Identifying Arrhythmias in Adults With Congenital Heart Disease by 24-h Ambulatory Electrocardiography |
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Authors: | Fred H Rodriguez Douglas S Moodie Marc Neeland Gerald J Adams Christopher S Snyder |
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Institution: | (1) Division of Cardiology, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC 19345-C, Houston, TX 77030, USA;(2) Tulane University School of Medicine, New Orleans, LA, USA;(3) Division of Cardiology, Department of Pediatrics, Ochsner Clinic Foundation, New Orleans, LA, USA |
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Abstract: | Adults with congenital heart disease (CHD) are at risk for the development of arrhythmias. This study aimed to assess the
incidence of unsuspected arrhythmias among adults with CHD identified on electrocardiograms (ECGs) and 24-h ambulatory electrocardiographic
monitoring (Holter monitoring). A review of the cardiology database at the authors’ institution from July 2004 through December
2007 identified all clinic patients 18 years old or older who had a recent ECG and Holter monitoring. Data collection included
diagnosis, ECG and Holter monitoring results, arrhythmias, and the presence or absence of symptoms. The review identified
140 patients. Analysis of the ECGs showed that 15% of the patients had an arrhythmia. These arrhythmias consisted of ectopy
(6%), supraventricular tachycardia (SVT) (3%), pacemaker issues (2%), and previously unrecognized atrioventricular block (AVB)
(1%). The majority of the patients with arrhythmias were asymptomatic (76%). Analysis of the Holter monitoring results showed
that 31% of the patients had arrhythmias consisting of ectopy (17%), SVT (12%), ventricular tachycardia (7%), high-grade AVB
(5%), and pacemaker issues (3%). Of the patients with arrhythmias, 80% were asymptomatic. Among the patients without arrhythmias
on ECG, 26% had arrhythmias noted on Holter monitoring. Of the patients with multiple Holter monitorings performed, 34% had
a new arrhythmia noted on repeat monitoring. In conclusion, arrhythmias were present in a significant number of adults with
CHD, but the majority were asymptomatic. Among adults with CHD, even those with normal ECGs, arrhythmias were frequently detected
on Holter monitoring. In addition, repeat Holter monitoring may identify significant arrhythmias over time. |
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