Evaluation of the results of monitoring of the daily rhythm of the heart in children of the first year of life with extrasistles

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EVALUATION OF THE RESULTS OF MONITORING OF THE DAILY RHYTHM OF THE HEART IN CHILDREN OF THE FIRST YEAR OF LIFE WITH EXTRASISTLES

Kuznetsova A.V., Naumenko Е.I, Prosvirykova V.A., Ovsiannikova I.S., Surkova I.A. National Research Mordovia State University, Saransk, Russia

Аннотация

Данная статья посвящена изучению гемодинамики по результатам инструментальных методов исследования при экстрасистолии у детей первого года жизни. Была выполнена оценка результатов Холтеровского мониторирования ЭКГ у детей грудного возраста с экстрасистолией, а также была дана соответствующая интерпретация результатов. Нами установлено, что у детей первого года жизни с экстрасистолией минимальная ЧСС меньше, длительность интервалов QT и QT_c значимо больше. Число экстрасистол в группах А, В и С больше регистрируется в ночное время и во время сна.

Ключевые слова: экстрасистолия, Холтеровское мониторирование ЭКГ, дети.

Abstract

This article is devoted to the study of hemodynamics according to the results of instrumental methods of research in extrasystoles in children of the first year of life. The results of Holter-ECG monitoring in infants with extrasystoles were evaluated, and a corresponding interpretation of the results was given. We found that in children of the first year of life with extrasystole the minimum heart rate is less, the duration of the QT and QTs intervals is significantly longer. The number of extrasystoles in groups A, B and C is more recorded at night and during sleep.

Key words: extrasystole, Holter-ECG, children.

In the past 20 years, the cardiovascular pathology of childhood requires significant changes [1, P. 382], and to date, cardiac rhythm and conduction disturbances, both of congenital heart defects, and in general, are extremely insufficient [2, P. 473]. This situation is due to the apparent absence of symptoms in this pathology [3, P. 380], as well as the relatively good state of health of children, contributing to the appearance of irreversible changes in the myocardium. Today, arrhythmia is perhaps one of the most common causes of hemodynamic disorders in a child [4, P. 184]. Quite often in childhood arrythmia. It is believed that in about 50% of cases [5, P. 245], cardiologists face this pathology [6, P. 204]. Despite the difficult diagnosis, it turned out that extrasystole takes the third place among cardiac diseases in childhood after congenital heart defects and arterial hypertension [7, P. 186], as a result of which heart rhythm disturbances occur, especially in children of the first year of life, which are one of the serious problems related to pediatric cardiology. According to statistics, extrasystoles are the most frequent arrhythmias in children up to 50%, but supraventricular extrasystoles are most common - 78% [8, P. 48].

The aim of our study was to monitor the circadian rhythm of the heart in children of the first year of life with extrasystoles.

Material and methods

In the course of our study, a retrospective analysis of 100 case histories of children of the first year of life who were treated in the neonatal pathology department of the Children's Republican Clinical Hospital in the city of Saransk was conducted. We formed two groups: children with extrasystole (n = 50) and children without extrasystoles (n = 50). The first group was divided into 3 subgroups: A - the number of extrasystoles from 1,000 to 5,000 (n = 15), B - from 5,000 to 10,000 extrasystoles (n = 11), C - over 10,000 (n = 24). The exception is less than 1000 extrasystoles per day, organic heart disease, intraventricular hemorrhage, pneumonia, hemolytic disease of the newborn. Analyzed ECG data with subsequent analysis of heart rate, QT and QTs intervals of ST segments and T wave, Holter-ECG, where the following indicators are assessed: HR min, HR max, HR average, HR day, HR night, HR during wakefulness, rhythm pause, QT, QTs. The reliability of the results is presented: p - reliability of differences between the I and II groups; p1 - significance of differences between groups A and B; p2 - significance of differences between groups A and C; p3 - significance of differences between groups B and C.

The age of children is equally comparable and in the 1st group is 5.20 ± 0.5 months. (subgroup A - 5.66 ± 1.04 months, B - 4.81 ± 1.04 months, C - 5.04 ± 0.68 months (p> 0.05)), in the second group 4, 88 ± 0.5 months (р> 0.05). Weight at birth in different groups was not significantly different.

Results and discussion

The analysis of the ECG showed that the heart rate in the ECG study is lower in children with extrasystoles (p <0.005), significantly lower in children with the number of extrasystoles more than 5 thousand (group B and C). The average duration of electrical systole was significantly higher in children of the 1st group and, mainly, in subgroup C (0.292 ± 0.005 versus 0.27 and 0.278 in groups A and B, respectively, p <0.05). Corrected QTs is also higher in children with extrasystoles (410.7 ± 4.135 versus 398.61 ± 4.135, p <0.05). Moreover, it is significant in group C (414.27 ± 7.45, p <0.05) as compared with A (403.06 ± 5.99) and B (408.5 ± 10.13). Metabolic disorders on ECG are recorded 2 times more often in children of the 1st group (p <0.001) and the percentage of registration increases with the number of extrasystoles per day: in 26.6% of children in group A, almost half of children with extrasystoles range from 5 to 10 thousand, and in 83.3% of children in group C. Thus, in ECG studies in children of the studied group, the heart rate is lower than in the control group, especially in group B and C. And more often metabolic (58%) are recorded, registration of these violations was higher than in group A and B. All children of the control and 1st group had Holter-ECG It was established that HR min was significantly lower in the 1st group, and in the subgroup C it is the lowest (p <0.005). HR max is higher in the control group than in the studied group, in children with extrasystoles more than 10 thousand the maximum heart rate is significantly higher than in children of groups A and B. The average heart rate is not significantly different in the comparison groups and is within the normal range. Heart rate at night and daytime in the 1st and 2nd groups did not differ significantly from each other, whereas during the day the heart rate was most pronounced in group B, and at night - in group C. During wakefulness of children in the studied and the control group HR did not differ significantly, however, it prevailed in children with the number of extrasystoles more than 5 thousand (p> 0.05). The duration of electrical systole QT and QTs are within the age norm of children, but in children of the study group (444.43 ± 3.58, p <0.005) of subgroup C (452.84 ± 8.11 ms), its duration prevails (against 447, 5 ± 4.02 ms in group A and 449.8 ± 6.9 ms in group B). The rhythm pauses prevail in the studied group (p> 0.05), the maximum value in children of group C (980.1 ± 114.2 ms).

Extrasystoles are more often recorded at night (p <0.05). In group C, the number of extrasystoles at night was 2 times higher than in the daytime (p <0.005).

The analysis of the number of extrasystoles during sleep and wakefulness. The number of extrasystoles during sleep prevails, especially in group B. In children with extrasystoles more than 10,000, episodes of alorhythmia of bigeminia are more often recorded, but the number of aberrant extrasystoles is the same in all comparison groups (p> 0.05).

According to the results of Holter-ECG, heart rate variability was evaluated.

The mean value of cardiac cycles (MEAN) - the main level of functioning of the sinus node is within the normal range in both groups. The function of the heart rate dispersion is higher in children with extrasystole -78.4 ± 9.2 (p <0.005). The rhythm concentration function is slightly higher in children of the 1st group (24.4 ± 3.3, p> 0.05). The representation of RR intervals exceeding the previous one is 50% higher in children of the 1st group (12.4%, p <0.05).

Thus, according to our data, in children of the first year of life with extrasystole, the minimum heart rate is less, the duration of QT and QTs is significantly longer (especially in group C). The number of extrasystoles in groups A, B and C is more recorded at night and during sleep, which indicates a decrease in the activity of the sympathetic division of the ANS and the predominance of the activity of the parasympathetic link in the ANS [9, p. 1142]. The assessment of rhythm variability indices also indicates the prevalence of parasympathetic ANS activity in young children with extrasystoles [10, p. 9].

extrasystole electrocardiography infant

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