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Koca S, Pac FA, Mihcioglu A, Eris D, Cay S, Ozeke O. Heart rate variability parameters in children with ventricular preexcitation. J Cardiovasc Electrophysiol 2018; 29:1135-1142. [PMID: 29676835 DOI: 10.1111/jce.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The autonomic nervous system has a regulatory effect on cardiac electrophysiology and arrhythmogenesis. We aimed to assess cardiac autonomic status using heart rate variability (HRV) parameters in children with ventricular preexcitation. METHODS The electrocardiography, Holter monitoring, transesophageal electrophysiological study (TEEPS), and invasive electrophysiological study (EPS) results of ventricular preexcitation patients obtained over a 7-year period in our clinic were evaluated. According to the TEEPS results, patients' accessory pathway conduction was classified as adverse (n = 40) or nonadverse (n = 25). The HRV parameters of patients were compared according to tachycardia inducibility that assessed by TEEPS and EPS. Also, HRV parameters were compared in patients with adverse and nonadverse pathway conduction. Further, the HRV parameters of preexcitation patients were compared with those of healthy controls. RESULTS LF/HF, the best measure of sympathovagal balance, was statistically higher in patients with adverse conduction than in patients without adverse conduction and controls (P = 0.001). The LF/HF ratio was higher in ventricular preexcitation patients with inducible tachycardia than those without in EPS (P = 0.001). In addition, the LF/HF ratio was higher in symptomatic ventricular preexcitation patients than asymptomatic ones (P = 0.001). No difference in HRV parameters was found between preexcitation patients and controls. CONCLUSION Autonomic tonus in patients with ventricular preexcitation may affect accessory pathway conduction properties, tachycardia inducibility, and symptomology. The indicator of sympathovagal balance, LF/HF ratio, increased in ventricular preexcitation patients with inducible tachycardia and those that were symptomatic.
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Affiliation(s)
- Serhat Koca
- Department of Pediatric Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Feyza Aysenur Pac
- Department of Pediatric Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Ajda Mihcioglu
- Department of Pediatric Cardiology, Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Deniz Eris
- Department of Pediatric Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Serkan Cay
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
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Moran B, Bryan S, Farrar T, Salud C, Visser G, Decuba R, Renelus D, Buckley T, Dressing M, Peterkin N, Coris E. Diagnostic Evaluation of Nontraumatic Chest Pain in Athletes. Curr Sports Med Rep 2017; 16:84-94. [PMID: 28282354 DOI: 10.1249/jsr.0000000000000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes. Cross-referencing published articles from the databases searched discovered additional articles. No dissertations, theses, or meeting proceedings were reviewed. The authors discuss the scope of this complex problem and the diagnostic dilemma chest pain in athletes can provide. Next, the authors delve into the vast differential and attempt to simplify this process for the sports medicine physician by dividing potential etiologies into cardiac and noncardiac conditions. Life-threatening causes of chest pain in athletes may be cardiac or noncardiac in origin, which highlights the need for the sports medicine physician to consider pathology in multiple organ systems simultaneously. This article emphasizes the importance of ruling out immediately life threatening diagnoses, while acknowledging the most common causes of noncardiac chest pain in young athletes are benign. The authors propose a practical algorithm the sports medicine physician can use as a guide for the assessment and diagnostic work-up of the athlete with chest pain designed to help the physician arrive at the correct diagnosis in a clinically efficient and cost-effective manner.
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Affiliation(s)
- Byron Moran
- 1Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; 2Department of Orthopedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; 3The University of South Carolina School of Medicine, Greenville, SC; 4Primary Care Sports Medicine Fellowship, University of South Florida-Morton Plant Mease, Clearwater, FL; 5Baycare Medical Group Primary Care, St. Petersburg, FL; 6Premiere Med Family and Sports Medicine, Ocoee, FL; 7Family Medicine Residency Program, University of South Florida-Morton Plant Mease, Clearwater, FL; 8Bayfront Primary Care Sports Medicine Fellowship, St. Petersburg, FL; 9Morsani College of Medicine, University of South Florida, Tampa, FL; 10Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL; and 11Baptist Primary Care, Jacksonville, FL; and 12Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
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Koca S, Pac FA, Kavurt AV, Cay S, Mihcioglu A, Aras D, Topaloglu S. Transesophageal and invasive electrophysiologic evaluation in children with Wolff-Parkinson-White pattern. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:808-814. [PMID: 28436586 DOI: 10.1111/pace.13100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/16/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Risk stratification for Wolff-Parkinson-White (WPW) pattern either by noninvasive or invasive tests is important to determine whether an ablation is necessary or not. The aim was to compare noninvasive tests and invasive studies in a pediatric WPW population. METHODS A total of 71 WPW patients (median age 14 years [interquartile range, 11-16 years]; 43 male) underwent Holter monitoring, exercise stress test (EST), and transesophageal electrophysiological study (TEEPS). In the case of a ≤270-ms effective refractory period of accessory pathway or induction of supraventricular tachycardia using TEEPS, patients were classified as high risk and underwent invasive electrophysiological study (EPS). RESULTS Nine of 23 patients with low risk by Holter and eight of 26 patients with low risk by EST had high risk in TEEPS. Risky TEEPS results were detected in 42 of 71 patients and those patients underwent EPS. High-risk characteristic in EPS was detected in seven of nine patients with low risk by Holter and in seven of eight with low risk by EST. Both tests yielded moderate specificity (52-69%) and negative predictive value (61-69%) according to TEEPS. CONCLUSION Holter and EST have low predictive value in WPW risk stratification. However, TEEPS and EPS are extremely valuable in WPW risk stratification. TEEPS may reveal important and useful results for WPW risk determination, especially in small children not having undergone EPS in order to avoid its complications.
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Affiliation(s)
- Serhat Koca
- Department of Pediatric Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Feyza Aysenur Pac
- Department of Pediatric Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Ahmet Vedat Kavurt
- Department of Pediatric Cardiology, Diyarbakir Children Hospital, Diyarbakir, Turkey
| | - Serkan Cay
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Ajda Mihcioglu
- Department of Pediatric Cardiology, Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Dursun Aras
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
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WACKEL PHILIP, IRVING CLAIRE, WEBBER STEVEN, BEERMAN LEE, ARORA GAURAV. Risk Stratification in Wolff-Parkinson-White Syndrome: The Correlation Between Noninvasive and Invasive Testing in Pediatric Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1451-7. [DOI: 10.1111/j.1540-8159.2012.03518.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Dilip R Patel
- Address: Kalamazoo Center for Medical Studies, 1000 Oakland Drive Kalamazoo Michigan 49008, USA E-mail:
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Abstract
A preparticipation cardiovascular screening is recommended for all athletes with the aim of identifying conditions that increase the risk for adverse cardiac event, including sudden death. History and physical examination are the mainstay of cardiovascular screening of young athletes. The ability to identify athletes at risk, however, based on history and physical examination alone is low, and inclusion of an electrocardiogram as a screening tool has been suggested to improve the sensitivity of screening. This article provides an overview of key aspects of cardiovascular screening currently recommended in the United States for young athletes.
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Affiliation(s)
- Saad Siddiqui
- Pediatric Cardiology, Hope Children's Hospital, Oak Lawn, IL, USA.
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Vetter VL, Elia J, Erickson C, Berger S, Blum N, Uzark K, Webb CL. Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder [corrected]: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing. Circulation 2008; 117:2407-23. [PMID: 18427125 DOI: 10.1161/circulationaha.107.189473] [Citation(s) in RCA: 229] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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van den Berg J, de Bie S, Meijboom FJ, Hop WC, Pattynama PMT, Bogers AJJC, Helbing WA. Changes during exercise of ECG intervals related to increased risk for ventricular arrhythmia in repaired tetralogy of Fallot and their relationship to right ventricular size and function. Int J Cardiol 2008; 124:332-8. [PMID: 17433470 DOI: 10.1016/j.ijcard.2007.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 12/20/2006] [Accepted: 02/16/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE Our study aimed to assess pro-arrhythmogenic electrocardiographic changes during maximal physical exercise in patients operated for Tetralogy of Fallot (TOF). METHODS TOF patients prospectively underwent: 1) bicycle ergometry, 2) cardiac MRI, and 3) 24-hour Holter. ECG data was analyzed at rest, at 60% of peak exercise and at peak exercise. R-R duration, QRS-, QT- and JT-duration and dispersions were assessed. Changes of ECG parameters during exercise were calculated and correlated to RV volume, RVEF, RV wall-mass, PR-percentage and VO(2max). Exercise ECG data from healthy controls were used as reference. RESULTS Thirty-one patients (mean age at repair (SD) 0.8 (0.5) years, age at study 16 (5) years) and 25 controls (age 12 (2) years) were included. With exercise mean QTc and JTc dispersions increased in patients (p<0.001), but not in controls. At peak exercise JTc dispersion was larger in patients (p<0.01). QTc did not change with exercise in patients (p=0.14) and decreased in controls (p<0.05). At all levels of exercise mean QTc, QRS and QRS dispersion were larger in patients (all p<0.001). Significant associations were found for; 1) a larger increase of JTc dispersion with a higher PR-percentage, a larger RV volume, a larger RV wall-mass, 2) a larger QTc increase with a larger RV volume and worse RVEF. CONCLUSION During physical exercise inhomogeneity of repolarisation, known to predispose for re-entry ventricular arrhythmia, increases in repaired TOF. Larger inhomogeneity is found with more severe PR.
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Affiliation(s)
- Jochem van den Berg
- Department of Paediatric Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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Abstract
The dynamic interaction between the heart and lungs leads to a degree of respiratory co-morbidity including both restrictive and obstructive airway abnormalities, which may be overlooked in children with congenital and acquired heart disease. The improving imaging techniques of the heart, both foetal and post-natal coupled with minimally invasive techniques for device implantation and better operative techniques for complex congenital heart disease have resulted in more children with longitudinally documented structural heart disease surviving into their adult years. Children presenting with cardiomyopathy or arrhythmias, as well as those with repaired cardiac disease, can be offered advice with regard to formal exercise testing and participation in sports, which may be particularly helpful in the adolescent years. Furthermore, through the interest of some adult cardiologists in paediatric heart disease over the past 20 years, facilities for the smooth transition of care to adult services are improving.
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