Developmental changes in sinus node function in growing children: an updated analysis.
Sinus node dysfunction (SAND) may be congenital or acquired following injury or surgery for congenital heart lesions. Sinus node function is evaluated by electrophysiological (EP) parameters of corrected sinus node recovery time (CSNRT) and sinoatrial conduction time (SACT). The aim of this study was to determine age- and gender-specific values for CSNRT and SACT in pediatric patients without structural congenital heart disease. Data were collected on 152 patients who underwent an EP study for evaluation of supraventricular tachycardia between 1997 and 2002. All patients received midazolam and propofol and/or isoflurane for sedation and anesthesia, which are known to not affect EP parameters. The age of transition at which CSNRT changed significantly was 14 years (241.5 +/- 102.0 msec in patients younger than 14 years old and 285.6 +/- 144.3 msec in those older than 14 years, p < 0.05). The upper limits of normal CSNRT (mean + 2 SD) were significantly higher (445 vs 275 msec) and the upper limits of normal SACT values were lower (120 vs 200 msec) than the currently used norms in the younger age group. CSNRT values and atrial refractory period values were significantly longer in males compared to age-matched females [278.5 +/- 15.3 VS : 236.4 +/- 13.6 msec (p < 0.05) and 269.0 +/- 4.9 VS: 244.7 +/- 6.8 msec (p < 0.005), respectively]. The new age- and gender-specific values of EP parameters, which reflect sinus node function, may enable more precise recognition of SAND.
Sanjeev
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Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA.
Karpawich
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PP
D000293:Adolescent; D000328:Adult; D000375:Aging / Q000502:physiology; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D012016:Reference Values; D012032:Refractory Period, Electrophysiological; D012189:Retrospective Studies; D012727:Sex Characteristics; D012804:Sick Sinus Syndrome / Q000175:diagnosis / Q000503:physiopathology; D012849:Sinoatrial Node / Q000254:growth & development* / Q000502:physiology*