A Quick Guide to Pediatric SVT

Non-pharmacologic options to break stable SVT - Ice pack to face. Face immersion in cold water for 30 seconds. Ask older child to blow into the end of a 10 cc syringe. Modified vagal maneuver with elevation of legs. Hold child upside down for 30 seconds? – shown to be effective (but something parents won’t love to see). Handstand? - can also be effective with older children.

 Supraventricular Tachycardia

SVT in Infants - Commonly have nonspecific complaints of “fussiness” or “not acting right.” Typically can tolerate SVT for 24 hours! SVT in older children - Rarely develop CHF from SVT, primarily because they are able to describe their symptoms. While awaiting access, this is a perfect time to use some vagal maneuvers... Telling a child to “bear down like you are having a bowel movement” will generally not produce the results that you were expecting… so you can: Use ice to an infant’s face, or Have an older child attempt to blow through a partially occluded straw... A higher initial dose of adenosine (0.2mg/kg to 0.25mg/kg) in both infants and children reduces the risk of unsuccessful cardioversion by 35% (number needed to treat: 3).” (Quail 2012)

 SVT in Infants - A Crash Course

The first thing to try is to physiologically revert the SVT. This can be done using valsalva in older children by blowing into a pipe/syringe. This can be blowing into a pipe attached to a sphygmomanometer to hit 40mmHg for a sustained 15 seconds. Or patients can blow into a 10ml syringe and aim to start moving the plunger. Both are effective. This works because the extra squeeze on the heart increases the cardiac output and increased carotid and baroreceptor stimulus increasing the BP in the initial stage. After the pressure is sustained, blood volume is forced into the legs and head (causing neck vein distension). The drop in preload means the atrium is stimulated and the heart pumps harder and faster to make up for it, and the blood pressure drops. At the end of the manoeuvre, there is a sudden release, and all the blood flows into the heart causing a huge flow of blood into the carotid and baroreceptors leading to vagal inhibition. Using a modified valsalva works better – if you lift the patients legs in the air and lie then flat immediately after the release, you will increase the venous return and improve the chances of reversion. The REVERT study showed that this method reverted SVT in 43% (vs 17%) of (adult) patients.

 Upside Down Vagal Maneuver for SVT

Get them inverted… safely! The inverted position can have improved rates of cessation of SVT. Whether by feet elevation, or handstand, or by just holding the young ones upside down, there appears to be an augmented vagal response. Just don’t drop the kid!

Acute Management of Refractory and Unstable Pediatric Supraventricular Tachycardia

In children with SVT, young age is associated with decreased response to the first dose of adenosine and increased odds of adenosine-refractory SVT. In the treatment of unstable SVT, medical management with various antiarrhythmics before cardioversion may have a role in a subset of patients. Synchronized cardioversion rarely is performed for acute SVT.

Annals of B-Pod: Pediatric SVT Case and Expert Discussion - Neonate

If vagal maneuvers fail, adenosine is considered the drug of choice as it is a short acting but quite powerful AV nodal blocking agent that interrupts the reentrant conduction pathways causing the arrhythmia. The recommended dosage in pediatrics is 0.1 mg/kg. If this is not successful, providers may reattempt with 0.2 mg/kg (max of 6mg and 12mg respectively). Other medications to consider would be amiodarone (5mg/kg over 20-60 minutes) or procainamide (15mg/kg over 30-60 minutes), but both of these medications may cause hypotension and involvement of a pediatric cardiologist prior to initiation may be advisable.

Common paediatric arrhythmias

SVT is the most common dysrhythmia seen in the paediatric population, and comprises over 90% of paediatric dysrhythmias. Of children presenting with SVT: Half will have no underlying heart disease. 1⁄4 will have WPW. Almost 1⁄4 will have congenital heart disease.

Pediatric Small Talk – The Rhythm Is Gonna Get Ya’: Age Based Approach to Pediatric Narrow Complex Tachydysrhythmia

Pediatric narrow complex tachycardia, commonly referred to as Supraventricular Tachycardia (SVT), is the most common rhythm disturbance in pediatrics, with an estimated prevalence of 1 in 250-1000. The range of presentations varies from subtle fussiness to palpitations. The spectrum of disease also varies from well-tolerated palpitations to fulminant cardiogenic shock – particularly in children with a history of structural congenital heart disease (CHD).

Pediatric SVT

SVT is the most common pediatric dysrhythmia that we see in the ED after sinus tachycardia. But sometimes, in very young children and infants, it can be hard to distinguish the two! This case highlights some important features of the management of SVT...

“Home remedies” for SVT

There are a few ways a parent or caregiver can provide SVT treatment at home, and these involve stimulating the vagus nerve to return the heart rate back to normal. If your child looks ill during SVT or SVT doesn’t stop with these methods, your child will need care from a professional...