Supraventricular tachycardias in the emergency room.

Supraventricular tachycardia (SVT) is the most common tachyarrhythmia in children. There are a few studies on the epidemiology, clinical characteristic and treatment of this condition in Asian children presented at the Emergency Room (ER). This study aims to determine the epidemiology, clinical characteristics, medications use for SVT and responses in children in the ER. Data were collected via retrospective reviews of SVT patients aged less than 15 years who visited the ER between January 2003 and December 2010. The aspects of these reviews included demographic data (age, gender), underlying heart conditions, heart rates and rhythms, time of onset, symptoms, types, treatments, dispositions, maintenance therapies, electrophysiologic study (EP) and radiofrequency abrasion (RF). There were 46 SVT patients; the equivalence of 0.5 per 1,000 children visited the ER. Twenty five (54%) patients required treatments at the ER. Among these, 13 were boys (52%) with a median of 9 years of age. Two patients (8%) had congenital heart diseases. Clinical manifestations varied from palpitation in 17 patients (68%), congestive heart failure in 6 patients (24%), alternation of consciousness in 2 patients (8%). The mean heart rate was 207 (±36) beats per minute (bpm). Although 4 patients (16%) were treated without medication. Among those given medication, 10 (36%) were treated only with adenosine. Adenosine successfully treated 40, 40 and 20% of patients on the first, second and third dose, respectively. Three patients required cardioversion. All were conversed to normal heart rates. Among those 17 patients (68%) received maintenance therapy, 7 (40%) were given digoxin. The further investigation, EP was done in 13 patients (52%), RF was performed and successful in 4 patients (30.8%). In conclusion, palpitation is a common clinical symptom of SVT in children at emergency room. Most patients responded well to the adenosine therapy.