Workload of ambulatory activities in a tertiary paediatric cardiac centre.

BACKGROUND: Few data are available on the evolution in the number of referrals and the spectrum and frequency of issues addressed in paediatric cardiac outpatient clinics. AIM: To assess the volume and range of symptoms and diagnoses in patients, referred to a paediatric cardiac outpatient clinic in an academic hospital setting. METHODS: Data were collected prospectively over 6 months. RESULTS: Historical comparison showed that the number of outpatient visits increased from 819 during the first semester of 2004 to 865, 1045 and 1391 during the first semesters of 2005, 2006 and 2007, respectively. During the 6-month study period in 2007, 854/1391 visits concerned patients with known heart disease; the reason for the visit was follow-up of congenital heart disease (n=616 children, 128 adults), arrhythmia (n=91) or acquired heart disease (n=19). During the visit, the decision to perform diagnostic or therapeutic cardiac catheterization or a surgical procedure was taken in 47 cases. Foetal echocardiography was performed in 60 foetuses and was abnormal in 21 cases. Among the other 477 visits, which concerned patients without known heart disease, the most frequent clinical concern was cardiac murmur (n=193) and there were new diagnoses of congenital heart disease (n=28), ventricular dysfunction (n=2) and arrhythmia (n=7). CONCLUSIONS: The ambulatory paediatric cardiology workload in tertiary academic hospital settings is increasing alarmingly. These data may be helpful in future planning of consultant manpower and in curriculum development for cardiac training of students and residents.

Epidemiology and outcome of tachyarrhythmias in tertiary pediatric cardiac centers.

INTRODUCTION: Little is known about the real importance of pediatric arrhythmias. METHODS: We analyzed the epidemiology, presentation and outcome of all clinically relevant tachyarrhythmias followed up in our pediatric institutions from 1995 to 2006. RESULTS: A total of 250 cases were identified. The mean age +/- SD at diagnosis was 4.7 +/- 5.3 years, 45 cases were neonatal (18%). Supraventricular arrhythmias were noted in 210 children (84%), ventricular arrhythmias in 40 (16%). The most frequent symptoms were palpitations (n = 71) and syncope (n = 48) in older children, as well as monitoring of diseases (n = 62) and heart failure (n = 49) in younger patients. Recurrence was noted under or after therapy in 75 cases, mostly in cases diagnosed beyond infancy. At long-term follow-up, 169 patients have no recurrence without treatment (of whom 34 had required catheter ablation), 71 are under therapy and 10 died. CONCLUSION: Supraventricular arrhythmias in younger children are often an incidental diagnosis, respond to antiarrhythmic therapy and have a high incidence of resolution. In older children with supraventricular arrhythmias and in those with ventricular arrhythmias, delayed diagnosis or misdiagnosis is not rare, the arrhythmias are unlikely to resolve spontaneously and long-term antiarrhythmic treatment or catheter ablation is necessary.