Permanent Junctional Reciprocating Tachycardia in Infants from Myocarditis-like Presentation to Simple Tachycardia: A Case Series
Mohmmed A. Mohmmedahmed *
Pediatric Cardiology Department, Prince Khaled Bin Sultan Cardiac Centre, Armed Forces Hospital Southern Region, 61961 Khamis Mushayt, Saudi Arabia and Pediatric Cardiology Intensive Care Unit, Sudan Heart Center, 11123 Khartoum, Sudan.
Bashir A. Yousef
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, 1111 Khartoum, Sudan.
Abdullah B. Alshehri
Pediatrics Department, Armed Forces Hospital Southern Region, 61961 Khamis Mushayt, Saudi Arabia.
Elhoury M. Eltayeb
Pediatric Cardiology Department, Prince Khaled Bin Sultan Cardiac Centre, Armed Forces Hospital Southern Region, 61961 Khamis Mushayt, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Permanent Junctional Reciprocating Tachycardia (PJRT) is a rare type of supraventricular tachycardia. It can be misdiagnosed and hence under-treated in infants and children, leading to significant cardiac morbidities and mortalities. We describe four cases of young infants who presented with a wide range of clinical scenarios from neonatal tachycardia to overtly decompensated heart failure, all caused by PJRT. All cases showed complete recovery with appropriate medical treatment. In this case series, we aim to discuss the diversity of clinical presentations, and the challenges surrounding the diagnosis, management, and prognosis. To achieve this aim, we have also performed a detailed literature review and reflected on our cases presented to our center between 2016 to 2020. PJRT is rare; it is often missed or diagnosed late in the presentation. Hence, the key is to keep it in mind in infants presenting with acute cardiac problems from simple tachycardia to a myocarditis-like presentation. Anti-arrhythmic medications are safe and effective as first-line therapy for PJRT in neonates and infants. They can prevent or delay the need for invasive cardiac ablation, which is more challenging in these age groups and should be considered in cases refractory to medical treatment.
Keywords: Permanent junctional reciprocating tachycardia, supraventricular tachycardia, myocarditis, dilated cardiomyopathy, anti-arrhythmic medications