Management and Outcomes of Paediatric Patients with Palpitations Examined in Our Clinic

Objective: We retrospectively reviewed the data of patients who presented to the paediatric cardiology clinic with complaints of palpitations. We aimed to describe the characteristics of these patients, the rhythm disorders that were detected, and the treatment methods with a particular attention on rare and vital diseases. Methods: In total, 1,680 patients aged 5-18 years who presented with palpitations at the paediatric cardiology clinic between January 2016 and June 2019 were enrolled. Of these, 714 (42.5%) were male and 966 (57.5%) were female. All the hospital records including electrocardiography, echocardiography, cardiovascular stress test, 24-h Holter monitoring, event recorder and genetic analysis results were reviewed. Results: The mean age of the patients was 13.5±3.2 years (range: 5-17.8 years). Palpitation was accompanied with chest pain in 218 patients, shortness of breath in 152 patients and weakness in 67 patients. Also, 726 Holter monitoring, 165 event recorder and 104 cardiovascular stress test results were evaluated. Dysrhythmia was detected in 306 patients (18.2%). The most common dysrhythmias were supraventricular extrasystoles (n=171, 55.8%) and ventricular extrasystoles (n=82, 26.8%). Five patients were diagnosed with non-sustained ventricular tachycardia (VT) episodes, one with long QTc syndrome and one with catecholaminergic polymorphic VT. Two patients were followed-up for arrhythmogenic right ventricular dysplasia (ARVD), 12 patients had mitral valve prolapsed (MVP), 8 had valvular heart disease caused by acute rheumatic fever (ARF) and 7 had bicuspid aortic valve (BAV). Conclusion: Palpitation is one of the common causes of outpatient clinic visits in children and it may be the first symptom of serious arrhythmias, although it is frequently associated with benign pathologies. Most life-threatening dysrhythmias can be detected by a thorough analysis of the patient using basic cardiological examination methods.

Çarpıntı Şikayeti ile Kliniğimizde İncelenen Çocuk Hastaların Sonuçları ve Tedavi Yönetimi

Amaç: Bu çalışmada, çocuk kardiyoloji polikliniğine çarpıntı şikayeti ile başvuran hastaların bilgileri retrospektif olarak incelendi. Bu konu ile ilgili güncel yaklaşımlar derlendi, ayrıca seyrek görülen ve hayati önemi olan hastalıklara dikkat çekilmeye çalışıldı. Yöntemler: Ocak 2016 - Haziran 2019 tarihleri arasında 5-18 yaş arasında olan ve çarpıntı şikayeti ile çocuk kardiyoloji polikliniğine başvuran 1680 hasta çalışmaya dahil edildi. Hastaların 714’ü erkek (%42,5) ve 966’sı (%57,5) kız idi. Hastaların elektrokardiyografi (EKG), ekokardiyografi, kardiyovasküler stres test, 24 saat ritim Holter, olay kaydedici ve genetik analiz bilgilerini içeren tüm hastane kayıtları incelendi. Bulgular: Hastaların yaş ortalaması 13,5±3,2 yıl (minimum/ maksimum: 5-17,8 yıl) idi. Çarpıntı şikayetine 218 hastada göğüs ağrısı, 152’sinde nefes darlığı ve 67’sinde halsizlik şikayeti eşlik ediyordu. Hastalara ait 726 ritim Holter, 165 olay kaydedici, 104 kardiyovasküler stres test incelendi. Hastaların 306’sında (%18,2) disritmi belirlendi. En sık belirlenen disritmiler supraventriküler ekstrasistol (n=171, %55,8) ve ventriküler ekstrasistol (n=82 %26,8) idi. Beş hasta ventriküler taşikardi, bir hasta uzun QTC sendromu, bir hasta katekolaminerjik polimorfik ventriküler taşikardi (VT) tanısı aldı. İki hasta aritmojenik sağ ventrikül displasizi açısından izleme alındı. Hastaların 12’sinde mitral kapak prolapsusu, 8’inde akut romatizmal ateşe bağlı kalp kapak hastalığı ve 7’sinde biküspit aortik kapak belirlendi. Sonuç: Çocuklarda yaygın poliklinik başvuru sebeplerinden olan çarpıntı şikayeti sıklıkla iyi huylu patolojilerle ilişkili olsa da ciddi aritmilerin ilk semptomu olabileceği mutlaka akla getirilmelidir. Hayatı tehdit edebilecek çoğu ritim bozukluklarını hastaların iyi bir şekilde analiz edilmesi ve temel kardiyolojik inceleme metodlarının kullanılması ile saptamak mümkündür.

Kaynakça

1. Kang KT, Etheridge SP, Kantoch MJ, Tisma-Dupanovic S, Bradley DJ, Balaji S, et al. Current management of focal atrial tachycardia in children: a multicenter experience. Circ Arrhythm Electrophysiol 2014;7:664-70.

2. Dickinson DF, Scott O. Ambulatory electrocardiographic monitoring in 100 healthy teen age boys. Br Heart J 1984;51:179-83.

3. Nagashima M, Matsushima M, Ogawa A, Ohsuga A, Kaneko T, Yazaki T, et al. Cardiac arrhythmias in healthy children revealed by 24-hour ambulatory ECG monitoring. Pediatr Cardiol 1987;8:103- 8.

4. Scott O, Williams GJ, Fiddler GI. Results of 24 hour ambulatory monitoring of electrocardiogram in 131 healthy boys aged 10 to 13 years. Br HeartJ 1980;44:304-8.

5. Southall DP, Richards J, Hardwick RA, Shinebourne EA, Gibbens GL, Thelwall-Jones H, et al. Prospective study of fetal heart rate and rhythm patterns. Arch Dis Child 1980;55:506-11.

6. Conti CR. Ventricular arrhythmias: a general cardiologist’s assessment of therapies in 2005. Clin Cardiol 2005;28:314-6.

7. Gaita F, Giustetto C, Di Donna P, Richiardi E, Libero L, Brusin MC, et al. Long-term follow-up of right ventricular monomorphic extrasystoles. J Am Coll Cardiol 2001;38:364-70.

8. Spector ZZ, Seslar SP. Premature ventricular contraction-induced cardiomyopathy in children. Cardiol Young 2016;26:711-7.

9. Alexander ME, Berul CI. Ventricular arrhythmias: when to worry. Pediatr Cardiol 2000;21:532-41.

10. Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, et al. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm 2014;11:55-78.

11. Wijnmaalen AP, Delgado V, Schalij MJ, van Huls van Taxis CF, Holman ER, Bax JJ, et al. Beneficial effects of catheter ablation on left ventricular and right ventricular function in patients with frequent premature ventricular contractions and preserved ejection fraction. Heart 2010;96:1275-80.

12. Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C, et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm 2010;7:865-9.

13. Takemoto M, Yoshimura H, Ohba Y, Matsumoto Y, Yamamoto U, Mohri M, et al. Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease. J Am Coll Cardiol 2005;45:1259-65.

14. Kuck KH, Schlüter M, Geiger M, Siebels J, Duckeck W. Radiofrequency current catheter ablation of accessory atrioventricular pathways. Lancet 1991;337:1557-61.

15. Jackman WM, Wang XZ, Friday KJ, Roman CA, Moulton KP, Beckman KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991;324:1605-11.

16. Calkins H, Sousa J, el-Atassi R, Rosenheck S, de Buitleir M, Kou WH, et al. Diagnosis and cure of the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiologic test. N Engl J Med 1991;324:1612-8.

17. Calkins H, Yong P, Miller JM, Olshansky B, Carlson M, Saul JP, et al. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group. Circulation 1999;99:262-70.

18. Hindricks G. The Multicentre European Radiofrequency Survey (MERFS): complications of radiofrequency catheter ablation of arrhythmias. The Multicentre European Radiofrequency Survey (MERFS) investigators of the Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1993;14:1644-53.

19. Jaeggi E, Öhman A. Fetal and Neonatal Arrhythmias. Clin Perinatol 2016;43:99-112.

20. Etheridge SP, Escudero CA, Blaufox AD, Law IH, Dechert-Crooks BE, Stephenson EA, et al. Life-Threatening Event Risk in Children With Wolff-Parkinson-White Syndrome: A Multicenter International Study. JACC Clin Electrophysiol 2018;4:433-44.

21. Koca S, Akdeniz C, Tuzcu V. Catheter ablation for supraventricular tachycardia in children ≤ 20 kg using an electroanatomical system. J Interv Card Electrophysiol 2019;55:99-104.

22. Kugler JD, Danford DA, Houston KA, Felix G; Pediatric Radiofrequency Ablation Registry of the Pediatric Radiofrequency Ablation Registry of the Pediatric Electrophysiology Society. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 2002;13:336-41.

23. Van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol 2004;15:759-70.

24. Aiyagari R, Saarel EV, Etheridge SP, Bradley DJ, Dick M 2nd, Fischbach PS. Radiofrequency ablation for supraventricular tachycardia in children < or =15 kg is safe and effective. Pediatr Cardiol 2005;26:622-6.

25. Chiu SN, Lu CW, Chang CW, Chang CC, Lin MT, Lin JL, et al. Radiofrequency catheter ablation of supraventricular tachycardia in infants and toddlers. Circ J 2009;73:1717-21.

26. Akdeniz C, Ergul Y, Kiplapinar N, Tuzcu V. Catheter ablation of drug resistant supraventricular tachycardia in neonates and infants. Cardiol J 2013;20:241-6.

27. Gartenberg AJ, Pass RH, Ceresnak S, Nappo L, Janson CM. Incidence of Echocardiographic Abnormalities Following Pediatric SVT Ablation: Comparison of Cases Utilizing Fluoroscopy Aloneto Caseswith Adjunctive 3D Electroanatomic Mapping. Pediatr Cardiol 2019;40:497-503.

28. Van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, et al. Prospective assessment after pediatric cardiac ablation: recurrence at 1 year after initially successful ablation of supraventricular tachycardia. Heart Rhythm 2004;1:188-96.

29. Philip Saul J, Kanter RJ; WRITING COMMITTEE, Abrams D, Asirvatham S, Bar-Cohen Y, Blaufox AD, et al. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease: Developed in partnership with the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American Academy of Pediatrics (AAP), the American Heart Association (AHA), and the Association for European Pediatric and Congenital Cardiology (AEPC). Heart Rhythm 2016;13:251-89.

30. Roston TM, Cunningham TC, Sanatani S. Advances in the diagnosis and treatment of catecholaminergic polymorphic ventricular tachycardia. Cardiol Young 2017;27:49-56.

31. Napolitano C, Priori SG. Diagnosis and treatment of catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm 2007;4:675-8.

32. Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, et al. Pharmacological and nonpharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC Arrhythmia Working Group joint consensus statement. Europace 2013;15:1337-82.

33. Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/ dysplasia: proposed modification of the Task Force Criteria. Eur Heart J 2010;31:806-14.

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