Yield of 48-hour Holter monitoring in children with unexplained palpitations and significance of associated symptoms.

OBJECTIVE: To determine the yield of 48-hour Holter monitoring in children with unexplained palpitations and the significance of associated symptoms. METHODS: This descriptive study was conducted at the Children's Hospital and Institute of Child Health, Lahore, Pakistan, from January 1 to December 31, 2015. All children above 5 years of age with history of intermittent palpitations and normal basic cardiovascular workup were enrolled. A 48-hour Holter study was performed using Motara Holter Monitoring System. Frequency of various symptoms and abnormal Holter findings were analysed. SPSS 21 was used for data analysis. RESULTS: Of the 107 patients, 69(64.5%) were males and 38(34.5%) females. The median age was 10 years (interquartile range: 5-18 years). Most common concomitant symptoms with palpitation included syncope/pre-syncope in 35(32.7%) patients, chest pain 22(20.5%), shortness of breath 21(19.6%) and colour change/pallor 11(10.3%). Holter recording was positive in 40(37%) patients. Frequent premature ventricular contractions 12(11.2%) and atrial ectopic beats 9(8.4%) were the most common findings. Holter findings were significantly more common in patients with history of shortness of breath and colour change/pallor during palpitations (p=0.002). CONCLUSIONS: Extended 24-hour Holter monitoring in children with palpitations was an inexpensive, non-invasive investigation with a reasonably high diagnostic yield in detecting arrhythmias.

Patient's age rather than severity of the arrhythmia influences the cost of medical treatment of atrioventricular nodal or atrioventricular reciprocating tachycardia.

PURPOSE: Radiofrequency ablation (RFA) is considered the treatment of choice in cases of atrioventricular nodal reciprocating tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). Published studies suggest a considerable time gap between the onset of the arrhythmia, correct diagnosis, and RFA which may reach 10-15 years. The cost of medical treatment during that period may be substantial. The aim of the study was to calculate the annual direct medical cost of medical treatment of patients with AVNRT and AVRT and identify potential factors influencing this cost. METHODS: Based on the consumption of particular resources and the unit costs of services in 2013, we calculated the annual direct medical cost of care for patients with AVNRT and AVRT in Poland. We adopted the public payer's and societal perspectives. Data on health resources was collected with a structured questionnaire and medical records of patients scheduled for RFA. Additional analyses were performed to identify factors influencing this cost. RESULTS: We enrolled 82 patients: mean age 43.9 ± 14.1 years old and mean symptom duration before the RFA 13.0 ± 11.3 years. The median annual cost of medical treatment was 546 USD [312-957], 411 € [278-786], and 616 USD [369-1044], 464 € [235-721], for the public payer and the common perspective, respectively, with hospitalizations being the main cost component. In multivariate analysis, only the age of the patient significantly influenced this cost. CONCLUSIONS: The annual cost of medical treatment of AVNRT or AVRT is substantial and dependent on the age of the patient rather than the severity of the arrhythmia (NCT01594814).

Permanent junctional reciprocating tachycardia in children: a multicenter experience.

BACKGROUND: Permanent junctional reciprocating tachycardia (PJRT) is an uncommon form of supraventricular tachycardia in children. Treatment of this arrhythmia has been considered difficult because of a high medication failure rate and risk of cardiomyopathy. Outcomes in the current era of interventional treatment with catheter ablation have not been published. OBJECTIVE: To describe the presentation and clinical course of PJRT in children. METHODS: This is a retrospective review of 194 pediatric patients with PJRT managed at 11 institutions between January 2000 and December 2010. RESULTS: The median age at diagnosis was 3.2 months, including 110 infants (57%; aged <1 year). PJRT was incessant in 47%. The ratio of RP interval to cycle length was higher with incessant than with nonincessant tachycardia. Tachycardia-induced cardiomyopathy was observed in 18%. Antiarrhythmic medications were used for initial management in 76%, while catheter ablation was used initially in only 10%. Medications achieved complete resolution in 23% with clinical benefit in an additional 47%. Overall, 140 patients underwent 175 catheter ablation procedures with a success rate of 90%. There were complications in 9% with no major complications reported. Patients were followed for a median of 45.1 months. Regardless of treatment modality, normal sinus rhythm was present in 90% at last follow-up. Spontaneous resolution occurred in 12% of the patients. CONCLUSION: PJRT in children is frequently incessant at the time of diagnosis and may be associated with tachycardia-induced cardiomyopathy. Antiarrhythmic medications result in complete control in few patients. Catheter ablation is effective, and serious complications are rare.

Nuestra experiencia con la taquicardia reciprocante permanente de la unión aurículo-ventricular / Experience with junctional atrioventricular reciprocating tachycardia

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Differences in accessory pathway location by sex and race.

BACKGROUND: The etiology of accessory pathway (AP) formation is generally unknown. OBJECTIVE: The purpose of this study was to test the hypothesis that AP formation is genetically mediated by examining whether AP location differs by sex and/or race, using sex and race as proxies to distinguish genetically different individuals. METHODS: This was a single-center, retrospective cohort study of 282 consecutive patients undergoing their first electrophysiology study that revealed at least one AP between 2004 and 2008. Sex and race were compared with AP location determined by invasive electrophysiology study. RESULTS: Eighty-nine (52%) males and 40 (36%) females had a left posterior AP (P = .006). Sixty-four (57%) females had a right annular AP, compared with 55 (32%) males (P <.001). After adjusting for age and race, females had 2.8-fold greater odds of having a right annular AP compared with males (95% confidence interval [CI] 1.70-4.65 greater odds; P <.001). While right anterior (free-wall) pathways were rare in all other races (12%), a significantly larger proportion of Asians (n = 10, 26%) had a right anterior AP (P = .017). After adjusting for sex and age, Asians had 3.8-fold greater odds of having a right anterior AP compared with other races (95% CI 1.5-9.4 greater odds; P = .004). CONCLUSIONS: Females more commonly had right annular APs, and Asians had right anterior APs substantially more frequently than other races. These findings suggest that the pathogenesis of AP formation may have a genetic component.