Çocukluk çağında çarpıntı yakınması ile başvuranlarda ritim holter monitorizasyon sonuçlarının değerlendirilmesi
Abstract
Amaç:
Çalışmamızda çarpıntı yakınmasıyla başvuran
çocuk hastalarda 24 saatlik ritim holter monitarizasyon (HM) endikasyonları
gözden geçirilmiş, holterde görülen ritim bozukluklarının tür ve sıklığının
saptanması, holterin tanı ve tedavideki yeri vurgulanmak istenmiştir.
Gereç
ve Yöntemler: Ocak 2016-Ocak 2018 tarihleri arasında kliniğimize çarpıntı
yakınması ile başvuran, 4-17 yaş arası (ortalama yaş 13.1 ± 3.4) 364 hastanın 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 disritmik
semptomları devam edenler hastalar oluşturmakta idi. Hastaların %56.9’unda
(n=206) izole çarpıntı ve %43.4’ünde (n=158) çarpıntıya eşlik eden yakınmalar;
bunlar içinde de en sık göğüs ağrısı (%24.2) ve senkop (%10.4)
kaydedildi. Hem EKG’de hem de HM’da
aritmi olan hastalarda (%36.1), EKG’si normal olup HM’da aritmi olan hastalara
(%15.5) göre ciddi disritmi saptanma oranı anlamlı yüksek saptandı (p=0.023). Holterde
en sık saptanan disritmiler %10.1 (n=37) ile supraventriküler ekstrasistol (SVE)
ve %9 (n=33) ile ventriküler ekstrasistol (VES) idi. Bu iki ritim bozukluğunun
birlikte görülme oranı ise %2.4 (n=9) bulundu. Yaş
gruplarına göre holterde ≤10 yaş SVE sıklığı %3, VES sıklığı
%1.4 iken, ≥11 yaş bu oranlar sırasıyla %7.1 ve %7.7 idi. Yaş gruplarına göre HM’nda
disritmi dağılımında istatiksel anlamlı fark saptanmadı (p>0.05).
Sonuç:
Çalışmamızda hastaların yaklaşık üçte birinde disritmi saptanmış ve bunların
da %7.1’inde (n=26) ciddi disritmiler
olduğu belirlenmiştir. Anormal EKG’nin holter kaydının tanıya katkısını arttırdığı saptanmıştır. Ayrıca EKG’si normal
olan hastalarımızda da holterde disritmi kaydedilmesi ritim
bozukluklarının saptanmasında EKG’nin yetersiz kalabildiğini ve HM’nun özellikle
pediatrik yaş grubunda yararlı bir tanı aracı olabileceğini düşünmekteyiz.
References
- 1. Kılıç Z, Karataş Z, Uçar B. Çocuklarda Retrospektif Üç Yıllık Holter Monitorizyonu Deneyimi. Yeni Tıp Dergisi 2012;29:95-99.2. Yiğit F. Ambulatuar Elektrokardiyografik Kayıt. 2007; 5(2): 109-1233. Hallıoğlu O, Giray D, Karpuz D, Özyurt A. Çarpıntı, göğüs ağrısı ve senkop yakınmalı çocuklarda holter monitorizasyon sonuçları: Sekiz yıllık deneyim. Mersin Üniversitesi Sağlık Bilimleri Dergisi 2017;10:82-87.4. Genç Ş. 24 Saatlik Holter EKG Monitorizasyonu Sonuçlarının Retrospektif Kesitsel Değerlendirilmesi, Uzmanlık Tezi. Antalya:2003 5. Harrison DC, Fitzgerald JW, Winkle RA. Ambulatory electrocardiography for diagnosis and treatment of cardiac arrhytmias. N Eng J Med 1976; 294: 373-80.6. Hegazy RA, Ltfy WN. The value of holter monitoring in the assessment of pediatric patients. Indian Pacing Electrophysiol J 2007;7:204-2147. ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias*—Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias), Circulation 2003 Oct 14;108:1871-9098. Badri Paudel and Klara Paudel. The Diagnostic Significance of the Holter Monitoring in the Evaluation of Palpitation. Journal of Clinical and Diagnostic Research. 2013; Vol-7(3): 480-4839. Wu J, Kessler DK, Chakko S, Kessler KM. A cost-effectiveness strategy for transtelephonic arrhythmia monitoring. Am J Cardio 1995;75:184-5.10. Kapoor WN, Hammill SC, Gersh BJ. Diagnosis and natural history of syncope and the role of invasive electrophysiologic testing. Am J Cardiol 1989;15:63:730-734.11. Kennedy HL. The history, science and innovation of Holter technology. Ann Noninvasive Electrocardiol. 2006; 11:85-94.12. Güven H, Levent E, Özyürek AR, Büyükinan M, Aydoğdu A, Parlar A. Çocuklarda 2 Yıllık Holter Monitörizasyon Deneyimi, Ege Tıp Dergisi 2002;41: 15 – 20.13. Ayabakan C, Ozer S, Celiker A, Ozme S. Analysis of 2017 Holter records in pediatric patients. Turk J Pediatr. 2000; 4: 286-93.14. Morita H, Wu J, Zipes DP. The QT syndromes: long and short. Lancet 2008; 372: 750- 63.15. Crawford MH, Bernstein SJ, Deedwania PC et al. ACC/AHA guidelines for ambulatory electrocardiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography), Circulation. 1999; 24:886-93.16. Steinberg L, Knilans T: Costs and Utility of tests in the evaluation of the pediatric patients with syncope. Prog Pediatr Cardiol 2001; 13: 139-49.17. Lown B. Cardiovascular collapse and sudden cardiac death. In: Braunwald E, ed. Heart Disease. A Textbook of Cardiovascular Medicine. Philadelphia: Saunders; 1984. p.2.18. O’Laughlin MP. Syncope in Pediatric Arrhythmias. Garson A, Gilette CP, eds. Electrophysiology and Pacing. 1nd ed. Philadelphia: WB. Saunders, Co. 1990. p. 600-16.19. Geggel RL. Conditions leading to pediatric cardiology concultatiton in a tertiary academic hospital. Pediatrics 2004;114: E409-E417 (2004)20. Lawrence PR, Delaney AE.: Chest pain in children and adolescents: most causes are benign.Adv Nurse Pract. 2004;12:61-66.21. CJ. Premature atrial contractions and atrial tachyarrhythmias. In: Garson A Jr, Gillette PC, eds. Pediatric arrhythmias: electrophysiology and pacing. WB Saunders 1990; 328-59.22. J, Luis J, Mota P, Anjos R, Meneses I, Bonhorst D, et al. Holter electrocardiography en pediatric cardiology: preliminary experience. Rev Port Cardiol 1996;15:27-33. 23. Fleg JL, Kennedy HL. Long-term prognostic significance of ambulatory electrocardiographic findings in apparently healthy subjects greater than or equal to 60 years of age. Am J Cardiol 1992;70:748-751. 24. Baker RL, Koelling TM: Prognostic value of ambulatory electrocardiography monitoring in patients with dilated cardiomyopathy. J Electrocardiol 2005;38:64-8.25. Levy AM, Camm AJ, Keane JF. Multiple arrhythmias detected during nocturnal monitoring in patients with congenital complete heart block. Circulation 1977;55:247-253. 26. Krahn AD, Klein GJ, Norris C, Yee R. The etiology of syncope in patients with negative tilt table and electrophysiological testing. Circulation 1995;92:1819-2427. Beder S, Cohen M, Riemenschineder T. Occult arrhythmias as the etiology of unexplained syncope in children with structurally normal hearts. Am Heart J 1985; 109: 309-13.
Abstract
References
- 1. Kılıç Z, Karataş Z, Uçar B. Çocuklarda Retrospektif Üç Yıllık Holter Monitorizyonu Deneyimi. Yeni Tıp Dergisi 2012;29:95-99.2. Yiğit F. Ambulatuar Elektrokardiyografik Kayıt. 2007; 5(2): 109-1233. Hallıoğlu O, Giray D, Karpuz D, Özyurt A. Çarpıntı, göğüs ağrısı ve senkop yakınmalı çocuklarda holter monitorizasyon sonuçları: Sekiz yıllık deneyim. Mersin Üniversitesi Sağlık Bilimleri Dergisi 2017;10:82-87.4. Genç Ş. 24 Saatlik Holter EKG Monitorizasyonu Sonuçlarının Retrospektif Kesitsel Değerlendirilmesi, Uzmanlık Tezi. Antalya:2003 5. Harrison DC, Fitzgerald JW, Winkle RA. Ambulatory electrocardiography for diagnosis and treatment of cardiac arrhytmias. N Eng J Med 1976; 294: 373-80.6. Hegazy RA, Ltfy WN. The value of holter monitoring in the assessment of pediatric patients. Indian Pacing Electrophysiol J 2007;7:204-2147. ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias*—Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias), Circulation 2003 Oct 14;108:1871-9098. Badri Paudel and Klara Paudel. The Diagnostic Significance of the Holter Monitoring in the Evaluation of Palpitation. Journal of Clinical and Diagnostic Research. 2013; Vol-7(3): 480-4839. Wu J, Kessler DK, Chakko S, Kessler KM. A cost-effectiveness strategy for transtelephonic arrhythmia monitoring. Am J Cardio 1995;75:184-5.10. Kapoor WN, Hammill SC, Gersh BJ. Diagnosis and natural history of syncope and the role of invasive electrophysiologic testing. Am J Cardiol 1989;15:63:730-734.11. Kennedy HL. The history, science and innovation of Holter technology. Ann Noninvasive Electrocardiol. 2006; 11:85-94.12. Güven H, Levent E, Özyürek AR, Büyükinan M, Aydoğdu A, Parlar A. Çocuklarda 2 Yıllık Holter Monitörizasyon Deneyimi, Ege Tıp Dergisi 2002;41: 15 – 20.13. Ayabakan C, Ozer S, Celiker A, Ozme S. Analysis of 2017 Holter records in pediatric patients. Turk J Pediatr. 2000; 4: 286-93.14. Morita H, Wu J, Zipes DP. The QT syndromes: long and short. Lancet 2008; 372: 750- 63.15. Crawford MH, Bernstein SJ, Deedwania PC et al. ACC/AHA guidelines for ambulatory electrocardiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography), Circulation. 1999; 24:886-93.16. Steinberg L, Knilans T: Costs and Utility of tests in the evaluation of the pediatric patients with syncope. Prog Pediatr Cardiol 2001; 13: 139-49.17. Lown B. Cardiovascular collapse and sudden cardiac death. In: Braunwald E, ed. Heart Disease. A Textbook of Cardiovascular Medicine. Philadelphia: Saunders; 1984. p.2.18. O’Laughlin MP. Syncope in Pediatric Arrhythmias. Garson A, Gilette CP, eds. Electrophysiology and Pacing. 1nd ed. Philadelphia: WB. Saunders, Co. 1990. p. 600-16.19. Geggel RL. Conditions leading to pediatric cardiology concultatiton in a tertiary academic hospital. Pediatrics 2004;114: E409-E417 (2004)20. Lawrence PR, Delaney AE.: Chest pain in children and adolescents: most causes are benign.Adv Nurse Pract. 2004;12:61-66.21. CJ. Premature atrial contractions and atrial tachyarrhythmias. In: Garson A Jr, Gillette PC, eds. Pediatric arrhythmias: electrophysiology and pacing. WB Saunders 1990; 328-59.22. J, Luis J, Mota P, Anjos R, Meneses I, Bonhorst D, et al. Holter electrocardiography en pediatric cardiology: preliminary experience. Rev Port Cardiol 1996;15:27-33. 23. Fleg JL, Kennedy HL. Long-term prognostic significance of ambulatory electrocardiographic findings in apparently healthy subjects greater than or equal to 60 years of age. Am J Cardiol 1992;70:748-751. 24. Baker RL, Koelling TM: Prognostic value of ambulatory electrocardiography monitoring in patients with dilated cardiomyopathy. J Electrocardiol 2005;38:64-8.25. Levy AM, Camm AJ, Keane JF. Multiple arrhythmias detected during nocturnal monitoring in patients with congenital complete heart block. Circulation 1977;55:247-253. 26. Krahn AD, Klein GJ, Norris C, Yee R. The etiology of syncope in patients with negative tilt table and electrophysiological testing. Circulation 1995;92:1819-2427. Beder S, Cohen M, Riemenschineder T. Occult arrhythmias as the etiology of unexplained syncope in children with structurally normal hearts. Am Heart J 1985; 109: 309-13.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | ORIGINAL ARTICLES |
| Authors | |
| Publication Date | June 26, 2020 |
| Submission Date | February 8, 2019 |
| Published in Issue | Year 2020 Volume: 14 Issue: 4 |
Cited By
Çarpıntı, Göğüs Ağrısı ve Senkop Yakınması Olan Çocukların Holter Kayıtları: Tek Merkez Deneyimi
Turkish Journal of Pediatric Disease
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