title: Rapid and low-cost method to prove the nature of no documented tachycardia in children and teenagers without pre-excitation syndrome.
abstract: Aims Symptoms in children are often difficult to interpret. The purpose of this study was to report the results of transoesophageal electrophysiological study (EPS) performed in children complaining of sudden onset tachycardia with normal non-invasive studies. Methods and results Eighty-two children and teenagers (mean age 15 +/- 3 years) presented with suspected but no documented paroxysmal supraventricular tachycardia (SVT). ECG was normal. Non-invasive studies were negative; 23 children had syncope with tachycardias. They underwent transoesophageal EPS in our out-patient clinic. The mean duration of transoesophageal EPS was 11 +/- 5 min. Electrophysiological study was negative in 25 children. AV nodal re-entrant tachycardia could be induced in 37 children, 11 of them associated with syncope. Wolff-Parkinson-White syndrome (WPW) was diagnosed in five children in which atrioventricular re-entrant tachycardia was inducible. Atrioventricular re-entrant tachycardia due to a concealed AP was induced in 14 children. Verapamil-sensitive ventricular tachycardia was induced in one patient. Factors associated with tachycardia inducibility were an older age (15.5 +/- 2 vs. 14 +/- 4 years) (P < 0.05) and the absence of syncope (81 vs. 52%) (P < 0.05). During a mean follow-up of 3 +/- 1 year, no patient with negative EPS developed documented tachycardia. In 17 children with inducible SVT, radiofrequency ablation of the re-entrant circuit was subsequently performed. Conclusion Transoesophageal EPS is a fast method for proving the nature of paroxysmal tachycardia in children and teenagers presenting with normal ECG and for demonstrating WPW syndrome not visible on standard ECG. The negative predictive value of transoesophageal EPS for the diagnosis of SVT was 100%.
authors.affiliation: Department of cardiology, CHU of Brabois, 54500 Vandoeuvre, France. b.brembilla-perrot@chu-nancy.fr
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.forename: Laurent
authors.initials: L
authors.lastname: Groben
authors.forename: Frédéric
authors.initials: F
authors.lastname: Chometon
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Lethor
authors.forename: Philippe
authors.initials: P
authors.lastname: Admant
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Cloez
authors.forename: Irina
authors.initials: I
authors.lastname: Popescu
authors.forename: Cecile
authors.initials: C
authors.lastname: Marchal
authors.forename: Juanico
authors.initials: J
authors.lastname: Cedano
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelaal
authors.forename: Olivier
authors.initials: O
authors.lastname: Huttin
authors.forename: Charif
authors.initials: C
authors.lastname: Tatar
authors.forename: Nacima
authors.initials: N
authors.lastname: Benzaghou
authors.forename: Berivan
authors.initials: B
authors.lastname: Azman
authors.forename: Arnaud
authors.initials: A
authors.lastname: Terrier De La Chaise
authors.forename: François
authors.initials: F
authors.lastname: Marçon
mesh_terms: D000293:Adolescent; D002648:Child; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods* / Q000639:trends*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011226:Pre-Excitation Syndromes / Q000175:diagnosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000517:prevention & control*