Çınar Betül, Kafalı Hasan C, Şahin Gülhan T, Ergül Yakup
Department of Pediatric Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, İstanbul, Turkey.
Department of Pediatric Cardiac Electrophysiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, İstanbul, Turkey.
Cardiol Young. 2025 Jul;35(7):1370-1376. doi: 10.1017/S1047951125100826. Epub 2025 Jul 31.
The persistence of palpitations in some patients after supraventricular tachycardia ablation is a common challenge despite high procedural success rates. Establishing a correlation between symptoms and tachycardia is especially crucial for adolescent patients, who face challenges in perceiving and articulating their symptoms. This study aimed to evaluate the significance and efficacy of external event recorders in detecting symptom-arrhythmia correlation in paediatric patients experiencing palpitations following successful supraventricular tachycardia ablation.
Among the 1682 patients who underwent successful supraventricular tachycardia ablation at our center between 2013 and 2023, the study included those who met the following criteria: 1) diagnosed with atrioventricular nodal reentrant tachycardia, concealed accessory pathway, or focal atrial tachycardia (excluding substrates identifiable on surface electrocardiogram such as Wolff-Parkinson-White and Mahaim type preexcitations), 2) without CHD, 3) aged over 10 years (as this age is considered sufficient for reliable symptom reporting), and 4) presenting with palpitations post-ablation, with no supraventricular tachycardia detected on electrocardiogram or 24-hour Holter monitoring. Patient data were retrospectively reviewed from medical records.
Among a total of 104 patients reporting palpitations (15%), event recording data of 73 patients were available. Supraventricular tachycardia was documented in eight cases, whereas sinus tachycardia was detected in nine patients. Symptom-arrhythmia correlation was achieved in 23% of patients, nearly half of whom had supraventricular tachycardia recurrence. Patients reporting palpitations with recurrent supraventricular tachycardia episodes were analysed according to diagnostic subgroups. The recurrence rate in patients with palpitations was higher in the focal atrial tachycardia group compared to the others (33%).
Despite successful ablation procedures, palpitations continue to pose a significant concern. To precisely explore the actual symptom-rhythm correlation, we advocate safe and effective utilisation of external event recorders in paediatric patients, particularly those with sporadic symptoms, as opposed to relying solely on electrocardiogram and Holter monitoring.
尽管室上性心动过速消融术的手术成功率很高，但一些患者术后仍有心悸症状持续存在，这是一个常见的挑战。对于青少年患者而言，在感知和表达自身症状方面面临挑战，因此确定症状与心动过速之间的关联尤为关键。本研究旨在评估外部事件记录仪在检测成功进行室上性心动过速消融术后出现心悸的儿科患者症状与心律失常相关性方面的意义和有效性。
在2013年至2023年间于本中心成功进行室上性心动过速消融术的1682例患者中，本研究纳入了符合以下标准的患者：1）诊断为房室结折返性心动过速、隐匿性旁路或局灶性房性心动过速（不包括体表心电图可识别的基质，如预激综合征和Mahaim型预激），2）无先天性心脏病，3）年龄超过10岁（因为这个年龄被认为足以可靠地报告症状），4）消融术后出现心悸，心电图或24小时动态心电图监测未检测到室上性心动过速。从病历中回顾性分析患者数据。
在总共104例报告有心悸的患者（15%）中，73例患者的事件记录数据可用。记录到8例室上性心动过速，9例患者检测到窦性心动过速。23%的患者实现了症状与心律失常的关联，其中近一半患者出现室上性心动过速复发。根据诊断亚组分析报告有心悸且室上性心动过速反复发作的患者。与其他组相比，局灶性房性心动过速组心悸患者的复发率更高（33%）。
尽管消融手术成功，但心悸仍然是一个重大问题。为了精确探究实际的症状与节律相关性，我们主张在儿科患者中安全有效地使用外部事件记录仪，特别是那些有散发性症状的患者，而不是仅仅依赖心电图和动态心电图监测。
