PECULIAR ASPECTS OF INFLAMMATORY SINO-ORBITAL SYNDROME IN CHILDREN
Abstract:
Introduction: It is already known that ambulatory monitoring of heart rhythm (Holter) is the gold standard in the diagnosis and evaluation of rhythm disorders and in the evaluation of the efficacy of antiarrhythmic therapy. The important role of sympathetic stimulation in induction of the majority of rhythm disorders, especially of those in ischemic patients, is also known. We considered the evaluation of patients with known rhythm disorders useful from the point of view of their manifestation during exercise stress testing in comparison with 24 hours ambulatory monitoring, this being the purpose of our study. Also we considered the role of these two methods in the evaluation of treatment efficacy of these patients, either medical or interventional therapy. Methods: We enrolled 225 patients with known rhythm disorders, hospitalized in the Cardiology Clinic of the Rehabilitation Hospital Cluj-Napoca, during 2004-226. These patients were untreated or treated with medication or ablation therapy. The patients were integrated into two groups. The first one was represented by 135 patients with atrial premature beats (APB, 25 patients), supraventricular tachycardia (SVT, 20 patients), Wolf-Parkinson-White syndrome (WPW, 30 patients), atrial fibrillation (AF, 30 patients) and ventricular premature beats (VPB, 30 patients). The second group was represented by 30 patients with supraventricular tachycardia, 30 patients with WPW syndrome and 30 patients with atrial fibrillation, treated medically or interventional (ablation). Results: Atrial premature beats were registered during treadmill test in 40% of subjects and in 72% during Holter monitoring. Eighty percent of patients with APB during treadmill test had the same modification during Holter. Two thirds of the ones without APB at exercise presented them on ambulatory monitoring. Supraventricular tachycardia was reproduced in 4 (16%) of the 25 cases during treadmill test, four tomes more frequent than during Holter, where only one patients had SVT. Among the patients without SVT during exercise test none had arrhythmic crises during Holter. It results that in the evaluation of SVT patients exercise test is superior to Holter monitoring, being useful mainly in unmasking those cases in which effort and sympathetic stimulation are responsible for the SVT. This situation is noted mostly in ischemic patients and in those with low left ventricular performance. An interesting analysis resulted from the WPW patients. In 20% of these patients exercise test induced paroxysmal atrial fibrillation, while only 2.25% presented AF during Holter monitoring. One patient from the group with no atrial fibrillation during exercise test (20 patients) presented AF during Holter and also just one from those with AF during exercise test had this modification at Holter, too. The WPW patients were also divided into two groups: 15 patients medically treated (beta-blocker, amiodarone or propafenone) and 15 ablated patients. It is known that atrial fibrillation is one of the risk factor s in WPW syndrome, so we evaluated if it was present or not during these examinations. During exercise test 5 medically treated patients (1/3) had atrial fibrillation, whereas only one presented it during Holter monitoring. Among ablated patients only one had atrial fibrillation, and this was during treadmill test. Another risk factor for the WPW syndrome is development of SVT. Eight out of 15 medically treated patients had SVT during exercise test and 2 (four time less) during Holter monitoring. For the ablated patients there was only one SVT crises and this was seen during exercise test. Conclusion: Holter monitoring and treadmill test have complementary value in the evaluation of rhythm disorders, but Holter is twice more sensitive in tracing the malign potential of premature ventricular beats. For the supraventricular tachycardia exercise test is superior in tracing relapses; it is also more sensitive for selecting WPW syndrome patients who are at higher arrhythmic risk. Exercise test is more valuable for evaluate the inadequate cronotropic response in atrial fibrillation patients.
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