Are Arrhythmias in Rheumatic Mitral Regurgitation Common as in Mitral Valve Prolapse in Children ?
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- Category: Vol. 77, March 2009
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Are Arrhythmias in Rheumatic Mitral Regurgitation Common as in Mitral Valve Prolapse in Children ?,WAEL LOTFY, OSAMA TAYEH, GEHAN HUSSEIN, SHERIF TAWFIK and FADIA MAHMOUD
Abstract
Rheumatic fever is a common cause of acquired heart disease in children and young adult throughout the developing world and the pancarditis caused by rheumatic fever may manifest by palpitations. Ventricular arrhythmias are a common feature in patients with mitral valve prolapse (MVP) and several factors have been identified in those patients who progress to sudden death, including severe mitral regurgitation. So could arrhythmias in children with rheumatic mitral regur-gitation (MR) be as common as in patients with mitral valve prolapse?
Patients and Methods: This study included 30 patients (pts) with isolated rheumatic mitral regurgitation with different grades (mild, moderate and severe mitral regurgitation) diag-nosed by echocardiography (group I) compared to group II (control group), which included 30 healthy children with a normal heart confirmed by echocardiography. All the study population was subjected to the following: Full medical history and physical examination, laboratory investigations, twelve leads ECG, chest X-ray, echocardiography and Ambulatory twenty four hours ECG monitoring (Holter).
Results: The total prevalence of arrhythmias detected by Holter monitoring in the studied patients and control group were 40% (12 pts) and 16.6% (5 pts) respectively, p value=0.04. As regard the type of arrhythmias; sinus tachycardia occurred in 10 pts (33.3%) and 4 pts (13.3%) in group I and II respec-tively (p value >0.05). Infrequent premature atrial contractions (PACs) occurred in 2 pts (6.7%) in group I and one patient (3.3%) in group II (p value >0.05). The incidence of arrhyth-mias detected by Holter recording was insignificant with mild MR compared to the control group (p value=0.4). Thereafter, the prevalence of arrhythmias increased proportionally to the degree of MR. The occurrence of arrhythmias in pts with moderate and severe rheumatic MR was significantly higher as compared to the control group (p value=0.02 & 0.009 respectively). The incidence of arrhythmias was not signifi-cantly higher in cases of rheumatic MR with active rheumatic fever (4 pts had arrhythmias out of 5 pts with rheumatic activity) than those with rheumatic MR without rheumatic activity (p value=0.07). The prevalence of arrhythmias in the patients studied in relation to the echocardiographic findings revealed a significantly higher incidence of arrhythmias in rheumatic MR with left atrial enlargement; eleven out of thirteen pts had sinus tachycardia and PACs (p value=0.0001).
Conclusions: We conclude from this study that rheumatic mitral regurgitation in the pediatric age group is associated with sinus tachycardia and uncommonly with premature atrial contractions; no other arrhythmias were detected even in association with cardiac enlargement or active carditis. The incidence of arrhythmias in MVP is much more common than in rheumatic MR. Ventricular arrhythmias occurs in MVP, while it did not occur with rheumatic MR in our study. The incidence of arrhythmias in rheumatic MR is significantly related to the severity of mitral regurgitation.