Europace Advance Access published online on January 16, 2007
Europace, doi:10.1093/europace/eul174
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Age-related role of ambulatory electrocardiographic monitoring in risk stratification of patients with complete congenital atrioventricular block
1,*1
uti11 Velinovi2
ehi11
1 Department of Paediatric Cardiology, Mother and Child Health Institute ‘Dr Vukan 
upi’, Radoja Dakica 6–8 street, Belgrade, Serbia, Serbia and Montenegro;
2 Institute of Cardiovascular Diseases of Clinical Center of Serbia, Belgrade, Serbia
Aims The aim of the paper was to assess the importance of 24 h electrocardiographic Holter monitoring in determining predictive factors for Adams–Stokes (AS) attacks and heart failure (HF) in children and adolescents with complete congenital atrioventricular block (CCAVB).
Methods and results Forty-five patients were divided into two groups according to the presence of AS attacks and HF and six age-related subgroups. The following parameters of 24 h electrocardiographic Holter monitoring were analysed: (i) minimum heart rate (HR), (ii) maximum HR, (iii) average HR, (iv) daytime HR (v) rhythm and conduction disturbance. Adams–Stokes attacks and HF occurred in 10 and 8 patients, respectively (40%). Five of six neonates with HF had maximum HR < 74 bpm and daytime HR < 58 bpm. Maximum HR below 68 bpm and daytime HR below 52 bpm were recorded in all the children up to 8 years of age with AS attacks and HF and only in 3 of 14 asymptomatic patients. All the patients above 8 years of age with AS attacks had maximum HR below 62 bpm. Of 6 patients with daytime HR < 50 bpm AS attacks were present in two. Episodes of marked ventricular slowing during sleep were registered in 4 of 10 (40%) patients and in 3 of 27 (11%) symptomless patients.
Conclusion Risk factors for development of AS attacks and HF in patients with CCAVB include: (i) maximum HR < 74 bpm in neonates, <68 bpm up to the age of 8 and <62 bpm at ages above 8, (ii) daytime HR <58 bpm in neonates and < 52 bpm till the age of 8, and (iiii) abrupt pauses in ventricular rate that are at least twice the basic cycle length after the neonatal period.
Key Words: Complete congenital atrioventricular block, Adams–Stokes attacks, Heart failure, WPW, Electrocardiographic holter monitoring, Heart rate
* Corresponding author. Tel: +381 11 3108 140; fax: +381 112697232. E-mail address: vvladavuk{at}ptt.yu
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