Uncommon case of permanent junctional reciprocating tachycardia present in a newborn

Introduction: Permanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular arrhythmia. It is characterized by anterograde conduction over the atrioventricular node and retrograde conduction over a decremental accesory pathway. The hallmark ECG feature is an incessant narrow complex tachycardia with inverted P waves in leads II, III and aVF, as well as the left lateral leads, and an RP interval longer than the PR interval. The arrhythmia is commonly incessant from birth or infancy, even though it may not be recognised until adulthood.
Case presentation: We report a case of a male new-born, from an insufficient dispensing pregnancy, diag-nosed peripartum period with tachycardia and in neo-natal period with permanent junctional reciprocating tachycardia.
The patient was peripartum diagnosed with fetal tachycardia by a territory unit. After birth, the heart rate remains high and the patient underwent vagal maneuvers with no results. Propranolol therapy was tried in order to obtain sinus rhythm. Beside the an-tiarrhythmic therapy, tachycardia maintains therefore the newborn was redirected to a level 3 clinic. The car-diac consult detect on a 12-lead ECG regular incessant tachycardia, with the aspects of PJRT. The echocardio-graphy showed a normal sized heart. Initially was associated Amiodarone to Propanolol but with no results. Due to persistent tachycardia, association Amiodarone and Digoxine was tented with very poor results (24 ho-urs ECG-Holter revealed short periods of sinus rhythm and the aspect of PJRT), requiring Metoprolol to thera-py. At 2 months old follow up, the 12-lead ECG showed sinus rhythm, with supraventricular extrasystoles. The 24 hours ECG-Holter revealed long periods of sinus rhythm, with frequent isolated and couplets of supra-ventricular extrasystoles, 2 episodes of self-limited PJRT, with medium heart rate of 130 beats per minute. The patient maintains the same treatment with dose adjustment based on weight.
Case particularity: The particularity of this case is the early diagnose of the patient, in the early postnatal period, while usually is diagnosed in childhood or adult life. An important caracteristic is that it is refractory to drug treatment, like in this case when antiarrhythmic medications did not complete controled the tachycardia but manage to stabilize the patient.
Conclusions: We presented a case of a newborn peri-partum diagnosed with tachycardia and postnatal with incessant PJRT. This tipe of supraventricular tachycar-dia is an uncommon arrhythmia and does not have the spontaneous resolution characteristics of other atrio-ventricular rentry tachycardias.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)