Permanent Junctional Reciprocating Tachycardia in Infants from Myocarditis-like Presentation to Simple Tachycardia: A Case Series
Asian Journal of Pediatric Research,
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.
- Permanent junctional reciprocating tachycardia
- supraventricular tachycardia
- dilated cardiomyopathy
- anti-arrhythmic medications
How to Cite
Salerno JC, Seslar SP. Supraventricular tachycardia. Arch Pediatr Adolesc Med. 2009;163:268-74.
Bonney WJ, Shah MJ. Incessant SVT in children: ectopic atrial tachycardia and permanent junctional reciprocating tachycardia. Prog Pediatr Cardiol. 2013;35:33-40.
Dorostkar PC, Silka MJ, Morady F, Dick M. Clinical course of persistent junctional reciprocating tachycardia. J Am Coll Cardiol. 1999;33:366-75.
Vaksmann G, D’Hoinne C, Lucet V, Guillaumont S, Lupoglazoff J-M, Chantepie A, et al. Permanent junctional reciprocating tachycardia in children: A multicentre study on clinical profile and outcome. Heart. 2006;92:101-4.
Barbero AH, Cesar S, Martinez-Osorio J, Margarit A, Moreno J, Campuzano O, et al. Long-term outcome of neonates and infants with permanent junctional reciprocating tachycardia. When cardiac ablation changes natural history. J Electrocardiol. 2019;56:85-9.
NOë P, VAN DRIEL V, Wittkampf F, Sreeram N. Rapid recovery of cardiac function after catheter ablation of persistent junctional reciprocating tachycardia in children. Pacing Clin Electrophysiol. 2002;25:191-4.
Press S, Lipkind RS. Acute myocarditis in infants: Initial presentation. Clin Pediatr. 1990;29:73-6.
Dancea AB. Myocarditis in infants and children: A review for the paediatrician. Paediatr Child Health. 2001;6:543-5.
Ross RD, Bollinger RO, Pinsky WW. Grading the severity of congestive heart failure in infants. Pediatr Cardiol. 1992;13:72-5.
Magee AG. Cardiomyopathy in Infants: Case-based management of potential pitfalls, look at the rhythm, then look again. Practical Pediatric Cardiology. Chapter 23: Springer. 2016:155-60.
Boulé S, Détis N, Lamblin N. Permanent junctional reciprocating tachycardia: A rare, but not to be missed, cause of cardiogenic shock in adults. Eur Heart J Acute Cardiovasc Care. 2016;2048872 616676604.
Kauh B, Leventhal A, Hesselson A. A rare case of permanent junctional reciprocating tachycardia in an adult who presents in cardiogenic shock. J Am Coll Cardiol. 2020;75:2624.
Yagishita A, Hachiya H, Higuchi K, Nakamura T, Sugiyama K, Tanaka Y, et al. Differentiation of atrial tachycardia from other long RP tachycardias by electrocardiographic characteristics. J Arrhythmia. 2014;30:376-81.
Drago F, Silvetti MS, Mazza A, Anaclerio S, Di Pino A, Grutter G, et al. Permanent junctional reciprocating tachycardia in infants and children: effectiveness of medical and non-medical treatment. Ital Heart J. 2001;2:456-61.
Van Stuijvenberg M, Beaufort-Krol GC, Haaksma J, Bink-Boelkens MTE. Pharmacological treatment of young children with permanent junctional reciprocating tachycardia. Cardiol Young. 2003;13:408.
Cornette J, Ten Harkel A, Steegers EP. Fetal dilated cardiomyopathy caused by persistent junctional reciprocating tachycardia. Ultrasound in Obstetrics and Gynecology: Ultrasound Obstet Gynecol. 2009;33:595-8.
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