ReviewSystematic review of risk stratification of pediatric ventricular arrhythmia in structurally normal and abnormal hearts

- Causes of pediatric VT are different from adults.
- Evidence based management outlines for pediatric wide ventricular tachycardia are still few in comparison to adult.
- We propose an evidence-based diagnostic decision making algorithm utilizing EKG, echo and Holter, to differentiate idiopathic benign from malignant pediatric VT.
- We also summarized evidence-based risks factors for sudden cardiac death in secondary VT in structurally normal and abnormal hearts.

Pediatric ventricular tachycardia (VT) occurs in both structurally normal and abnormal hearts. Spontaneous, sustained VT has an incidence of 1/100,000 among children. However, short episodes of VT can occur in up to 3% of healthy teenagers and up to 16% in hypertrophic cardiomyopathy. Prevalence of VT after tetralogy of Fallot repair has been estimated to be between 3% and 14% in several large clinical series, with a 2% incidence of cardiac death over 32 years. Because VT-related fatality is more prevalent in adults, it was previously believed that VT in children/adolescents had the same characteristics, etiologies, and outcomes despite not having evidence-based data. So, our systematic literature review was designed to identify evidence-based characteristics, etiologies, and risk stratification of the benign and malignant types of VT.We performed a systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.“PubMed,” “Science Direct,” “Web of Science”, “CINAHL” and “Cochrane” databases were searched for relevant studies using the search terms “ventricular tachycardia,” “pediatric,” “children,” “management,” “risk,” and “treatment”. Inclusion criteria included neonatal/pediatric/adolescent subjects; retrospective or prospective case series, case-control studies that described natural history of idiopathic VT in structural normal hearts, and sudden cardiac death risk factors in secondary VT in structurally normal or abnormal hearts. Studies were excluded if they were performed using animal models, exclusively described adult patients, or were review articles. We found 64 studies focused on three types of pediatric VT. These can be subdivided as follows: Idiopathic VT in structurally normal heart (24 studies), secondary VT in structurally normal hearts (22 studies), and VT in structurally normal hearts (18 studies). We propose an algorithm to differentiate benign from malignant VT using EKG morphologies, Holter criteria, and echocardiography. Also we risk stratify SCD in secondary pediatric VT in patients with structurally normal as well as structurally abnormal hearts in evidence-based methodology. Pediatric VT can be benign or malignant according to underlying etiologies. We propose an evidence-based algorithm to make this differentiation, followed by risk stratification of SCD in malignant and secondary VT in structurally normal or abnormal hearts.