Respiratory syncytial virus (RSV), a common cause of
respiratory infections in children, has only rarely been associated with acquired
heart disease. We reviewed hospital charts, rhythm strips, and electrocardiograms of 8 infants with abnormal
supraventricular tachycardia (SVT), > 250 beats/min, associated with acute
RSV infections. Cultures of nasopharyngeal specimens from six of eight infants grew RSV. Two infants with negative viral culture results had symptoms typical of an
RSV infection during a documented RSV epidemic. Two infants had
congenital heart defects. Seven of the eight infants had an
ectopic atrial tachycardia, chaotic atrial
tachycardia, or
atrial flutter, and five of eight had episodes of nonsustained wide-complex SVT. One patient was initially treated with intravenously administered
lidocaine for an incorrect diagnosis of
ventricular tachycardia. SVT was unrelated to either beta-agonist
therapy or hypoxic episodes. SVT did not recur after discharge in any infant with a structurally normal heart. Both patients with structural
heart disease had recurrences of SVT. We conclude that
RSV infections in infants may be associated with unusual atrial
tachycardias and that the diagnosis may be complicated by episodes of nonsustained, wide-complex
tachycardias. In patients with RSV and structurally normal hearts, chaotic and
ectopic atrial tachycardias are self-limited and do not require prolonged
drug therapy.