Çocuklarda retrospektif üç yıllık Holter monitorizyonu deneyimi
Küçük Resim Yok
Tarih
2012
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info:eu-repo/semantics/openAccess
Özet
Amaç: Disritmilerin çoğunlukla aralıklı olarak ortaya çıkması nedeniyle, başvuru sırasında tespit edilmesi mümkün olmayabilir. Bu nedenle Holter monitörizasyonu disritmi tanısında en önemli tanı yöntemlerinden biridir. Yöntemler: Temmuz 2003-Mayıs 2006 yılları arasında pediatrik kardiyoloji bilim dalında Holter monitorizasyon ile değerlendirilen 402 hastaya ait 666 kayıt retrospektif olarak incelendi. Hastaların yaşları 2 gün ile 18 yaş arasında değişmekteydi ( median 1 1 y aş) v e 2 02’si k ız, 200’ü erkek idi. En sık başvuru şikayetleri göğüs ağrısı (%33,6), çarpıntı (%22,9) ve bayılma (%7) idi. Hastaların %1,7’sinde ise standart EKG’de disritmi saptanması nedeniyle Holter incelemesi yapılmıştı. Bulgular: Kayıtların %43,7’sinde disritmi saptandı. Bunlar ventriküler erken vuru (VE) (%80), supraventriküler erken vuru (SVE) (%62,9), gezici atrial pacemaker (%35,2), sinüzal taşikardi (%7,9), sinüzal duraklama (%7,6), 2. derece Mobitz tip 1 (%0,7), 3. derece atriyoventriküler blok (%0,7), supraventriküler taşikardi (%5,5), nodal vurular (%3,8), atrial escape (%2,4), ventriküler taşikardi (%1) ve uzun QT sendromu (%1) idi. Hastaların Ekokardiyografik inceleme yapılanların %61,5’inde herhangi bir pataloji saptanmazken, %28,7’sinde do-ğumsal kalp hastalığı, %7,4’ünde romatizmal kalp hastalığı, %2,8’inde kardiyomiyopati saptandı. Holterde disritmi saptananların 173’üne efor testi yapıldı. Yirmi hastada efor esnasında ventriküler erken vurularda azalma saptandı. Holter monitörizasyonu sonucuna göre 36 hastaya medikal tedavi başlandı. Bir hastaya intrakardiyak elektrofizyolojik çalışma, 4 hastaya intrakardiyak pacemaker implantasyonu yapıldı. Sonuç: Bu çalışmada disritmisi olan vakaların tanı, izlem ve tedavisinin planlanmasında uygulanması kolay ve invazif olmayan Holter monitörizasyonun son derece yararlı olduğu vurgulandı.
Objective: Holter monitoring (HM) is widely used in arrhythmic disorders since they may occur briefly and unpredictably throughout the day. The aim of this study is to evaluate the value of HM in the diagnosis and treatment of dysrhythmia in pediatric patients. Methods: We retrospectively evaluated 666 Holter records of 402 children aged between 2 days to 18 years (median age 11 years) who were followed-up in pediatric cardiology unit between July 2003 and May 2006. Results: The most common presenting symptoms were chest pain(33.6%), palpitation (22.9%) and syncope (7%) and 292(43.8%) out of 666 records showed dysrhythmia. Findings at HM were as follows; ventricular extrasystoles (VE) (44.2%), supraventricular extrasystoles (SVE) (26.7%), wandering atrial pacemaker(34.9%), sinusal tachycardia (7.9%), sinusal pause (7.6%), Mobitz type 1 second degree AV block(0.7%), 3rd degree AV block(0.7%), supraventricular tachycardia (5.5%), nodal (3.8%) and atrial escape beats(2.4%), ventricular tachycardia(1%) and long QT(1%). Only 35 out of the 292 patients with dysrhythmia according to HM had dysrhythmia on cardiac auscultation. Dysrhythmia was determined in only 31 of them with 12-lead ECG whereas 61.5% of the patients had a normal echocardiogram, however 28.7% of them had congenital heart defects, 7.4% had rheumatic heart disease and 2.8% had cardiomyopathy. Medical treatment modalities were started in 36 patients according to the findings at HM. Electrophysiological study was performed for one patient and intarcardiac pacemaker implantation was performed for 4 patients. Conclusions: Herein, we suggest that HM is a reliable and non-invasive diagnostic method for the detection, follow-up and treatment of the patients with dysrhythmia.
Objective: Holter monitoring (HM) is widely used in arrhythmic disorders since they may occur briefly and unpredictably throughout the day. The aim of this study is to evaluate the value of HM in the diagnosis and treatment of dysrhythmia in pediatric patients. Methods: We retrospectively evaluated 666 Holter records of 402 children aged between 2 days to 18 years (median age 11 years) who were followed-up in pediatric cardiology unit between July 2003 and May 2006. Results: The most common presenting symptoms were chest pain(33.6%), palpitation (22.9%) and syncope (7%) and 292(43.8%) out of 666 records showed dysrhythmia. Findings at HM were as follows; ventricular extrasystoles (VE) (44.2%), supraventricular extrasystoles (SVE) (26.7%), wandering atrial pacemaker(34.9%), sinusal tachycardia (7.9%), sinusal pause (7.6%), Mobitz type 1 second degree AV block(0.7%), 3rd degree AV block(0.7%), supraventricular tachycardia (5.5%), nodal (3.8%) and atrial escape beats(2.4%), ventricular tachycardia(1%) and long QT(1%). Only 35 out of the 292 patients with dysrhythmia according to HM had dysrhythmia on cardiac auscultation. Dysrhythmia was determined in only 31 of them with 12-lead ECG whereas 61.5% of the patients had a normal echocardiogram, however 28.7% of them had congenital heart defects, 7.4% had rheumatic heart disease and 2.8% had cardiomyopathy. Medical treatment modalities were started in 36 patients according to the findings at HM. Electrophysiological study was performed for one patient and intarcardiac pacemaker implantation was performed for 4 patients. Conclusions: Herein, we suggest that HM is a reliable and non-invasive diagnostic method for the detection, follow-up and treatment of the patients with dysrhythmia.
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Yeni Tıp Dergisi
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Cilt
29
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2
