Permanent Junctional Reciprocating Tachycardia (PJRT) in Children
Permanent junctional reciprocating tachycardia, more commonly referred to as PJRT, is a rare form of supraventricular tachycardia (SVT) typically seen in infants and children. It is similar to AVRT in that it involves an accessory pathway or bypass tract to connect the atria to the ventricles allowing for an electrical connection between the atria and ventricles which causes abnormally fast heart rates. Because of the properties of the accessory pathway that causes PJRT, the tachycardia can be constant and could lead to tachycardia induced cardiomyopathy if left untreated.
Signs and Symptoms
Unlike AVRT or WPW where heart rates can be above 200 bpm, PJRT in some instances can be noted to have slower rates making diagnosis difficult because symptoms can be less mild. Symptoms can be similar to those of SVT and include but are not limited to:
- Sensation of rapid, fluttering or pounding heartbeats (palpitations)
- Chest discomfort
- Difficulty breathing
- Exercise intolerance
It is possible for patients that develop tachycardia induced cardiomyopathy due to PJRT to experience symptoms of:
- Shortness of breath
- Exercise intolerance
- Worsening fatigue
- Swelling of abdomen or lower extremities
Your doctor or health care team may refer you to a pediatric electrophysiologist (EP) or someone who specializes in children with heart rhythm disorders. Your EP team may use one or multiple tools to help diagnose PJRT similar to how other forms of SVT would be diagnosed. These could include but not limited to:
Your EP team may prescribe medication for treatment. Medication is not a cure but can decrease the number of episodes and help to control symptoms. In most cases, these medications are taken daily.
The vagus nerve is a nerve in the body that can affect the heart rate. When it is stimulated, the heart rate can slow down. Certain maneuvers, called vagal maneuvers, are designed to stop the PJRT by stimulating the vagus nerve.
For older children, vagal maneuvers include:
- "Bearing down": pretending as if you are having a bowel movement - blowing on your thumb
- Doing a headstand, if you already know how to do one.
- Putting very cold water/ice on your face
For babies or young children who can't follow these directions, vagal maneuvers include:
- Place an ice pack over the eyes for 15-30 sec. A frozen bag of vegetables works really well. Avoid placing anything around the infant's nose.
- Pressing the infant's knees to the chest for 15-30 seconds
If the episode is lasts a long time, your child is ill or has fainted or you don't feel comfortable doing these maneuvers at home, you can call your doctor or go to an emergency room. If your child appears very ill, you should call 911. In the emergency room, your child may receive an intravenous (IV) medication to stop the SVT. If the medication is not successful and your child remains ill, a brief electrical shock (cardioversion), may be required. This is usually done while your child is sedated.
Typically, children and adolescents with AVRT do not have activity restrictions but understanding what triggers an individual’s SVT like exercise or strenuous activity can help avoid further episodes.