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Outcome of children presenting with suspected cardiac arrhythmia to a paediatric clinic
  1. P Shah,
  2. A Lakshmanan,
  3. H Galton,
  4. W Kelsall
  1. Department of Paediatrics, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Abstract

Introduction The presentation of cardiac arrhythmias varies depending on the type and age at presentation. Appropriate investigations must be conducted as some rhythm disturbances are life threatening.1 The aim of this study was to evaluate the outcome of children presenting with concerns about the heart rate and rhythm to a clinic run by a paediatrician with expertise in cardiology.

Methods Children referred for assessment of arrhythmias between March 2004 and August 2009 were included in the study. A retrospective analysis of their clinic letters was undertaken. Patients already known to have arrhythmias were excluded.

Results Over 5 years, 205 children were identified. Of these, 115 (56%) were male. The median age of first clinic attendance was 12 years (range 1 month to 17 years). There were 141 (69%) general practitioner referrals and 53 (26%) were referred following inpatient admission, emergency department attendance or from other clinics. 11 (5%) children were already under cardiac review with the arrhythmia as a new concern. The commonest presenting symptoms were palpitation/tachycardia, chest pain and syncope/faint in 101 (49%), 42 (20%) and 33 (16%) children, respectively. Pathological arrhythmias were confirmed in 26 (13%) children, of these, 24 were subsequently seen in the specialist outreach clinic. Supra-ventricular tachyarrhythmias including Wolf Parkinson White syndrome were diagnosed in 18 (9%) children of whom four were less than 1 year of age at diagnosis. Electrophysiological studies with radiofrequency ablation were performed in 9 (4%) children. Prolonged QT syndrome and ventricular tachyarrhythmia was diagnosed in 4 children each. Most children 162 (79%) were discharged after their initial or first follow up appointment, 33 (16%) are followed in paediatric clinics and 10 (5%) have been transferred to adult services. There have been no deaths in this study group.

Conclusion Cardiac arrhythmias are commonly seen in paediatric cardiology clinics. These children require careful assessment. A significant proportion of children have pathological arrhythmias that require treatment and long-term follow-up.

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