Investigation of Asymptomatic Rhythm and Conduction System Disorders in Pediatric Patients Diagnosed with Acute Rheumatic Fever According to Current Guidelines

Objective: Acute rheumatic fever (ARF) is a non-suppurative, inflammatory disease. Various arrhythmias, the pathogenesis of which is unknown but thought to be immunological, are observed in ARF. This study aimed to detect the frequency of rhythm and conduction disorders, and to evaluate their relation with clinical findings in ARF patients diagnosed according to the updated Jones criteria, using 24-hour electrocardiography (ECG) recordings. Materials and Methods: This study included patients who applied between 2018 and 2021 and were diagnosed with ARF. Rhythm and conduction abnormalities were determined by examining their surface ECG and 24-hour ECG recordings (Holter). The relationship between rhythm and conduction abnormalities and clinical findings were also investigated. Results: Thirty-two patients with ARF with a mean age of 11.5 ± 2.9 years were included in this study. On the surface ECG, accelerated junctional rhythm (AJR) was detected in 2 patients. In Holter recordings, 7 patients had a prolonged PR interval, and a second-degree atrioventricular (AV) block was observed in 1 patient. In addition, 5 patients had AJR, and 1 patient had accelerated nodal beats (6/32, 18.7%), 2 patients had rare ventricular premature beats, 2 patients had rare, 3 patients had frequent supraventricular premature beats, 1 patient had nonsustained, and 1 patient had sustained supraventricular tachycardia. Accelerated junctional rhythm was more prevalent among patients with carditis+polyarthralgia (33%). Conclusion: The frequency of AJR detected on ECG and Holter monitoring in ARF is similar to that of other minor findings. Therefore, the presence of AJR could be used as a minor finding in the diagnosis of ARF.