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Investigation of clinical characteristics of ventricular extrasystole in children--using two dimensional RR interval
N Nagai1, M Nagashima, A Tsuji
1Department of Pediatrics, Nagoya University School of Medicine, Japan.
Insights
This study introduces a new method to classify ventricular premature contractions (VPCs) in children based on RR intervals. The classification helps understand VPC origin and associated heart conditions.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Medical Technology
Background:
- Ventricular premature contractions (VPCs) are common in children.
- Understanding the origin and characteristics of VPCs is crucial for diagnosis and management.
- Current methods for analyzing VPCs can be complex and time-consuming.
Purpose of the Study:
- To develop and validate a novel two-dimensional RR interval plotting method for classifying VPCs in children.
- To investigate the relationship between VPC origin (right vs. left ventricle) and different VPC types.
- To explore associations between VPC types and the presence of organic heart disease and ventricular tachycardia (VT).
Main Methods:
- Eighty-three children with VPCs underwent Holter electrocardiography.
- A two-dimensional RR interval plotting method was used to analyze the relationship between preceding RR intervals and coupling intervals.
- Patients were classified into 'fixed' and 'unfixed' types, with the latter further divided into 'scattered', 'dependent', 'biphasic', and 'intermediate' subtypes based on plotted morphology.
Main Results:
- The 'fixed' and 'dependent' VPC types were significantly more common in subjects with right ventricular origin VPCs compared to left.
- The 'scattered' VPC type showed a significantly lower proportion of right ventricular origin VPCs.
- Organic heart disease was present in 15.7% of subjects, predominantly in the 'fixed' type with right ventricular origin.
- Ventricular tachycardia (VT) was observed in 34 subjects and was rare in the 'scattered' type.
Conclusions:
- The developed RR interval plotting method effectively classifies VPCs in children.
- Specific VPC types are associated with the origin of the arrhythmia (right vs. left ventricle).
- This classification may aid in identifying children at higher risk for organic heart disease and VT.
Abstract:
Eighty-three children were monitored by Holter electrocardiography for ventricular premature contraction (VPC), and the relationship between the preceding RR interval and the coupling interval was plotted using a two-dimensional RR interval plotting method. With this method, the slope (a) and standard deviation (SD) of the linear regression (Y = aX+b) were determined. These parameters were used to classify the patients into one of two types: a fixed type (SD < 40 msec, a < 0.2) and an unfixed type. The unfixed type was further divided into four subtypes, based on the plotted morphology: scattered, dependent, biphasic, and intermediate. The relationships between the VPC origin, organic heart disease, ventricular tachycardia (VT) and parasystole were investigated in the five types. The fixed and dependent types comprised significantly greater proportions of the subjects with VPC of right ventricular origin than of subjects with VPC of left ventricular origin (fixed: 31/59 right VPC vs 4/24 left VPC, p < 0.005; dependent: 13/59 vs 1/24, p < 0.05). On the other hand, comparatively very few subjects of the scattered type showed right VPC (4/59 vs 18/24, p < 0.005). Finally, the biphasic and intermediate types were distributed fairly equally among the subjects with VPCs of right and left ventricular origin (biphasic: 5/59 vs 0/24, p = 0.31, intermediate: 6/59 vs 1/24, p = 0.67). Organic heart disease was present in 13 subjects (15.7% of total subjects), seven of whom were of the fixed type with right ventricular origin (22.6% of subjects of this type). VT was observed in 34 subjects, but was rare in the scattered type (2/22 subject, 9.1%).(ABSTRACT TRUNCATED AT 250 WORDS)