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ARRHYTHMIAS AMONG YOUNG MALE SOLDIERS UP TO 40 YEARS OF AGE WITH STRUCTURALLY NORMAL HEART.

Byline: Ajab Khan, Imran Ali, Azmat Hayat, Muhammad Shabbir, Rehana Khadim, Ali Nawaz, Hafiz Muhammad Shafiq and Naqib Ullah

ABSTRACT

Objective: To classify different types of arrhythmias and to study their frequency and presentations among young male soldiers up to 40 years of age who have structurally normal heart.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: Inpatient and Outpatient departments of Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from Jan 2016 to December 2017.

Materials and Methods: It was a descriptive cross sectional study conducted at inpatient and outpatient departments of AFIC/NIHD, Rawalpindi from Jan 2016 to Dec 2017. Male soldiers between 18 to 40 years of age; with no known structured heart disease and presenting with cardiac arrhythmias, not secondary to electrolytes imbalances, hormonal disorders or drugs intake were included in the study through consecutive sampling from hospital record papers. Ethical and institutional approval was taken from IERB committee. Arrhythmias and types were defined as per standard ECG criteria and Holter monitoring. Types of arrhythmias were noted through recorded ECGs and holter reports. Data was entered and analyzed using SPSS version 23.

Results: A total of 286 patients were recruited in the study. Mean age of the patients was 34.5 +- 7.6 years. The most common arrhythmia type was found to be supra ventricular tachycardia (SVT) 126 (44%), followed by premature ventricular contractions (PVCs) 80 (28%), early repolarization 34 (11.9%), Atrial Fibrillation (AF) 25 (8.7%), first degree heart block 15 (5.2%), Inappropriate sinus tachycardia (IST) 6 (2.1%). Among SVT common arrhythmias were Atrial Tachycardia (AT) 50 (17.5%) and atrioventricular nodal re-entry tachycardia (AVNRT) 38 (13.2%). Among the recorded symptoms, a palpitation was the most common symptom. No symptoms were recorded for first degree heart block and early repolarization.

Conclusion: Common arrhythmias in young male soldiers having structurally normal hearts were PVCs and SVTs. Among SVTs, AT and AVNRT were commonly observed arrhythmias. Dizziness was the common complaint in PVCs. Palpitations was the most commonly observed symptom.

Keywords: Arrhythmias, Atrioventricular nodal re-entry tachycardia, Atrial tachycardia, Atrial fibrillation, First degree heart block, Supra ventricular tachycardia.

INTRODUCTION

Cardiac arrhythmias can be benign and can lead to potentially disabling medical conditions or even sudden cardiac death1,2. Varied causes can lead to arrhythmias in structurally normal or abnormal hearts, including electrolytes abnormalities, channelopathies, hormonal disorders and ischemic cardiac events3. Common presenting symptoms are dizziness, palpitations, and syncope but in contrast to these ubiquitous complaints, sudden cardiac death remains an important public health concern. statistics from the center for disease control and prevention have estimated sudden cardiac death rates at more than 600, 000 per year in USA4. Atrial fibrillation is the most common arrhythmia and accounts for the majority of arrhythmiarelated hospitalizations5. Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common of paroxysmal supraventricular tachycardia (PSVT) in adults6,7. Idiopathic ventricular tachycardia (VT) account for 10% of all VT diagnoses8,9.

There are community based studies reporting prevalence of different types and common presentations of arrhythmias but, to best of our knowledge and search, no study has been done on soldiers. Purpose of this novel study, is to classify different types of arrhythmias, their presentations and frequencies among soldiers up to 40 years of age who have structurally normal heart.

MATERIAL AND METHODS

It was a descriptive cross sectional study conducted at inpatient and outpatient departments of Armed Forces institute of cardiology and National institute of heart diseases, Rawalpindi from Jan 2016 to Dec 2017. Male soldiers between 18 to 40 years of age; with no known coronary artery disease and presenting with cardiac arrhythmias, not secondary to electrolytes imbalances, hormonal disorders or drugs intake were included in the study through consecutive sampling from hospital record papers. Ethical and institutional approval was taken from IERB committee. Arrhythmias and types were defined as per standard ECG criteria and Holter monitoring. Types of arrhythmias were noted through recorded ECGs and Holter reports. Palpitations are defined as an unpleasant awareness of forceful or rapid heartbeats10.

Dizziness and syncope are defined as the sudden transient loss of consciousness with associated loss of postural tone and spontaneous recovery without neurological deficit11. Data was entered and analyzed using SPSS version 23.

Table-I: Showing types of arrhythmias.

Types of Arrhythmias###n=286 (%)

Supra Ventricular Tachycardia (SVT)###126 (44%)

AVNRT###38 (13.2%)

AVRT###30 (10.4%)

Atrial Tachycardia###50 (17.5%)

Atrial Flutter###8 (2.8%)

Atrial Fibrillation###25 (8.7%)

Premature Ventricular Contractions###80 (28.0%)

Inappropriate Sinus Tachycardia###6 (2.1%)

First Degree Heart Block###15 (5.2%)

Early Repolarization###34 (11.9%)

Table-II: Common presentations of arrhythmias.

Presenting complaint AVNRT###AVRT###AT###AFL###AF###PVCs###IST

Dizziness###1%###10%###-###20%###-###30%###-

Palpitation###65%###50%###72%###70%###80%###10%###77%

Blackouts###-###-###-###-###-###-###-

Dyspnea###7%###-###-###5%###-###-###5%

Pre-Syncope###-###-###18%###-###-###-###16%

Syncope###-###-###-###-###-###-###-

RESULTS

A total of 286 patients were recruited in the study. Mean age of the patients was 34.5 +- 7.6 years. The most common arrhythmia was found to be Supra ventricular tachycardia (SVT) 126 (44%), followed by premature ventricular contractions (PVCs) 80 (28%), early repolarization 34 (11.9%), Atrial fibrillation (AF) 25(8.7%), first degree heart block 15(5.2%),inappropriate sinus tachycardia (IST) 6 (2.1%). Among SVT common arrhythmias were atrial tachycardia (AT) 50 (17.5%) and atrioventricular nodal re-entry tachycardia (AVNRT) 38 (13.2%), while Atrioventricular re-entry tachycardia (AVRT) and atrial flutter (AFL) were less common found in 30 (10.4%) and 8 (2.8%) cases, respectively, as shown in table-I. Among SVTs, AT presented with palpitations (72%) and pre-syncope (18%), while AVNRT, AVRT and AFL commonly presented with palpitations and dizziness (65% and 15%), (50% and 10%) and (70% and 20%), respectively.

Among PVCs, common presenting complaints were dizziness (30%) and palpitations (10%). Pre-syncope was common in AT and IST, as shown in table-II.

DISCUSSION

There has been significant progress in the understanding of the electrophysiological mechanisms and remodeling processes12. In present study SVT were the most common arrhythmias in patients with structurally normal hearts present in 44% cases. Among the SVTs most common arrhythmia was noted to be AT (17.5%) followed by AVNRT (13.2%) and AVRT (10.4%). Reported frequency of SVTs in studies conducted by Budhwar et al13 and Irfan et al14 is 34% and 38%, respectively. Other common arrhythmias in our study were PVCs present in 28% cases and early repolarization, in 11.9% cases. But in study reported by Abass et al, PVCs were found in 1% and early repolarization in 6% studied male population under 40 years of age with normal hearts15, while reported frequencies by Liesemer et al16 were 1.5% and 1.1% for PVCs and early repolarization among male cadets, respectively. In our study, AF was found in 8.7%. Reported incidence of AF was 4.4% among military crew in study by Hunter et al17.

First degree heart block and IST were relatively less frequent, found in 5.2% and 2.1% subjects, respectively. This study has given an account of common clinical presentations for observed arrhythmias. Studies have showed no specific complaint or combination of complaints was likely to predict a disturbance in rhythm18. Only 40% subjects having PVCs had symptoms, and dizziness was the common complaint (30%). In AT 90% subjects had symptoms where palpitations was the common complaint. Among other arrhythmias, 95% of AFL, 87% of AVNRT and 80% of AF cases were symptomatic. Palpitations was the most common of the symptoms, with variable proportions, related with all types of studied arrhythmias. For first degree heart block and early repolarization no symptoms were noted. In study by Irfan et al, most frequently observed symptom was palpitations, but the mentioned proportions of each symptom was different than our study14.

Nevertheless, it should be kept in mind that the group of subjects analyzed in this study can only be described as selective, since all subjects were young soldiers (less than 40 years of age), it must be assumed that the prevalence revealed by this study is lower than would be the case in an age-matched comparison group from the general population. Furthermore, the major limiting factor was the frequency of symptoms itself, which may be complicated by the fact that the same arrhythmia may occur with different symptoms over a course of time.

CONCLUSION

Common arrhythmias in young male soldiers having structurally normal hearts were PVCs and SVTs. Among SVTs, AT and AVNRT were commonly observed arrhythmias. Palpitations was the most commonly observed symptom. Significant arrhythmias were detected in both symptomatic and asymptomatic patients, but it is difficult to attribute a symptom to an arrhythmias. Large population study is needed to demonstrate a close temporal relationship between symptoms and types of rhythm disorder.

CONFLICT OF INTEREST

This study has no conflict of interest to declare by any author.

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Publication:Pakistan Armed Forces Medical Journal
Date:Feb 28, 2018
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