İbrahim İlker ÇETİN, Emine AZAK, Hazım Alper GÜRSU, Gamze KARAMANLI, Ayşe Esin KİBAR GÜL

Çocukluk Çağında Çarpıntı Yakınması ile Başvuran Hastalarda Ritim Holter Monitorizasyon Sonuçlarının Değerlendirilmesi

Amaç: Çalışmamızda çarpıntı yakınmasıyla başvuran çocuk hastalarda 24 saatlik ritim holter monitorizasyon (HM)endikasyonları gözden geçirilmiştir. Bu çalışmanın amacı, holterde görülen ritim bozukluklarının tür ve sıklığınınsaptanması, holterin tanı ve tedavideki yeri vurgulanmaktır.Gereç ve Yöntemler: Ocak 2016-Ocak 2018 tarihleri arasında kliniğimize çarpıntı yakınması ile başvuran, 4-17 yaşarası (ortalama yaş 13.1 ± 3.4) 364 hastanın 383 adet HM sonuçları geriye dönük değerlendirildi.Bulgular: Hastaların %11.5’inde (n=42) elektrokardiyografide (EKG), %33’ünde (n=120) holterde disritmi bulundu.Holter endikasyonları içinde; %88.5’ini EKG incelemesi normal olup nedeni belli olmayan çarpıntı ve/veya disritmiksemptomları devam edenler hastalar oluşturmaktaydı. Hastaların %56.9’unda (n=206) izole çarpıntı ve %43.4’ünde(n=158) diğer eşlik eden yakınmalar; bunlar içinde de en sık göğüs ağrısı (%24.2) ve senkop (%10.4) kaydedildi. HemEKG’de hem de HM’da disritmi olan hastalarda (%36.1), EKG’si normal olup HM’da disritmi olan hastalara (%15.5) göreciddi disritmi saptanma oranı anlamlı yüksek saptandı (p=0.023). Holterde en sık saptanan disritmiler %10.1 (n=37) ilesupraventriküler ekstrasistol (SVE) ve %9 (n=33) ile ventriküler ekstrasistol (VES)’di. Bu iki ritim bozukluğunun birliktegörülme oranı ise %2.4 (n=9) bulundu. Holter monitorizasyondaki ritim bozuklukları yaş gruplarına göre incelendiğinde≤10 yaş SVE sıklığı %3, VES sıklığı %1.4 iken, ≥11 yaş bu oranlar sırasıyla %7.1 ve %7.7’di. Yaş gruplarına göre HM’dadisritmi dağılımında istatiksel anlamlı fark saptanmadı (p>0.05).Sonuç: Çalışmamızda, çocuk kardiyoloji kliniğine çarpıntı şikayeti ile başvuran hastaların yaklaşık üçte birinde disritmisaptanmış ve bunların da %7.1’inde (n=26) ciddi disritmiler olduğu belirlenmiştir Anormal EKG’nin holter kaydınıntanıya katkısını arttırdığı saptanmıştır. Ayrıca EKG’si normal olan hastalarımızda da holterde disritmi kaydedilmesi ritimbozukluklarının saptanmasında EKG’nin yetersiz kalabildiğini ve HM’nun özellikle pediatrik yaş grubunda yararlı bir tanıaracı olabileceğini düşünmekteyiz.

Evaluation of the results of rhythm holter monitorization in children with palpitation in childhood

Objective: In our study, we evaluated 24-hour rhythm holter monitarization (HM) indications in pediatric patients presenting with palpitations. The aim of this study was to determine the type and frequency of rhythm disorders seen in holter, and to emphasize the place of holter in diagnosis and treatment.Material and Methods: 383 HM results of 364 patients in the age of 4 and 17 (average age 13.1 ± 3.4) who applied to the pediatric cardiology outpatient clinic with complaint of palpitation between January 2016 and January 2018 were evaluated retrospectively. Results: In 11.5% of patients (n=42) dysrhythmia was detected in ECG, in 33% of them (n=120) dysrhythmia was detected in Holter. If we look at the Holter indications of the patients 88.5% had normal ECG examination, but ongoing unspecified of palpitations and dysrhythmic. 56.9% of patients (n=206) had complaint of isolated palpitation, 43.4% of patients (n=158) had other coexisting complaints such as chest pain (24.2%) and syncope (10.4%). In patients with dysrhythmias in both ECG and HM (36.1%), ECG was normal and the rate of severe dysrhythmia was found to be significantly higher in patients with arrhythmia (15.5%) than in patients with HM (p = 0.023). The most common rhythm disorders in holter results were 10.1% (n=37) SVE and 9% (n=33) VES. Coincidence of two rhythm disorders was 2.4% (n=9). If the rhythm disorders in HM were examined according to age groups, in the age ≤ 10; the frequency of SVE was %3, the frequency of VES was 1.4%. On the other hand in patients of age ≥11, the frequency of SVE was 7.1%, the frequency of VES was 7.7%. According to age group there was no statistically significant difference in dysrhythmia distribution in ECG and HM (p>0.05). Conclusion: In this study, dysrhythmia was detected about one third of patients who applied to the pediatric cardiology outpatient clinic with the complaint of palpitation and serious dysrhythmia was detected in 7.1% of them (n=26). Abnormal ECG was found to increase the contribution of holter recording to the diagnosis. In addition, in patients with normal ECG, the recording of dysrhythmia in the holter, ECG may be inadequate in detecting rhythm disorders and therefore, HM may be a useful diagnostic tool especially in pediatric age group.

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