Supraventriküler taşikardili çocukların klinik özellikleri ve prognozun değerlendirilmesi
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Date
2016
Authors
Özbek, Alper Tunga
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada, supraventriküler taşikardi (SVT) tanısı konan çocuk yaş grubundaki hastaların klinik özelliklerinin incelenmesi ve kısa süreli prognozunun değerlendirilmesi amaçlandı. Uludağ Üniversitesi, Tıp Fakültesi, Pediatrik Kardiyoloji Bilim Dalı'nda 2010-2015 yılları arasında SVT saptanan 213 hastaya ait veriler retrospektif olarak tarandı. Cinsiyet dağılımına bakıldığında erkek ve kız hastaların oranı 1:1.25 olarak bulundu. Tedaviye yanıt ve prognoz açısından erkeklerde SVT atağının tekrarlama oranı daha yüksek bulundu. Hastaların SVT tanısı aldıkları andaki en sık başvuru yakınması çarpıntı olarak bulundu. Ayrıca hastaların %17.8'inin rutin kontrollerinde saptanan taşikardi nedeni ile tanı aldığı, bu hastaların hemen hepsinin 1 yaşın altında olduğu görüldü. Hastaların %56.3'ünün ilk tanısının çocuk acil polikliniğinde konulduğu, akut tedavide hastaların %30'una vagal uyarı ile müdahale edildiği ve bu hastaların %61'inin atağının durduğu, %41'ine ise ilaç tedavisi uygulandığı, en sık kullanılan ilacın adenozin olduğu ve adenozin uygulanan hastaların %79'unun atağının durduğu görüldü. Hastaların ilk ataktan sonraki izlemlerinin değerlendirmesinde hastaların %56.3'ünde atakların tekrarladığı, hastaların %71'inde ikinci atağın ilk 3 ay içerisinde olduğu görüldü. Hastaların %94.4'üne profilaktik ilaç tedavisi başlanmıştı ve ortalama profilaksi süresi 2.5±1.6 yıldı. Tedavisi sonlandırılan hastaların %75.4'ünün tedavi kesim sonrasında şikayeti olmazken, %24.6'sının tedavi kesimi sonrası SVT atakları tekrar etmişti. Hastaların 36'sına (%16.9) dış merkezlerde elektrofizyolojik çalışma yapılmış, bu hastaların 33'üne (%15.5) radyofrekans ablasyon uygulanmıştır. Sonuç olarak çocukluk çağında taşikardilerin klinik özellikleri ve tedavi yaklaşımları çeşitlilik göstermektedir. Çocukluk çağında en sık SVT'ler görülmektedir. Özellikle asemptomatik seyreden hastalar ve aileleri bazen durumun ciddiyetini fark edemeyip takiplerine düzenli olarak devam etmemektedir. Uzun süren taşikardi durumunda kalp yetersizliği gelişebileceği ve ani ölüm riski konusunda hasta ve yakınları detaylı olarak bilgilendirilmeli, tanıdan sonra izlemin önemi anlatılmalıdır.
In this study, we aim at examining clinical features and evaluating short-time prognosis in patients diagnosed with supraventricular tachycardia (SVT) during childhood. Data for 213 patients diagnosed with SVT between the years 2010-2015 at Uludag University Faculty of Medicine Department of Pediatric Cardiology were retrospectively investigated. Gender distribution for male and female patients was found to be 1:1.25. In terms of prognosis and response to treatment, the rate of repetition of SVT episodes was found to be higher in male patients. Palpitations were the most common presenting complaint at the time of SVT diagnosis. It was also noted that 17.8% of the patients with tachycardia during routine check-up developed SVT and almost all of them were under the age of one year. Among all patient with SVT, 56.3% had their first diagnosis at pediatric emergency department where vagal stimulation was applied during acute treatment in 30% of the cases. The attack ceased in 61% whereas medication was applied in 41% and adenosine ,the most used medication, stopped the attack in 79% of the patients. During follow-up after the first attack, 56.3% of the patients had repeated attacks and the second attack was seen within the first 3 months in 71% of the patients. Prophylactic drug therapy was started in 94.4% of the patients and the average duration of prophylaxis was 2.5 ± 1.6 years; 75.4% of patients whose treatment was stopped had no complaints after the cessation whereas 24.6% had repeated SVT attacks. Electrophysiologic study was done in 36 patients(16.9%) at a different health centre and radiofrequency ablation was performed in 33 (15.5%) of them. In conclusion, the clinical features and treatment approach for childhood tachycardias are variable. Supraventricular tachycardias are the most common during childhood. Follow-up is not regularly performed especially in asymptomatic patients and in cases where families are unaware of the seriousness of the condititon. Patients and their relatives should be given detailed information concerning the possibility of heart failure and sudden death in prolonged tachycardia and the importance of follow-up after diagnosis should also be explained.
In this study, we aim at examining clinical features and evaluating short-time prognosis in patients diagnosed with supraventricular tachycardia (SVT) during childhood. Data for 213 patients diagnosed with SVT between the years 2010-2015 at Uludag University Faculty of Medicine Department of Pediatric Cardiology were retrospectively investigated. Gender distribution for male and female patients was found to be 1:1.25. In terms of prognosis and response to treatment, the rate of repetition of SVT episodes was found to be higher in male patients. Palpitations were the most common presenting complaint at the time of SVT diagnosis. It was also noted that 17.8% of the patients with tachycardia during routine check-up developed SVT and almost all of them were under the age of one year. Among all patient with SVT, 56.3% had their first diagnosis at pediatric emergency department where vagal stimulation was applied during acute treatment in 30% of the cases. The attack ceased in 61% whereas medication was applied in 41% and adenosine ,the most used medication, stopped the attack in 79% of the patients. During follow-up after the first attack, 56.3% of the patients had repeated attacks and the second attack was seen within the first 3 months in 71% of the patients. Prophylactic drug therapy was started in 94.4% of the patients and the average duration of prophylaxis was 2.5 ± 1.6 years; 75.4% of patients whose treatment was stopped had no complaints after the cessation whereas 24.6% had repeated SVT attacks. Electrophysiologic study was done in 36 patients(16.9%) at a different health centre and radiofrequency ablation was performed in 33 (15.5%) of them. In conclusion, the clinical features and treatment approach for childhood tachycardias are variable. Supraventricular tachycardias are the most common during childhood. Follow-up is not regularly performed especially in asymptomatic patients and in cases where families are unaware of the seriousness of the condititon. Patients and their relatives should be given detailed information concerning the possibility of heart failure and sudden death in prolonged tachycardia and the importance of follow-up after diagnosis should also be explained.
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Keywords
Supraventriküler taşikardi, Çarpıntı, Çocuk, Supraventricular tachycardia, Palpitations, Child
Citation
Özbek, A. T. (2016). Supraventriküler taşikardili çocukların klinik özellikleri ve prognozun değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.