Conversion of paroxysmal supraventricular tachycardia in a child with a slow verapamil infusion: case report and literature review.

The investigators present the case of a 12-month-old female with Down's syndrome and an endocardial cushion defect who presented acutely ill in paroxysmal supraventricular tachycardia (PSVT). Unsuccessful vagal maneuvers were followed by a slow intravenous infusion of verapamil, during which the rhythm converted. The discussion which follows highlights the many issues to be addressed in the acute management of pediatric PSVT including the varied presentations, underlying etiologies, differential diagnosis, electrocardiographic findings, electrophysiologic mechanisms, and prognosis. The literature review concludes with a discussion of the many different therapies available for pediatric PSVT including vagal maneuvers, cardioversion, overdrive pacing, and pharmacologic therapies. In particular, the relative merits of verapamil and adenosine are discussed.