Pharmacological management and outcomes of sustained ventricular tachycardia in children and adolescents: a single-center retrospective study.

BACKGROUND: Evidence related to the efficacy and prognosis of pharmacologic therapy for sustained ventricular tachycardia (VT) in the pediatric population remains scarce. This single-center retrospective study aimed to evaluate the therapeutic outcomes and drug sensitivity of sustained VT in children and adolescents. METHODS: We analyzed patients hospitalized due to sustained VT at the Department of Pediatric Cardiology, Shengjing Hospital of China Medical University, between February 2018 and September 2025. Patients were prescribed antiarrhythmic drugs according to electrocardiogram (ECG) morphology. Electrocardiographic and echocardiographic data, cardioversion success rate, and adverse events were recorded. Following VT termination, oral antiarrhythmic drugs were initiated for VT prevention. RESULTS: In total, 29 patients (18 boys, 11 girls) were included, with a mean age of 8.3 ± 4.6 years. The patients were diagnosed with idiopathic VT (n = 25), VT associated with myocarditis (n = 3), or VT associated with structural heart disease (n = 1). According to ECG morphology, patients were classified as presumed left fascicular VT (n = 21, 72.4%), outflow tract VT (n = 2, 6.9%), polymorphic VT (n = 3, 10.3%), and other-origin VT (n = 3, 10.3%). A total of 38 sustained VT episodes occurred among these patients. Four episodes of VT terminated without antiarrhythmic intervention, while the remaining 34 episodes were successfully cardioverted under medical intervention, with monotherapy effective in 25 episodes (73.5%). Intravenous verapamil was effective for presumed left fascicular VT (success rate of 92.3%). During a mean follow-up period of 2.1 ± 1.7 years, 41.4% of the patients had complete resolution of VT with drug discontinued, while the remainders still required antiarrhythmic drugs. Drug therapy alone resulted in a higher complete resolution rate in patients with infantile onset (<1 year) compared to those with older onset (66.6% vs. 13.0%, P = 0.006). Transient, reversible cardiac dysfunction occurred in only three patients. All patients maintained cardiac function well during follow-up, and no sudden cardiac death was recorded. CONCLUSION: Idiopathic VT is the predominant type of sustained VT in children and adolescents. In this study, the vast majority of the cases were left fascicular VT. Patients with presumed left fascicular VT exhibit sensitivity to intravenous verapamil, although clinicians must remain vigilant of transient hypotension. The long-term follow-up results revealed an overall favorable prognosis in pediatric VT.