TC Yung, MP Leung

Introduction: Cardiac arrhythmia is an uncommon disorder in children. Although an accurate diagnosis can usually be made from the surface electrocardiogram (ECG), paediatricians who are not familiar with cardiac arrhythmia may request a second opinion. In 1995, we introduced ECG fax consultation service at the Grantham Hospital. The objective of this study was to assess the efficacy of this consultation service and compare it with our out-patient cardiac arrhythmia clinic.

Result: From August 1995 to June 1997 (23 months), we received 54 ECG consultations through fax from 11 public hospitals. Forty (74%) consultations requested expert opinion on the cardiac rhythm. Fourteen (26%) cases were consulted for diagnosis. All the faxed ECG tracings were of reasonable quality and could be interpreted. The rhythm diagnosis were SVT (9), VE (7), AT (6), SR (6), SVE (5), VT (4), JT (4), A Flutter (3) and others (10). All consultations were replied within 24 hours by phone. In 10 cases (18.5%), advice on acute treatment was given (4 DC version, 5 anti-arrhythmic drug, 1 cardiac pacing). Thirty-four cases (63%) did not require subsequent referral for further assessment.

During the same study period, there were 116 new cases referred to our cardiac arrhythmic clinic (the ratio of fax to out-patient consultation was 1:2). The average time between referrals and consultation replies was 26.4 days (average waiting time for consultation = 21 days, range = 1-88 days; average time from consultation to sending out replies = 5.4 days, range = 0-14 days).

Conclusions:

1. ECG fax consultation significantly reduced the workload of out-patient arrhythmia clinic.

2. The fax consultation was more efficient than the outpatient service.

3. Accurate diagnosis could be made from the faxed ECG tracings to guide the acute management of arrhythmia.