Idiopathic ventricular tachycardia in children: curative therapy with radiofrequency ablation.

UNLABELLED: Idiopathic ventricular tachycardia is a rare condition, and there is a lack of clear guidelines for the necessity and indications for prophylactic antiarrhythmic or curative treatment. The aim of this study was to review the clinical picture of idiopathic ventricular tachycardia and evaluate the efficacy and safety of radiofrequency ablation therapy in children. MATERIAL AND METHODS: The subjects of this study were 16 children with idiopathic ventricular tachycardia. The mean age at onset of idiopathic ventricular tachycardia was 12 years. All patients underwent electrophysiological examination. Nonfluoroscopic mapping technology (Carto) was used in one case. Radiofrequency ablation was performed in all children (mean duration of follow-up was 46 months). RESULTS: Six children with idiopathic ventricular tachycardia were free of symptoms. Palpitation was the only complain in four patients, and six patients presented with symptoms of circulatory disorder (the tendency of the higher rate of ventricular tachycardia and more premature contractions and episodes of ventricular tachycardia in one day were noticed in five of them). All children after radiofrequency ablation were alive, and only one complication (complete right bundle branch block) occurred. Success at last follow-up included five children with left and six with right idiopathic ventricular tachycardia. CONCLUSIONS: Catheter ablation seems a promising therapeutic option with the outlook possible of the idiopathic ventricular tachycardia in children. It is safe enough and should be considered as the therapy of choice even in children without of symptoms if they wish to live active social and physical life.

[Heart fibroma: an unusual cause of ventricular tachycardia in a child]. / Sirdies fibroma--reta vaiko skilvelines tachikardijos priezastis.

Ventricular tachycardia with underlying structural heart disease is a potential dangerous pathology in children. In most cases, ventricular tachycardia occurs after ventricular surgery for congenital anomalies. Ventricular tachycardia associated with primary heart tumors is extremely rare. A 4-year-boy presented with primary heart tumor, fibroma, manifesting as ventricular tachycardia. Manifestation of the disease was ventricular tachycardia. The complete resection of the tumor was performed successfully. The diagnosis was confirmed histologically.

[Juvenile idiopathic systemic arthritis]. / Sisteminis jaunatvinis idiopatinis artritas.

UNLABELLED: THE PURPOSE OF THE STUDY was to evaluate the peculiarities of the clinical features, laboratory parameters and tactics of treatment in juvenile idiopatic systematic arthritis. METHODS: A retrospective data review of 41 children (26 boys and 15 girls) who underwent treatment for systemic arthritis (according to ILAR criteria) in our institution between 1992 and 2002 was performed. RESULTS: The disease started with fever of unknown origin in all cases. In 73% of patients it lasted longer than one month, in 54% fever was with twice daily spikers in the morning and in the evening. The rash during the rise of temperature appeared in 49%, in most cases (70%) there was a maculo-papular rash. Lymphadenopathy and serositis were observed in 32%, hepatomegaly in 29%, and splenomegaly in 24%. Arthritis coincided with the fever in 29% of patients, in majority of cases it was progressing to a severe persistent arthritis after the systematic phase. There was no specific laboratory findings: neutrophilic leucocytosis was found in 73%, anemia - in 80.5%, trombocytosis - in 36.6%, elevated CRP - in 63.4%, dysproteinemia - in 79% of patients. Antinuclear factors were absent in all examined children. For all patients intravenous methylprednisolone pulses have been administered (10-22 mg/kg/infusion). Prednisolone was also continued orally (1-2 mg/kg/day). 24.4% of patients required in addition immunosupressive agents such as methotrexate, azathioprine and cyclophosphamide. CONCLUSION: Puls-therapy of methylprednisolone is a safe and sufficiently effective method of treatment in most cases of the systematic juvenile arthritis.