الفهرس 
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Abstract
This was a prospective, observational study at Electrophysiology Unit-Ain Shams University from October 2018 to September 2020. the study was conducted on 60 child ≤18 years referred to Electrophysiology Unit-Ain Shams University with High burden PVCs (≥10% of total beats per day) that were divided into two groups, each composed of children and of both sexes, referred for possible Electrophysiology study and radiofrequency catheter ablation. We included only children with up to two PVCs morphologies and at least 10% ventricular ectopy burden on a 24-h Holter monitor and structurally normal heart.
the study population was divided into group A, in whom antiarrhythmic drugs were offered with strict follow-up and the Electrophysiology study was deferred and group B, where children ≥ 4 years old in whom Electrophysiology study and radiofrequency catheter ablation was performed if still symptomatic despite at least 3 months duration of AADs or developed adverse effects from AADs and if started to develop PVCs induced cardiomyopathy manifestations, either clinically or via echocardiographic parameters.
All selected patients were subjected to baseline full history taking along with full clinical examination, standard or 12-lead Holter recording, and echocardiography were performed. Patients were asked to return for regular follow-up at 3, 6 and 12 months after either RFA or starting AAD. Clinical symptoms were collected. Physical examination, repeat standard ECG, standard or 12-lead Holter recording, and echocardiography were performed.
We studied the influence of high burden PVCs on myocardial velocities and function assessed by transthoracic echocardiography, and we compared the efficacy of RFA and AADs on PVC burden and the echocardiographic parameters in clinical practice. And we tried to identify factors associated with risk of developing PVC induced cardiomyopathy in children.
In our study of sixty consecutive children divided into two equal groups in number according to whether RFCA was performed or AADs was continued with high burden idiopathic PVCs were prospectively, evaluated for almost 1 year follow-up duration at both groups. The study consisted of 33 boy and 27 girls distributed on both groups.
The mean Burden (%) of PVCs during baseline 24-h Holter monitoring was 23.3±9.0 and 21.6±8.2 in RFCA group and AADs group, respectively. The mean time to follow-up Holter monitoring was 1.1±0.5 year after therapy.
In our study we found no significant differences between the studied groups regarding age at intervention, age at follow up, follow up duration and gender. Treatment success was significantly more frequent among RFCA group. FU burden was significantly lower in RFCA, Burden reduction was significantly higher in RFCA. Sinus cycle length significantly increased in both groups. Burden significantly decreased in both groups.
Also, we found that no significant differences between the studied groups regarding baseline, follow up and changes in weight, height and BSA. Weight, height and BSA significantly increased in studied groups. No significant differences between the studied groups regarding baseline, follow up and changes in all echocardiography findings. No significant changes in all echocardiography findings except LVEDD, LVESD and RVSP; were significantly increased in both groups as well as Peak systolic tricuspid annular velocity; significantly decreased in RFCA.
There were no significant differences between the studied groups regarding baseline main symptom. Asymptomatic presentation at follow up was significantly more frequent in RFCA group. Asymptomatic presentation frequency significantly increased in both groups. AADs medications cessation was significantly more frequent among RFCA group.
In cases that continued medications, Baseline side effects were significantly more frequent in RFCA group. No significant differences between the studied groups regarding follow-up side effects. AADs side effects significantly decreased in RFCA group.