DETECTION OP ARRHYTHMIAS IN CHILDHOOD: USE OP TREAD-MILL AND DYNAMIC ECG

Abstract

Graded treadmill exercise testing(GTET)to elicit and manage arrhytlimias in children with structural heart disease (SHD)was evaluated and compared with dynamic ECG recording(24 hour Holter Monitor (HM). Using the Bruce Protocol, 200 children with SIID and 150 without SHD were exercised with leads II, AVP and V6 monitored.

Arrhythmias were present in 58 of 200 patients(pts)with SHD studied by GTET: Ventricular ectopy(VE)in 48, atrial ectopy(AE)or sick sinus syndrome(SSS)in 7, and complete heart block(CHB)in 3. Among the 30 pts with VE at rest, GTET suppressed the ectopy in 15, had no effect in 7 and exacerbated the ectopy in 8(episodes of ventricular tachycardia(VT)in 3). Three of 7 pts with AE or SSS developed short runs of atrial tachycardia and 1 pt with CHB developed three seconds of asystole. Ectopy not suspected before GTET was elicited in 10%(20/200) of pts with SHD, but only 2%(3/150)of those without SHD(X²=7.82P<.01). Serial GTET(N=14)performed in 5 pts with life threatening arrhythmias on therapy demonstrated a reduction in ectopy in 3. HM was obtained within 72 hours of GTET in 21 pts with SHD. Significant arrhythmias were identified by GTET in 4/21 pts(short runs of VT in 3 and 3 second asystole in 1)that wore not demonstrated on HM. No significant arrhythmias were found on HM that were missed by GTET.

We conclude that GTET is an excellent method for detecting and inducing arrhythymias in children with SHD and may be useful in evaluating the response to antiarrhythmic therapy. GTET may also reveal serious arrhythmias that are not apparent during HM.

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