Çocuklarda Senkop: Ritim Holter Monitörizasyonu Gerekli mi?

Yıl 2016, , 124 - 128, 01.12.2016

Fahrettin Uysal Özlem Mehtap Bostan Fatma Çetinkaya Tuba Deniz Ergün Çil

https://doi.org/10.4274/jcp.32932

Öz

Giriş: Senkop geçiren hastalarda anamnez, fizik muayene ve elektrokardiyografi EKG ile etiyoloji açıklanamıyorsa genellikle Holter monitörizasyonu HM yapılır. Bu çalışmada senkoplu çocuklarda HM’nin tanısal değerinin belirlenmesi amaçlanmıştır.Gereç ve Yöntem: Bu çalışmada 2010-2014 yılları arasında hastalara uygulanan toplam 3,122 HM retrospektif olarak incelendi. Hastaların cinsiyet, tanı yaşı, ayrıntılı anamnez, fizik muayene, 12-derivasyon EKG ve ekokardiyografik sonuçları standart form kullanılarak kayıt edildi.Bulgular: Çalışmaya yaş ortalaması 13,21±3,67 olan 323 hasta dahil edildi. Hastaların 199’u kız, 124’ü erkek idi. Tüm hastaların 284’ünde %87,9 Holter sonuçları normal saptanırken 11 hastada %3,4 senkopu açıklayan anormal Holter sonuçları tespit edildi. Anormal Holter sonuçları olan 11 hastanın üçünde HM öncesinde uygulanan EKG ile tanı konduğu için HM’nin tanısal değeri %2,4 olarak hesaplandı. Aile öyküsü pozitif olan çocuklarda ise HM’nin tanısal değeri %16,6 olarak bulundu. Çalışmada EKG’si normal olan yedi hastada ise HM sonucu ile uzun QT sendromu düşünüldü

Anahtar Kelimeler

Senkop, çocuk, Holter monitörizasyonu, gizli uzun QT sendromu

Syncope in Children: Is Rhythm Holter Monitoring Necessary?

Öz

Introduction: Holter monitoring HM is usually used in patients with syncope when etiology cannot be explained with history, physical examination and electrocardiography ECG . In this study the objective was to evaluate the diagnostic value of HM in children with syncope.Materials and Methods: Databases were collected retrospectively by analyzing the HM results of 3.122 pediatric patients between 2010-2014. Gender, age at diagnosis, detailed clinical history, physical examination, 12-lead electrocardiographic and echocardiographic results were noted using standardized form.Results: The study included 323 patients with syncope with a mean age of 13.21±3.67. There were 199 female and 124 male patients in this study. Among all patients 284 87.9% had normal HM results, while 11 3.4% patients had abnormal Holter studies that consider to explain as syncope. Three of 11 patients with abnormal Holter results diagnosed through ECG before HM, hence, the diagnostic value of HM was calculated as 2.4%. In contrast, diagnostic value of HM in patients with positive family history was found to be 16.6%. In this study, 7 patients were considered to have long QT syndrome according to their HM findings. Conclusions: Detailed clinical history has a great value in children with syncope. As a result, HM has low diagnostic value if the patients are not in high risk group. However, HM was considered to be important because of concealed long QT syndrome especially if the patient had positive family history and exercise related syncope

Anahtar Kelimeler

Syncope, children, Holter monitoring, concealed long QT syndrome

Kaynakça

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