| Abstract: |
pediatric dysrhythmias presents a diagnostic challenge to most clinicians, but this shouldn′t be the matter for pediatric intensivists who must identify and appropriately manage these disorders. In pediatric intensive care unit, it is necessary to quickly determine which pediatric ECG findings (on the bedside monitor or ECG strip) are normal, which is abnormal, and which must be addressed immediately. Not all patients who suffered cardiac arrhythmias in our pediatric intensive care unit were admitted for arrhythmias. The majority of these patients were admitted for other indications. So, a pediatric intensivist must be aware of the different types of arrhythmias and the possible risk factors that can initiate or aggravate these arrhythmias. This will be useful to shorten the duration of arrhythmia and to decrease the liability for clinical deterioration or degeneration into cardiopulmonary compromise or death.Objectives: The objective to be achieved of this study is to determine the incidence, risk factors and prognostic value of arrhythmias in Pediatric Intensive Care Unit.Patients and methods: During this study, 526 patients were admitted to our PICU for different indications. On admission, patients were grouped into five groups according to the diagnosis at admission. Arrhythmia patients were thoroughly studied for underlying medical disease, presenting hemodynamic status, metabolic disorders. electrolyte abnormalities, hypoxemic changes, and history of drug intake or previous cardiac surgery. Apart from sinus tachycardia, arrhythmias by its different types had no significant association to age. Sex had no statistically significant effect on arrhythmias.Results: Hypoxemia in its first hours represented a major risk factor for sinus tachycardia. Sinus bradycardia was significantly related to drug toxicities (digoxin overdose or toxicity), and electrolyte and metabolic disorders. Only, sinus tachycardia and sinus bradycardia were documented to have statistically significant effect on the outcome of admitted patients. Congenital and acquired heart diseases either previously operated or not has a high incidence of different abnormal heart rhythms including PVCs that may herald serious and fatal arrhythymias. These dysrhythmias should not be missed, but early recognized and managed for better survival rates. PACs in this study were of benign pattern and were not associated with hemodynamic disturbances. Ventricular conduction disturbances were highly associated with previously operated heart. Long QT duration cases were all acquired cases and significantly associated with hematological abnormalities and other multiple underlying medical conditions. 1st degree heart block is common and significantly associated with congenital heart diseases, metabolic, and electrolyte disorders. Also it is common to occur secondary to associated sins bradycardia. SVT was significantly associated with acquired heart diseases. Eight cases (53.3%) were idiopathic. Although it is the most common manifesting arrhythmia in children, it was found that it has no significant impact on the outcome of affected patients.
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