TRANSTELEPHONIC ECG VERSUS ELECTROPHYSIOLOGIC STUDY IN CHILDREN WITH RECURRENT PALPITATION ATTACKS

Palpitation may be a terrifying event for children and pose diagnostic problems for pediatric cardiologists. Routine methods often fail to d ocument episodic arrhythmia because the episodes may be biref or infre quent or both. The purpose of this study was to evaluate and compare v alues of non-invasive and invasive techniques. Twenty-three children ( mean age 11.7 +/- 2 years, range 7-16 years) with recurrent palpitatio n attacks (> 2 times), who had normal physical examinations, EGG, echo cardiography 24 hour ambulatory ECG monitoring and treadmill exercise tests, were included in the study. Redline(R) Model CG 4000 TTE record ers were given to patients for 10 or 20 days. We performed an intracar diac electrophysiologic study (EPS) on 14 patients. The mean number of palpitation attacks was 11.3 +/- 7.4 (median: 5), lasting 9.6 +/- 7 ( median 3) minutes. The number of transmitting records was 2 +/- 1.4 (1 -20). Of the 23 patients, only 15 (65%) transmitted during the palpita tion attacks. Twenty-four-hour ambulatory ECG monitoring findings were normal In all patients. One patient had a wide QRS tachycardia attack in the TTE records. We stimulated ventricular tachycardia In the same patient in the EPS. Among the other patients who transmitted TTE reco rds during palpitation attacks, we diagnosed two cases of concealed ac cessory pathway and eight cases of dual AV nodal pathway in the EPS. I n conclusion, TTF is a sensitive and accurate method for diagnosis and follow up of patients with cardiac arrhythmia. It can be used before invasive studies in children with recurrent palpitation attacks.