridge, S. P., & Sanatani, S.
- Affiliations
- BC Children's Hospital (CA)
- Vanderbilt University Medical Center (US)
- Mitera Hospital (GR)
- Primary Children's Hospital (US)
- Stollery Children's Hospital (CA)
- Université de Montréal (CA)
- Centre hospitalier universitaire de Québec (CA)
- Universitätsmedizin Göttingen (DE)
- Providence Sacred Heart Medical Center (US)
- Mayo Clinic (US)
- Lucile Packard Children's Hospital (US)
- Schneider Children's Hospital (US)
- University Hospital in Motol (CZ)
- Corresponding author
- Sanatani, Shubhayan
- ORCID
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 11
- Issue
- 8
- Pages
- 1426-1432
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2016975810
- Cited by
- 86
- References
- 15
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 7 · 2023: 10 · 2022: 3 · 2021: 8 · 2020: 9 · 2019: 11 · 2018: 1 · 2017: 12 · 2016: 8 · 2015: 6 · 2014: 1
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- GRO (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Keywords
- permanent junctional reciprocating tachycardia, supraventricular tachycardia, pediatric arrhythmia, catheter ablation, tachycardia-induced cardiomyopathy, antiarrhythmic drugs, spontaneous resolution, arrhythmia treatment outcomes
- MeSH terms
- Adolescent, Canada, Child, Child, Preschool, Electrocardiography, Female, Follow-Up Studies, Heart Conduction System, Humans, Infant, Infant, Newborn, Male, Retrospective Studies, United States, Incidence, Tachycardia, Reciprocating
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