RESUMEN

OBJECTIVES: To assess whether right atrial enlargement (RAE) on electrocardiogram (ECG) correlates with true RAE on echocardiogram in previously healthy young patients and to understand which patients with RAE on ECG may warrant additional testing. STUDY DESIGN: A single-center, retrospective review of previously healthy young patients with (1) ECGs that were read as RAE by a pediatric cardiologist and (2) echocardiograms obtained within 90 days of the ECG. ECGs were reviewed to confirm RAE and determine which leads met criteria. The echocardiograms were then reviewed and RA measurements with z scores obtained. A z score >2 was considered positive for RAE on echocardiogram. RESULTS: In total, 162 patients with median age 10.8 years were included in the study. A total of 23 patients had true RAE on echocardiogram, giving a positive predictive value (PPV) of 14%. In patients <1 year of age, the PPV increased to 35%. In patients older than 1 year, the PPV was low at 7%. Patients with true RAE were more likely to meet criteria for RAE in the anterior precordial leads (V1-V3) (48% vs 5%, P < .001) and meet criteria for right ventricular hypertrophy (22% vs 6%, P = .023). CONCLUSION: Our findings show that RAE on ECG has a low PPV for RAE on echocardiogram in previously healthy young patients. The highest yield for RAE on echocardiogram was observed in patients who were <1 year of age, had RAE in the anterior precordial leads, or displayed right ventricular hypertrophy on ECG.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVE: To characterize the management of acute pediatric supraventricular tachycardia (SVT), placing special emphasis on infants, patients refractory to adenosine (refractory SVT), and patients with hypotension, poor perfusion, or altered mental status (unstable SVT). STUDY DESIGN: Retrospective cohort study of patients 0-18 years of age without congenital heart disease who presented to our pediatric hospital from January 2003 to December 2012 for the treatment of acute SVT. Multiple logistic regression was applied to identify whether age was a risk factor for different SVT therapies. Model fit and residuals also were examined. RESULTS: We identified 179 episodes for SVT. First dose of adenosine was effective in 72 (56%) episodes, and a second dose was effective in 27 of 54 (50%) episodes, leaving 27 (15%) episodes with refractory SVT. The response to the first dose of adenosine increased proportionally with age (OR 1.13, 95% CI 1.05-1.2). Only 1 of 17 episodes in infants responded to the first dose of adenosine. Refractory SVT was more frequent in infants vs older children (χ2 = 5.9 [1 df], P = .01). Unstable SVT was present in 13 episodes and was treated with adenosine and antiarrhythmics. Synchronized cardioversion was performed on 3 patients, 2 patients with unstable SVT, and 1 with refractory SVT. CONCLUSION: In children with SVT, young age is associated with decreased response to the first dose of adenosine and increased odds of adenosine-refractory SVT. In the treatment of unstable SVT, medical management with various antiarrhythmics before cardioversion may have a role in a subset of patients. Synchronized cardioversion rarely is performed for acute SVT.

Asunto(s)

RESUMEN

OBJECTIVE: To describe the presentation and clinical course of patients with ventricular ectopy (VE) without known heart disease seen at a single institution. STUDY DESIGN: Patients with VE were identified from the cardiology database. Patients with known hemodynamically significant heart disease or systemic diseases were excluded. RESULTS: A total of 219 patients constitute the study population, with 59% male and median age of diagnosis 11.3 years. A total of 138 patients had follow-up data. Median duration of follow-up was 3.1 years (n = 138, range 0-21 years) for a total of 587 patient-years. Simple VE was found in 83%, and 17% had ventricular tachycardia. Most patients were asymptomatic at presentation (77%) At presentation, echocardiograms were performed in 164 patients, with 98% normal. Of the 36 patients with sequential echocardiograms, 32 (88%) remained normal, 3 (9%) had abnormal echocardiograms which normalized, and 1 (3%) had progressive left ventricular dysfunction. On sequential Holter data (n = 48), 54% showed stable or decreased VE, 40% showed resolution, and 6% showed worsening. No cases of death or resuscitated sudden death occurred. CONCLUSIONS: Most patients were asymptomatic. There were rare cases of progression of VE and development of left ventricular dysfunction but the majority had stable findings. No deaths occurred.

Asunto(s)

RESUMEN

OBJECTIVES: To use smartphone applications (apps) to measure heart rates during supraventricular tachycardia (SVT) in pediatric patients and compare them with heart rates measured by standard electrocardiogram (ECG). STUDY DESIGN: Patients <18 years of age (n = 26) undergoing an electrophysiology study were enrolled. During the study, heart rates were measured at baseline and during SVT by the use of 2 smartphone apps. The obtained heart rates were compared with a simultaneous standard ECG. Pearson correlation coefficient (r) was used to compare the accuracy of the apps with ECG. RESULTS: At baseline, 33 heart rates were obtained with apps and all were within ±4 beats per minute (bpm) of the ECG heart rate. During SVT, 38 heart rate measurements were attempted during 21 SVT events in 18 patients. App 1 failed to provide a measured heart rate in 11 of 21 attempts. The 10 heart rates obtained had an r of 0.56. When tachycardia rates were <210 bpm, accuracy increased (r = 0.86) and when tachycardia rates were <200 bpm, the accuracy increased further (r = 0.99). App 2 failed to provide a measured heart rate in 12 of 17 attempts. The 5 heart rates obtained had an r of -0.43. CONCLUSIONS: During tachycardia, neither of the 2 apps consistently determined an accurate heart rate at rates >200 bpm. The apps tested should not be considered an accurate tool for assessment of heart rates during SVT in pediatric patients. Select apps may have utility detecting slower SVT or confirming normal heart rates with further validation.

Asunto(s)