Division of Pediatric Cardiology, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY.
Division of Pediatric Cardiology, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY.
J Pediatr. 2018 Feb;193:109-113. doi: 10.1016/j.jpeds.2017.10.014. Epub 2017 Dec 1.
We hypothesize that routine daily transtelephonic monitoring (TTM) transmissions can accurately detect supraventricular tachycardia (SVT) in asymptomatic infants and/or assuage parental concerns rather than being used solely to diagnose arrhythmias.
Single center, retrospective chart review of 60 patients with fetal or infant SVT prescribed TTM for at least 30 days, January 2010-September 2016. Patients were excluded if initial SVT was not documented, was perioperative, was atrial flutter/fibrillation, or chaotic atrial tachycardia. Categorical variables expressed as mean ± SD. Mann-Whitney, Spearman correlation, and Fisher exact tests were used for continuous and categorical variables respectively.
Sixty patients were included. There were 2688 TTM transmissions received from 55 of 60 patients over 61.1 ± 66.7 days (0.73 ± 0.65 TTM/patient/days). Routine asymptomatic TTM transmissions revealed actionable findings in 5 of 2801 TTM transmissions sent by 5 patients (8.3%). No patient presented in shock or died. Forty-five of 2688 TTM transmissions were sent for parental concerns/symptoms in 16 patients (25.8%) with findings of normal sinus rhythm in 37 of 45 TTM transmissions and SVT in 8 of 45 TTM transmissions. Symptomatic actionable findings were more likely sent by patients discharged on class I or III antiarrhythmics (95% CI = 11.5%-68.3%, P = .004) and patients with prolonged initial hospitalizations (95% CI = 6.98%-59.7%, P = .01). Flecainide was discontinued in 1 patient after widened QRS was noted on routine TTM.
TTM accurately diagnose asymptomatic recurrent SVT in neonates and infants before they develop signs of congestive heart failure or shock and is helpful for recurrent SVT management.
我们假设常规每日远程电话监测（TTM）传输可以准确检测无症状婴儿的室上性心动过速（SVT），并减轻父母的担忧，而不仅仅是用于诊断心律失常。
对 2010 年 1 月至 2016 年 9 月期间因胎儿或婴儿 SVT 而接受至少 30 天 TTM 治疗的 60 例患者进行单中心回顾性图表审查。如果最初的 SVT 未记录、是围手术期、是心房扑动/颤动或混乱性房性心动过速，则将患者排除在外。分类变量表示为平均值±标准差。连续变量和分类变量分别采用曼-惠特尼、斯皮尔曼相关和 Fisher 确切检验。
共纳入 60 例患者。55 例患者中有 60 例患者共收到 2688 次 TTM 传输，时间为 61.1±66.7 天（0.73±0.65 TTM/患者/天）。常规无症状 TTM 传输显示，在 5 名患者发送的 2801 次 TTM 传输中有 5 次（8.3%）发现有治疗价值的发现。没有患者出现休克或死亡。2688 次 TTM 传输中有 45 次是因父母担忧/症状而发送的，涉及 16 名患者，其中 37 次 TTM 传输显示窦性节律正常，45 次 TTM 传输显示 SVT。有症状的治疗价值发现更可能由出院时服用 I 类或 III 类抗心律失常药物的患者（95%CI=11.5%-68.3%，P=0.004）和初始住院时间延长的患者（95%CI=6.98%-59.7%，P=0.01）发送。1 例患者因常规 TTM 发现 QRS 波增宽而停用氟卡尼。
TTM 可准确诊断新生儿和婴儿无症状性复发性 SVT，在出现充血性心力衰竭或休克迹象之前，并有助于复发性 SVT 管理。
