Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy

Area of Science:

• Pediatric Cardiology
• Cardiac Electrophysiology
• Sleep-Disordered Breathing

Background:

• Adenotonsillar hypertrophy (ATH) is associated with right ventricular dysfunction and elevated pulmonary arterial pressure in children.
• The impact of ATH on the cardiac conduction system, particularly atrial electromechanical function, remains less understood.
• Investigating these effects is crucial for understanding potential long-term cardiac consequences in affected children.

Purpose of the Study:

• To evaluate the influence of moderate to severe adenotonsillar hypertrophy (ATH) on cardiac conduction and electrophysiological parameters in children.
• To compare echocardiographic and atrial electromechanical delay (AED) findings in children with ATH versus healthy controls.
• To assess the reversibility of these cardiac changes following adenotonsillectomy.

Main Methods:

• A comparative study involving 46 children diagnosed with ATH and 46 healthy controls.
• Utilized conventional echocardiography, P-wave dispersion (Pd) analysis, tissue Doppler imaging (TDI), and atrial electromechanical delay (AED) measurements.
• Evaluations were conducted before and after adenotonsillectomy in the patient group.

Main Results:

• Children with ATH exhibited significantly prolonged P-wave duration, increased P-wave dispersion (Pd), and prolonged inter- and intraatrial electromechanical delays (AED).
• ATH patients showed impaired right ventricular dimensions, elevated mean pulmonary arterial pressure (PAP), and altered mitral and tricuspid valve inflow patterns (E/A ratios).
• Tissue Doppler imaging revealed reduced E'/A' ratios and myocardial performance index in various cardiac segments. All measured parameters normalized post-adenotonsillectomy.

Conclusions:

• Adenotonsillar hypertrophy is associated with significant electrophysiological abnormalities, including prolonged P-wave duration and atrial electromechanical delay, in pediatric patients.
• These cardiac alterations, potentially induced by ATH-related hypoxia, are reversible after surgical intervention (adenotonsillectomy).
• The findings highlight a novel association between ATH and cardiac conduction disturbances, suggesting a potential risk for arrhythmias if left untreated.