Retrospective evaluation of benign ventricular arrhythmias in children

Introduction: Ventricular arhythmias is frequently seen in clinical practice in childhood. Clinical cases can vary up asymptomatic process to left ventricular dysfunction and congestive heart failure, and they can generally detected incidentally by electrocardiogram or holter electrocardiography. If there is no accompanying clinical symptoms and structural heart disease, medical treatment is not necessary, but medical treatment can be tried for symptomatic patients who have continuous symptoms. Radyoablative treatment can be applied in resistant cases. Catheter ablation has emerged as a safe and effective option for the treatment of frequent PVC's. It has proven that superficial ECG is beneficial for find out the localization of ectopic focus of PVC's. Determining the focus is useful for prognosis of the patient. Patients should be monitored by the repeated holter monitoring. Objective: The main purpose of our study is to determine the natural history of benign Ventricular arhythmias, to evaluate the impact of treatment on disease progression and to reduce the symptoms of arrythmia. Even without symptoms in patients. We aimed to determine the patients who had benign ventricular tachycardia consisting of cardiomyopathy associated with arrhythmia is intended the progress of should receive early detection and treatment. Hypothesis: Benign ventricular arrhythmias are rarely to be mortal, because of this during the diagnosis period and follow up period a detailed assessment is essential. In order to predict a patient's prognosis, it is a valuable finding to determine PVC 's origin. Method: This study included 60 patient with bening premature ventricular complexes who were followed Ege University Faculty of Medicine Pediatric Cardiology Department. Their clinical findings, electrocardiography, 24 hour Holter ECG, exercise testing and echocardiography findings, with treatment and without treatment follow up modalities, treatment responses and prognosis were evaluated retrospectively from existing clinic files. Results: %45 of the patients were female, %55 were male. The mean age at diagnosis was 10,2 ± 4,2 years. %46,7 of the patients were asymptomatic and they were v diagnosed incidentally. In the symptomatic group palpitation were the most common symptom. Complaints in %27,2 of 33 patients (with any complaint in the application time) were increased during the exercise. Before the diagnosis %15 of patients used proarrhythmogenic drug. In 24 hour holter ECG, PVC's was %6,4± 8,7 and VT was 0,66 ± 1,1%. According to electrocardiographic examination %56,7 of PVC 's were originated from right ventricle, and %43,3 were from the left ventricle. PVC's morphology was monomorphic and %95 of all patients were unifocal. Right origin PVC's patients had higher rate of VT compared to patients in the left origin PVC's on holter ECG (p= 0,06). In 55% of patients were found positive exercise stress test. %73 of patients in positive exercise test group were left PVC's origin (p=0,014). Echocardiographic evaluation was normal in all patients, and there was no significant structural heart disease. There was no malignant arrhythmias and sudden cardiac death in patients after an average period of 27,7 ± 25 months. Medical treatment was given to %66,7 of the patients (%52,2 of beta blocker, %47,5 of propafenone) during 19,45 ± 13,6 months. According to PVC's reduction ratio in holter ECG, %16,7 of patients had complete progress. The patients who had no treatment, were found a higher rate of complete progress (p=0,07). The patients who had any treatment and use propafenone, were seen more successful in clinical response (p=0,033). According to the patient with right or left origin, there was no any significant difference between them in terms of clinical complete response (p=0,49). However the patient who had no treatment and had a right origin PVC 's was higher responses than the patients in treated group (p=0,012). Four patients (%6,7) who were resistant to medical treatment, were referred to an experienced center for EPS. Discussion: PVC's demonstrate a good prognosis in children without structural heart disease PVC 's origins can show the prognosis. In the beginning patients with VTE were found no clinical improvement. It is the right approach that majority of patients who had benign ventricular arrhythmias should not be initiated antiarrhythmic therapy. PVC's often observed patients should be monitored for at least two years for malignant arrhythmias and the risk of developing left ventricular dysfunction.