Provides a historical overview of the evolution of arrhythmia management in pediatric patients from pharmacologic suppression to curative anatomic approaches.
Provides context for current pediatric arrhythmia strategies; leaves open prospective validation of anatomic cures.
THE PAST Over the past 15 years, remarkable advances have occurred in the care of pediatric patients with arrhythmias. For the most part, progress has been the result of information obtained from invasive diagnostic electrophysiologic studies in infants and children, 1 which have allowed a mechanistic analysis of the cause of the arrhythmia and a targeted therapeutic approach to drug treatment. 2 The latter has focused on developing more specific antiarrhythmic agents and increasingly effective suppression of arrhythmias for children and adults. However, whereas the benefits of these pharmacologic advances have been striking, the emphasis has been on suppression of the rhythm disturbance rather than on cure. In addition to elucidating the mechanism of an arrhythmia, electrophysiologic studies detect the origin or anatomic circuit; this information has been used to design more definitive arrhythmia therapy. Originally, the only management approach to take advantage of anatomic information was surgical. A variety
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Thomas S. Klitzner (1993) studied this question.
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