A 12 yo boy presents with an episode of syncope during exertion exercise. Whilst in the emergency department he develops palpitations and an ecg is done. His ecg is shown below.
Keone R et al. Journal of Arrhythmia 33 (2017) 533–544
What is the diagnosis?
Is this a benign arrhythmia in childhood?
Is this a benign arrhythmia in childhood?
SOLUTION
This is bidirectional ventricular tachycardia, similar to what may occur, with digoxin toxicity.
In this case it is it is Catecholamine induced polymorphic tachycardia.
This is an inherited condition, that if untreated carries a 30% mortality.
It is a stress induced tachycardia that can lead to syncope or cardiac arrest and patients can suffer a VF arrest or sudden cardiac death.
Treatment is initially with a beta blocker such as Propranolol, Atenolol or Nadolol. If this fails to control the arrhythmia an implantable defibrillator may be needed.
