Çocukluk Çağı Supravetriküler Taşikardilerinde Holter, "Event Recorder" ve Transözofageal Elektrofizyolojik Çalışma Yöntemlerinin Karşılaştırılması

Abstract

Supraventricular tachycardia (SVT) is a common rhythm problem in childhood and usually temporary even without ECG findings. Patients with a preliminary diagnosis of SVT is investigated in two groups. Group 1 (40 patients) was evaluated with Holter, event recorder and transesophageal electrophysiologic study (TEEPS) and group 2 (95 patients) was evaluated with Holter and TEEPS. All patients in group 1 underwent Holter monitoring. TEEPS was applied to half of patients after event recorder. Event recorder was applied to rest of the patients after TEEPS. Results of the first half of patients who underwent event recorder and then TEEPS showed 4 supraventricular extrasystoles (SVE) and 2 ventricular extrasystoles (VES) on Holter monitoring. Event recorder showed 13 arrhythmia and/or tachycardia (1 SVT, 1 atrial tachycardia(AT), 1 Wolff-Parkinson-White(WPW), 1 ventricular tachycardia(VT), 1 SVE and 8 sinus tachycardia (ST)). Of the 8 patients who were found to have sinüs tachycardia from results of event recorder, two of them had SVE and one of them had VES on Holter monitoring. Event recorder result of one patient was VT instead of VES which showed up with Holter monitoring. Holter monitoring and event recorder result of one patient was the same (SVE). Two of eight patients TEEPS results were atrioventricular nodal reentrant tachycardia (AVNRT) which were ST on event recorder. Event recorder results were normal in 7 patients. In these patients one of them had AVNRT and another one had AVRT on TEEPS. Event recorder and TEEPS results were the same in two patients (VT,WPW). TEEPS results were normal in 3 patients which had SVT, AT and SVE on event recorder. Six patients were diagnosed SVT with TEEPS and successfully ablated. Results of second half of patients who underwent TEEPS and then event recorder showed 2 SVE and 1 VES on Holter monitoring. Only one of 20 patients had AVNRT with TEEPS. Tachycardia wasn't induced in the rest of 19 patients. TEEPS results were normal in 3 patients which were abnormal (arrhythmia) on Holter monitoring. Of 19 patients who were found to have normal TEEPS, 10 of them had ST and 1 of them had SVT on event recorder. Two patients were diagnosed SVT with event recorder and TEEPS, and were successfully ablated. In the second group, Holter monitoring results were normal in 52 patients and displayed arrhythmia in 43 (18 SVT, 10 SVE, 7 WPW, 6 VES, 2 VES+SVE) patients. SVT was induced with TEEPS in all 95 patients. Sixty of 95 patients who were diagnosed SVT were applied intracardiac electrophysiology study (EPS) then ablation. In our study, we observed TEEPS is more valuable than Holter and event recorder in the diagnosis of SVT. Event recorder may be applied to patients before invasive prosedures when TEEPS results are normal in case of continued symptoms of patients.