Journal of the Bahrain Medical Society
Year 2021, Volume 33, Issue 4, Pages 12-18
https://doi.org/10.26715/JBMS.33_2021_4_4Suad R Al Amer1, Abhinav Agarwal2*, Vimalarani Arulselvam3, Abdulla Faisal Alshaiji4, Neale Nicola Kalis5
1Senior Lecturer, Pediatrics, Royal College of Surgeons of Ireland – Medical University of Bahrain (RSCI-MUB). Consultant, Department of Pediatric Cardiology, Mohammed bin Khalifa bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital,Kingdom of Bahrain.
2Senior Resident, Department of Pediatric Cardiology, Mohammed bin Khalifa bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Kingdom of Bahrain.
3Chief Resident, Department of Pediatric Cardiology, Mohammed bin Khalifa bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Kingdom of Bahrain.
4Resident,Department of Pediatric Cardiology, Mohammed bin Khalifa bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Kingdom of Bahrain.
5Professor, Pediatrics, Royal College of Surgeons of Ireland – Medical University of Bahrain (RSCI-MUB). Head of Department, Department of Pediatric Cardiology, Mohammed bin Khalifa bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Kingdom of Bahrain.
*Corresponding author: Abhinav Agarwal, MBBS, MD, FPC (RGUHS), The Mohammed bin Khalifa bin Salman Al-Khalifa Cardiac Center, Road 4524, Block 945, Al Rifa Wa Al Mintaqah, Awali, Kingdom of Bahrain; Tel: + (973) 32072096, E-mail: abhi899@gmail.com
Received date: 23 July 2021; Accepted date: 6 September 2021; Published date: December 31, 2021
Abstract
Background & Objectives: Arrhythmias are common in pediatric population and is suspected in patients presenting with palpitations and/or syncope. These patients are commonly referred to Pediatric Cardiology for further evaluation either after identifying rhythm abnormality or based on clinical suspicion only. The objective of this study was to assess the yield of pediatric cardiology referrals for arrhythmia evaluation.
Methods: This is a single-center retrospective observational descriptive study. A total of 486 patients referred to the pediatric cardiology department from the year 1998 to 2020 were included. Patients were grouped based on referral, Group 1 consisted of patients referred with documented arrhythmia and Group 2 had patients referred on clinical suspicion. Patient’s age at presentation, gender, reason for referral, type of arrhythmias, any associated structural heart disease, interventions, and outcomes were analysed.
Results: Group 1 had 156 (32.1%) patients and group 2 had 330 (67.9%) patients. The most common diagnosis in group 1 was atrioventricular re-entry tachycardia and in group 2 was premature ventricular contractions. There was no variability for the type of arrhythmia between the two groups. Among patients in group 2, 315 (95.4%) had no evidence of electrophysiological abnormalities. Positivity rates for arrhythmia were only 3.2% for palpitations and 9% for syncope. 28 (5.8 %) patients required interventions; all from group 1.
Conclusion: Clinically significant arrhythmias were mostly diagnosed at the point of first contact. Patients referred on clinical suspicion were mostly normal electro-physiologically. Inappropriate referrals increase the workload on pediatric cardiology services. There is an urgent need to regularise referrals.
Keywords: Cardiac arrhythmia, Heart diseases, Referral and consultation, Syncope, Tachycardia