The two primary mechanisms of palpitations in children are sinus tachycardia or supra-ventricular tachycardia. (NB ventricular tachycardia usually present with syncope rather than palpitations) There are many causes of sinus tachycardia but episodic palpitations are often found to arise from anxiety, panic or chronic hyperventilation.

The symptoms and signs often abate before children can attend their GP. In between "attacks" the clinical examination may be entirely normal, however all children with palpitations must have an ECG completed to exclude Wolf Parkinson White (WPW) syndrome a potentially life threatening form of tachycardia.

If a child is seen in primary care during an attack it is very helpful to record a 12 lead ECG plus a rhythm strip as soon as possible to help clarify the diagnosis. Please forward this with the patient at referral.

‘Capturing the diagnosis’ in children with presumed SVT can be an elusive process and may require holter monitoring or an "open letter" to the local after hours Accident and Medical clinic requesting an ECG on presentation with palpitations

Children in whom a diagnosis of SVT has been established require long term follow-up as the frequency and/or duration of tachycardia tend to increase with time. Some will require radiofrequency ablation of their accessory atrioventricular pathway.