Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA.
Cardiol Young. 2023 Feb;33(2):255-259. doi: 10.1017/S1047951122000580. Epub 2022 Mar 7.
There is sparse literature on cardiac arrhythmias and the utility of ambulatory rhythm monitoring in patients with postural tachycardia syndrome and orthostatic intolerance. This study's primary aim was to investigate the prevalence of arrhythmias in this population. Knowing the prevalence and types of arrhythmias in dysautonomia patients could influence the decision to pursue ambulatory rhythm monitoring and ultimately guide therapy.
This retrospective descriptive study examined the frequency of cardiac arrhythmias, as detected by ambulatory rhythm monitoring, in children with postural tachycardia syndrome/orthostatic intolerance or syncope who were seen at the Children's National Hospital Electrophysiology Clinic between January 2001 and December 2020.
In postural tachycardia syndrome/orthostatic intolerance patients, arrhythmia was detected on 15% of 332 ambulatory rhythm monitors. In syncope patients, arrhythmia was detected on 16% of 157 ambulatory rhythm monitors, not significantly different from the postural tachycardia syndrome/orthostatic intolerance group. The difference in rate of arrhythmia detection between 24-hour Holter and 2-week Zio® monitoring was not statistically significant.
This study suggests that a substantial proportion of postural tachycardia syndrome/orthostatic intolerance patients may have concomitant underlying cardiac arrhythmias, at a frequency similar to what is seen in patients undergoing primary evaluation for cardiac symptoms such as chest pain, palpitations, and syncope. In the appropriate clinical context, physicians caring for postural tachycardia syndrome/orthostatic intolerance patients should consider additional evaluation for arrhythmias beyond sinus tachycardia.
有关体位性心动过速综合征（postural tachycardia syndrome，POTS）和直立不耐受患者的心律失常以及动态心电图监测在这些患者中的应用价值的文献很少。本研究的主要目的是调查该人群心律失常的发生率。了解自主神经功能障碍患者心律失常的发生率和类型可能会影响进行动态心电图监测的决策，并最终指导治疗。
本回顾性描述性研究分析了 2001 年 1 月至 2020 年 12 月在儿童国家医院电生理诊所就诊的 POTS/直立不耐受或晕厥患者的动态心电图监测中发现的心律失常的频率。这些患者均接受了动态心电图监测。
在 POTS/直立不耐受患者中，332 份动态心电图监测中有 15%检测到心律失常。在晕厥患者中，157 份动态心电图监测中有 16%检测到心律失常，与 POTS/直立不耐受组无显著差异。24 小时 Holter 监测与 2 周 Zio®监测的心律失常检出率差异无统计学意义。
本研究表明，相当一部分 POTS/直立不耐受患者可能同时存在潜在的心脏心律失常，其频率与因胸痛、心悸和晕厥等心脏症状而接受主要评估的患者相似。在适当的临床情况下，治疗 POTS/直立不耐受患者的医生应考虑对窦性心动过速以外的心律失常进行额外评估。
