title: Factors of negativity of electrophysiological study in children and teenagers complaining of tachycardia and prognostic significance.
abstract: When non-invasive studies remain negative, the diagnosis of unexplained tachycardia in the young is a dilemma. The purpose of the study was to determine the factors of negativity of transesophageal electrophysiological study (EPS) in children/teenagers complaining of tachycardia and the prognostic value. Two hundred and seventy-three children with a normal ECG in sinus rhythm, aged from 6 to 19 years (15 ± 3), complained of tachycardia. Transesophageal EPS consisted of atrial stimulation in control state and after isoproterenol. Supraventricular tachycardia (SVT) was induced in 149 patients (group I) and EPS remained negative in 124 (group II). Age did not differ (15 ± 3 vs 15 ± 3). Female gender and familial history of SVT were as frequent in group I (47, 11%) than in group II (55%, p = 0.15; 7%;p = 0.2). Feeling of dizziness/syncope with tachycardia was less frequent in group I (12%) than in group II (48%) (p < 0.0001). Feeling of chest pain with tachycardia was less frequent in group I (2%) than in group II (28%) (p < 0.0001). The presence of non-cardiac disease was less frequent in group I (1.3%) than in group II (6.4%) (p < 0.025). Patients with negative study remained free of SVT after a follow-up of 3.5 ± 3 years, but one had a complete AV block. In children with apparently normal ECG in sinus rhythm, who complained of tachycardia clinical history (association with syncope, chest pain, or the presence of another disease) can predict negativity of EPS with a relatively high accuracy; EPS may not be necessary. In very symptomatic patients, transesophageal EPS, which is inexpensive and non-invasive, might be performed to stop investigations.
authors: Adult and Paediatric Cardiology, CHU de Brabois, 54500, Vandoeuvre Les Nancy, France, b.brembilla-perrot@chu-nancy.fr.
authors: Béatrice
authors: B
authors: Brembilla-Perrot
authors: Alice
authors: A
authors: Brembilla
authors: Anne
authors: A
authors: Moulin-Zinsch
authors: Jean Marc
authors: JM
authors: Sellal
authors: Arnaud
authors: A
authors: Olivier
authors: Vladimir
authors: V
authors: Manenti
authors: Thibaut
authors: T
authors: Villemin
authors: Jean Paul
authors: JP
authors: Lethor
authors: Samira
authors: S
authors: Taihï
authors: Joseph
authors: J
authors: Rizk
authors: Marc
authors: M
authors: Rodermann
authors: François
authors: F
authors: Marçon
authors: Nicolas
authors: N
authors: Girerd
mesh_terms: D000293:Adolescent; D002648:Child; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000503:physiopathology*; D018667:Tilt-Table Test