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Microvolt T-Wave Alternans during Holter Monitoring in Children and Adolescents

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Background: Time-domain microvolt T-wave alternans (TWA) has been described as a noninvasive marker of sudden cardiac death in adults. The incidence of TWA in pediatric populations has not been defined well. The aim of the study was to determine peculiarities of TWA in children.

Methods: We examined 68 healthy patients—newborns (20) and children in age group of 7–17 years (48)—and 85 pediatric patients: ventricular premature beats—65; dilated cardiomyopathy (DCMP)—2; long QT syndrome (LQTS)—10; Brugada syndrome (BrS)—5, catecholaminergic ventricular tachycardia (CVT)—3. All underwent Holter monitoring (HM) with definition of the peak value of TWA by modified moving average method.

Results: In healthy newborns, TWA was 32 ± 8 (12–55) V (HR 123–156 bmp). In healthy children (7–17 years) it was 30 ± 11 (10–l 55) V, (HR 64–132 bmp) without any differences between boys and girls. In all group of patients, TWA were significantly higher (P < 0.05) than in healthy. Circadian peak of TWA was found (90%) in a second part of day and at sleep (8%). Among them 60% (LQTS, BrS, and DCPM) had TWA > 55 V.

Conclusion: Time-domain TWA during HM in children was independent of age, gender, and heart rate. In 94% healthy children, values of TWA do not exceed 55 V but 20–50% children with cardiac pathology had TWA more than 55 V. Night circadian type of TWA in diseases with risk of life-threatening arrhythmias associated with TWA was more than 55 V.

Ann Noninvasive Electrocardiol 2010;15(2):138–144
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Keywords: Brugada syndrome; Holter monitoring; catecholaminergic ventricular tachycardia; healthy children; long QT syndrome; microvolt T-wave alternans

Document Type: Research Article

Affiliations: Center for Syncope and Cardiac Arrhythmias in Children and Adolescents of the Federal Medical-Biological Agency of Russia, Clinical Children Hospital #38 of Federal Medical-Biological Agency of Russia, Moscow, Russia

Publication date: April 1, 2010

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