Singla Mohit, Tyrrell Pascal N, Khural Manveer, Gross Gil J
Congenital Cardiology Clinic, Brampton, Ontario, Canada.
Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada.
CJC Pediatr Congenit Heart Dis. 2023 Nov 10;3(2):74-78. doi: 10.1016/j.cjcpc.2023.10.013. eCollection 2024 Apr.
Electrocardiographic early repolarization (EER) is linked with idiopathic ventricular fibrillation in adults. It is frequently seen in children, with poorly understood significance. Some evidence suggests that it could be a vagally mediated phenomenon. A retrospective case-control study was undertaken to test the hypothesis that EER is more common among children with typical vasovagal syncope (VVS) than among their peers with nonvagal syncope (NVS) or with no syncope.
Patients aged 4-18 years with syncope were identified by a single-centre database search followed by a review of history for features of VVS (n = 150) or NVS (n = 84). The first available electrocardiogram (ECG) for VVS or for NVS was retrieved. Age- and sex-matched children with no known syncope or heart disease were then identified (n = 216). ECGs were assessed separately for EER based on published criteria by 2 observers blinded to patients' clinical status.
Mean age was 12.3 ± 3.2 years, and heart rate was 74.2 ± 16.5 beats/min. EER was more prevalent in VVS (33.3%) than among patients with NVS (19.1%; odds ratio: 2.29; confidence interval: 1.32-5.50) or among those with no syncope (12.5%; odds ratio: 3.14; confidence interval: 1.81-5.46). Heart rates were significantly lower in VVS and NVS (heart rate: 70.1 ± 13.8 and 70.7 ± 12.4 beats/min, respectively) compared with children with no syncope (heart rate: 78.2 ± 18.0 beats/min), both < 0.001.
EER is more common in paediatric patients with VVS than those with NVS or without syncope, consistent with a possible vagal contribution to the ECG finding.
心电图早期复极（EER）与成人特发性室颤有关。它在儿童中很常见，但其意义尚不清楚。一些证据表明这可能是一种迷走神经介导的现象。进行了一项回顾性病例对照研究，以检验EER在典型血管迷走性晕厥（VVS）儿童中比在非迷走性晕厥（NVS）或无晕厥的同龄人中更常见的假设。
通过单中心数据库搜索，然后回顾病史以了解VVS（n = 150）或NVS（n = 84）的特征，确定4至18岁的晕厥患者。检索VVS或NVS的第一份可用心电图（ECG）。然后确定年龄和性别匹配的无已知晕厥或心脏病的儿童（n = 216）。由2名对患者临床状况不知情的观察者根据已发表标准分别评估ECG是否存在EER。
平均年龄为12.3±3.2岁，心率为74.2±16.5次/分钟。EER在VVS中比在NVS患者（19.1%；比值比：2.29；置信区间：1.32 - 5.50）或无晕厥患者（12.5%；比值比：3.14；置信区间：1.81 - 5.46）中更普遍。与无晕厥儿童（心率：78.2±18.0次/分钟）相比，VVS和NVS的心率显著更低（心率分别为：70.1±13.8和70.7±12.4次/分钟），均P<0.001。
EER在患有VVS的儿科患者中比患有NVS或无晕厥的患者更常见，这与迷走神经可能对心电图表现有影响一致。
