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Electrocardiographic ST-segment depression in children with fontan circulation
1Department of Paediatrics, Division of Paediatric Cardiology, University Hospital of Umeâ, Umeâ, Sweden.
Insights
Children with Fontan circulation frequently exhibit electrocardiographic ST depression during daily activities. This finding was not observed in healthy children, suggesting a common issue in Fontan patients.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Congenital Heart Disease
Background:
- Fontan-type procedures palliate complex congenital heart defects but often result in persistent effort limitation.
- Previous observations noted electrocardiographic ST depression in children with Fontan circulation during exercise tests.
Purpose of the Study:
- To determine the prevalence of electrocardiographic ST depression in children with Fontan circulation.
- To compare ST depression findings between Fontan patients and healthy controls.
Main Methods:
- Conducted echocardiography and 24-hour ambulatory electrocardiographic monitoring on 14 Fontan patients and 28 healthy controls.
- Analyzed ST changes using a PC-based Holter system.
- Performed exercise testing (bicycle ergometer and treadmill) on a subset of participants.
Main Results:
- Significant ST depression was found in 10 of 13 analyzed Fontan patients on ambulatory ECG.
- No healthy controls exhibited ST depression on ambulatory ECG.
- Three Fontan patients showed ST depression during exercise testing.
Conclusions:
- Electrocardiographic ST depression during daily activity is a common finding in children with Fontan circulation.
- The study highlights a potential indicator of cardiac strain or dysfunction in these patients.
Abstract:
Despite successful operation, many patients palliated with a Fontan-type procedure continue to show effort limitation. We previously observed that these children showed electrocardiographic ST depression during exercise tests. The purpose of the study was to investigate whether electrocardiographic ST depression is a common finding in children with Fontan circulation. Forty-two children in two groups were examined: group A consisted of 14 patients who had all undergone a modified Fontan procedure, and group B consisted of 28 children with a structurally normal heart, matched for length, weight and gender to group A. Complete echocardiographic examinations were performed in all patients and controls. All 14 patients and all 28 healthy children underwent standard 24 h ambulatory electrocardiographic monitoring. All the recordings were analysed by a PC-based Holter system where an analysis of ST changes was performed. Seven patients and 14 matched healthy children were exercised on bicycle ergometers. Four patients and eight matched healthy children underwent exercise testing by walking/running a treadmill. Ten of 13 patients analysed had significant ST depressions on ambulatory electrocardiogram (>0.20 mV). Three of the 10 patients with ST depression were on digoxin. Three patients showed depressions of the ST segment in the electrocardiogram during exercise, with a maximal depression of 0.20-0.35 mV. None of the 28 matched healthy children showed electrocardiographic ST depression on the ambulatory 24 h ECG. These findings indicate that ST depression in daily activity is a common finding in children with Fontan circulation.