[Event recorder for etiological evaluation of sporadically occurring cardiovascular complaints and symptoms]. / Event-Rekorder zur ätiologischen Abklärung sporadisch auftretender kardialer Beschwerden und Symptome.

Rarely and transient occurring arrhythmia, palpitation, dizziness, syncopes and chest pain frequently cause symptoms and complaints to patients with congenital cardiac defects. The reliable identification of their pathogenesis is often difficult. The study presented here demonstrates the impact of an event recorder for enlightening sporadically occurring complaints and symptoms. Fifty patients (age between 11 and 70 years, median 27 years) were examined with an event recorder (King of Hearts Express, Instromedix, Hillsboro, USA). The patients were referred to an outpatient clinic for congenital cardiac defects in order to clarify unexplained arrhythmia, palpitations, dizziness, or syncope. Included were patients above 10 years of age. Previous cardiac studies (including ECG, exercise-ECG, Holter-Monitoring) were non-diagnostic in all. Altogether 227 ECGs had been recorded. 95% of them were of diagnostic quality. The event recorder afforded ambulatory monitoring and the median duration of monitoring was 22.5 days. The average number of registered events was 4.5 +/- 3.8. In 24% of the patients (n = 12) diagnostic and/or therapeutical consequences resulted: electrophysiological examination (n = 5), drug treatment (n = 4) and pacemaker implantation (n = 3). The event recorder is an important and highly effective tool in diagnosing sporadical transient symptoms and complaints, especially arrhythmias.

[Munchausen syndrome by proxy]. / Münchhausen-by-proxy-Syndrom.

The term "Munchausen by proxy" denotes a special form of factitious disorder and a rare kind of child abuse. We present the case of a 12-year-old boy, whose mother's manipulations culminated in his immobilization in a wheelchair and the implantation of a pacemaker. Problems of diagnosis and clinical management of Munchausen by proxy are discussed.

Atrial automatic tachycardia in infancy and childhood.

Twenty-one cases (13 male, eight female) of atrial automatic tachycardia (AAT) assessed by standard and Holter-ECG in otherwise healthy infants and children have been documented. AAT was incessant in 12 patients, repetitive in seven, and of undetermined type in the remaining two. The frontal P wave axis suggested an ectopic focus in the high right atrium or right atrial appendage in 13 patients, in the low right atrium in one patient, and in the left atrium in seven patients. Thirteen out of 14 patients with the incessant or undetermined type of AAT were symptomatic, in contrast to only two of seven patients with the repetitive type. All patients were treated with between one and eight (median three) antiarrhythmic drugs. The most effective drug was amiodarone, followed by the class I C antiarrhythmic drugs, propafenone and flecainide. At present, all patients are alive 4 months to 21 years (median 2.5 years) after diagnosis of AAT. Twelve patients are in sinus rhythm, five of them without any medication. Nine patients still have AAT, which, however, is repetitive or intermittent in all but one. In conclusion, AAT is an unusual, and in its incessant form often severely symptomatic arrhythmia, which is resistant to conventional antiarrhythmic medication. However, amiodarone and class I C antiarrhythmic drugs are frequently effective. Since medical treatment with these drugs is often successful, and AAT may resolve completely, a conservative approach is indicated in many cases.

[Extrasystole in the neonatal period]. / Extrasystolie im Neugeborenenalter.

We investigated the clinical course in 35 healthy newborn with premature beats and studied the literature with regard to their frequency, pathogenesis, and therapy with the following results: Investigations with continuous monitoring or long-term ECG registration show a frequency of 7-25%. In literature, almost one-fourth, in our patients one-half of the newborn have ventricular premature beats. These will probably disappear later than atrial premature beats, but their prognosis is not worse. The premature beats of newborn are often complex (blocked or aberrant conduction, bigeminus, tachycardia). Atrial flutter is sometimes associated. In one-half of cases they disappear spontaneously during the first month of life. However, they lasted for longer than 4 months in 7 out of 35 infants. The disorder increased after birth in 2 children, which is unusual. Therapy was indicated if there were signs of heart failure, frequent or increasing rate of tachycardia or atrial flutter. Premature beats do not indicate primary operative delivery. Immaturity of the central and autonomous nervous system and of the conduction-tissue of the heart may be the reason for frequent perinatal premature beats.