1. Pediatric Arrhythmia 台大醫院小兒部 邱舜南醫師

2. Newborn 1 week to 3 months 3 months to 2 years 2 years to 10 years 10 years to adult 100-180 100-220 80-170 70-110 55-90 80-160 80-200 70-120 60-90 50-90 Up to 220 Up to 220 Up to 200 Up to 200 Up to 200 Age Resting (awake) Resting (sleeping) Exercise, fever Heart Rate (beats per min) Normal heart rates for infants and children

3. Pediatric Arrhythmia Tachycardia: PSVT VT Bradycardia: Sinus bradycardia AV block

4. Paroxysmal supraventricular tachycardia

5. Supraventricular tachycardia in pediatric patients * HR 215-350 (mean 280) in infants * 98% narrow QRS * Atrial fibrillation 0.4% 1-4% in infants with preexcitation

6. Josephson Wu D Gillette Ko Wu M Naheed (adult) (adult) (Ped) (Ped) (Ped) (Fetal) AVNRT 51 72 24 13 18 - AVRT 34 13 33 73 72 73 Atrial 15 15 42 14 10 27

7. PSVT in children AVRT AVNRT EAT

8. AVRT in Pediatric Patients * Peak age: young infants 5- 8 yr >13 yr * The younger the onset age, the less the recurrences ~ JACC 16(5):1215-20, 1990

9. AVRT * Manifest (delta wave) 0.06-0.3% general population 0.3-1% congenital heart disease * Concealed 57% for all AP (68% for left AP, 42% for right AP) * Ebstein’s anomaly * l –TGA * ? Heterotaxy syndrome

10. WPW WPW ~ A Population Study of the Natural History of Wolff-Parkinson-White Syndrome in Olmsted Count, Minnesota, 1953-1989(Circulation 1993;87:866-873

13. Tachycardia in WPW syndrome

22. Initial Success of RFCA of SVT in Children Without CHD AVRT 91% (2816/3110) AVNRT 96% (885/920) 98% (60/61) 100% (15/15) PRCAR NTUH-P Favor able factors left lateral AP(95%) experience (> 20 cases) Unfavorable factors Right free wall AP(86%) Septal AP (87%) decreased BW

24. Complications of RFCA of SVT in Children Without CHD AV block 0.68% (25) 1% (1) Perforation 0.66% (10) 0 (0) brachial palsy 0.27% (10) 2% (2, transient) emboli 0.22% (8) 0 (0) pneumothorax 0.19% (7) 0 (0) death 0.11% (4) 0 (0) Risk factors : BW <15 kg, left free AP, experience AV block risk factors : anteroseptal AP, AVNRT, BW < 15 kg PRCAR NTUH-P 3.2% (118) 3 (3)

25. RFCA of SVT in Children Without CHD Recurrences AVRT 23 % 12 % AVNRT 29 % 7 % Unfavorable factors right free wall septal pathway PRCAR NTUH-P

27. Ventricular Tachycardia

32. 86 VT patients in our institution (M/F 49/37) Infant Child(1-10yr) Adolescent p value VT spon. resolution 4/5(80%) 0/10(0%) 1/20(5%) <0.05(I. vs C.) <0.05(I. vs A.) Ablation 0/0(0%) 4/10(40%) 16/20(80%) 0.11(I. vs C.) <0.05(I vs A.) Recur After Ablation 1/4(25%) 3/16(18%) 0.79 Idiopathic LV RV P-value Initial success 17/18(94%) 2/3(67%) 0.271 Recurrence 3/17(17%) 2/2(100%) 0.058

37. Atrioventricular block Acquired: surgery (VSD, LVOTO, L-TGA), myocarditis Congenital: transplacental autoimmune injury l -TGA

40. Congenital AV block Epicardial VVI® pacemaker Transvenous VDD pacemaker

44. Thanks for your attention!