CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
237
centre and to report on the prevalence of cardiac diagnoses among
these patients.
Methods:
The work was a retrospective study conducted at a tertiary
referral arrhythmolology service. The clinical charts of 1 896 paedi-
atric patients presenting with a primary complaint of syncope with
an average age of 8.3
±
2.1 (3.4–17) years were reviewed by the
investigators. Statistical Package of Social Science (SPSS) version 14
was used for the analysis of data. A complete history, physical exami-
nation, 12-lead ECG, EEG, echocardiography and Holter monitoring
were done for the whole study group.
Results:
The commonest trigger for syncope in the study population
was early following exercise (
n
=
526) and the commonest prodrome
was palpitation, noted in 190 patients. A murmur was present in
147 of our patients (7.7%) while 107 (5.6%) had abnormal ECGs.
Echocardiography revealed a cardiac cause in 109 (5.7%) of them,
two were missed by ECG. The most common cardiac cause was
HOCM. All patients were offered ambulatory 24-hour ECG. One
patient with sick sinus syndrome was diagnosed only with Holter.
EEG diagnosed a neurological cause for syncope in 88 (4.6%)
patients, all suspected through history taking.
Conclusions:
Twelve-lead ECG and history taking are the most
cost-effectivel investigations in diagnosing syncope in children.
Transthoracic echocardiography, Holter monitoring and EEG have a
low yield in paediatric syncope and should be reserved for when an
abnormality is suspected from the history or 12-lead ECG.
1398: THE YIELD OF AMBULATORY 24-HOUR HOLTER
MONITORING IN PAEDIATRIC PATIENTS
Ranya Hegazy, Wael Lotfy, Osama Abdel Aziz
Department of Paediatrics, Faculty of Medicine, Cairo University,
Egypt
Background:
The diagnosis of arrhythmias may be a tedious process,
due to the episodic and often transient nature of the disease, hence the
need for longer periods of ECG recording. Holter monitoring (HM)
has been established as one of the most effective non-invasive clinical
tools in the diagnosis, assessment and risk stratification of cardiac
patients. However, studies on its value in children remain debatable.
The present work aims at determining the value of HM in the diag-
nosis and management of children.
Methods:
The work was a retrospective study conducted at a tertiary
referral arrhythmolology service. Holter records of 4 015 paediatric
patients (52% males and 48% females) with an average age of 4.8
±
2.9 years (2 days – 16 years) were reviewed. The indications for
which Holter monitoring was done were analysed as well as all the
abnormalities diagnosed and factors that may increase Holter yield.
Results:
The most common indications were palpitations (23%),
syncope (16%), cardiomyopathy (14%), chest pain (8%), evaluation
of anti-arrhythmic therapy (8%), postoperative assessment (3.7%)
and complete AV block (4.5%). A total of 602 Holter recordings
were found abnormal with a total diagnostic yield of 15%. The
highest contribution to diagnosis was in postoperative assess-
ment (37%), cardiomyopathy (28%) and palpitations (14%), where
the most common abnormalities were frequent supraventricular/
ventricular premature beats, supraventricular tachycardia, ventricular
tachycardia and AV block. Diagnostic yield was lowest in patients
with syncope (0.4%) and chest pain (0%). An abnormal ECG was
significantly associated with a higher diagnostic yield (
p
=
0.0001).
Conclusions:
HM plays an extremely valuable role in the assessment
of high-risk patients (postoperative and cardiomyopathy) and those
with palpitations. However in children with syncope and chest pain,
HM had a low yield. In this group of patients an abnormal ECG is
more likely to be associated with abnormal Holter recordings.
1401: TELECARDIOLOGY PARTNERSHIP BETWEEN
WASHINGTON, DC AND MARRAKECH, MOROCCO:
SUPPORTING A GROWING PAEDIATRIC CARDIOVASCU-
LAR SERVICE IN THE DEVELOPINGWORLD
Yassine Boukaidi
1
, Drissi Boumzebra
1
, Saloua Karimi
1
, Mary Fuska
2
,
Molly Reyna
2
, Philip Hopkins
2
, Ron Dixon
2
, Svetlana Sinykin
2
,
Ouahbi Karim
1
, Craig Sable
2
1
Hospital Ibn Tofail, Marrakech, Morocco
2
Children’s National Medical Centre, Washington, DC, USA
Background:
Only 7% of the world’s population has access to
modern paediatric cardiology, resulting in nearly six million children
with treatable conditions who are denied care. Telemedicine has the
potential to help bridge this gap by providing remote consultation and
distance education.
Methods: The
Children’s National Medical Centre developed a
telemedicine partnership with Marrakech, Morocco (4–5 hours time
difference) to augment the skills of the paediatric cardiovascular
team. Videoconferencing units and satellite dishes were installed in
2009 with subsequent training in 2010.
Results:
Live monthly videoconferences were started in 2009,
increasing to weekly in 2011 between cardiovascular teams in
Washington (CS, SS) and Marrakech (DB, YB). Patient data and
echocardiograms were reviewed in real time. The Children’s Hospital
technical team managed conferences remotely; 38 conferences
occurred in the last 12 months and 14 were cancelled due to sched-
uling conflicts (no technical difficulties). Ninety-five cases/73
patients were presented; 22 were discussed more than once. Most
common diagnoses were tetrology of Fallot (
n
=
14), transposition
of the great arteries (
n
=
10), double-outlet right venticle (
n
=
9),
atrio-ventricular canal (
n
=
8), and ventricular septal defect (
n
=
6).
Mean age was 4.8 years (3 days – 30 years); 44 cases were under two
years old. Mean oxygen saturation was 83%; 22
≤
80%. Additional
imaging was recommended in 22 patients; improvement in echocar-
diography skills was observed. Cardiac surgery was performed in
25% of patients, half had a difference in approach as a result of the
teleconference. Three operations (tetralogy of Fallot, atrioventricular
canal, D-transposition) were performed sucussfully in infants for the
first time. Meetings with US and Moroccan government officials
contributed to ongoing support. Focus on barriers including technol-
ogy, satellite availability, language, funding and time difference has
contributed to the sustainability of the project.
Conclusions:
Telemedicine is an innovative and practical means to
augment the skills of paediatric cardiovascualar surgery teams in the
developing world.
1402: INTERMEDIATE-TERM RESULTS FOLLOWING
POST-CARDIOTOMY EXTRACORPOREAL MEMBRANE
OXYGENATION (ECMO) SUPPORT IN CONGENITAL
HEART SURGERY(CHS) PATIENTS
Syed Murfad Peer
1
, Dominic A Emerson
1
, Michael Philippe-
Auguste
1
, David Zurakowski
2
, Pranava Sinha
1
, Richard A Jonas
1
,
John T Berger
1
, Dilip S Nath
1
1
Children’s National Medical Centre, Washington DC, USA
2
Children’s Hospital Boston, USA
Background:
There are considerable data regarding in-hospital
results of CHS patients requiring post-cardiotomy ECMO; however
there is limited information on mid-term outcomes.
Methods:
A retrospective, single-institutional review of 25 consecu-
tive CHS patients who survived to hospital discharge following
post-cardiotomy ECMO between January 2003 and June 2008
was completed. Primary endpoint was survival at last follow up.
Secondary endpoints included evidence of neurological deficits,
renal injury, respiratory failure, and unplanned cardiac re-interven-
tions and hospitalisations.
Results:
Median age at ECMO support was four months. Primary
indications for ECMO included cardiac arrest (12.48%), low cardiac
output (7.28%), failure to wean from CPB (5.20%), and hypoxia
(1.4%). There were 24 survivors; one death occurred within 48
hours of hospital discharge. Median follow up was 3.4 years (IQR:
1.7–6.0). Kaplan–Meier patient survival was 95% at three years
(95% CI: 88–99%). Neurological deficits were present in seven
