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Sunthankar SD, Kannankeril PJ, Gaedigk A, Radbill AE, Fish FA, Van Driest SL. Influence of CYP2D6 Genetic Variation on Adverse Events with Propafenone in the Pediatric and Young Adult Population. Clin Transl Sci 2022; 15:1787-1795. [PMID: 35514162 PMCID: PMC9283732 DOI: 10.1111/cts.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/12/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022] Open
Abstract
Propafenone is an antiarrhythmic drug metabolized primarily by cytochrome P450 2D6 (CYP2D6). In adults, propafenone adverse events (AEs) are associated with CYP2D6 poor metabolizer status; however, pediatric data are lacking. Subjects were tested for 10 CYP2D6 allelic variants and copy number status, and activity scores assigned to each genotype. Seventy‐six individuals (median 0.3 [range 0–26] years old) were included. Propafenone AEs occurred in 29 (38%); 14 (18%) required drug discontinuation due to AE. The most common AEs were QRS (n = 10) and QTc (n = 6) prolongation. Those with AEs were older at the time of propafenone initiation (1.58 [0.13–9.92] vs. 0.20 [0.08–2.01] years old; p = 0.042). CYP2D6 activity scores were not associated with presence of an AE (odds ratio [OR] 0.48 [0.22–1.03]; p = 0.055) but with the total number of AE (β1 = −0.31 [−0.60, −0.03]; p = 0.029), systemic AEs (OR 0.33 [0.13–0.88]; p = 0.022), and drug discontinuation for systemic AEs (OR 0.28 [0.09–0.83]; p = 0.017). Awareness of CYP2D6 activity score and patient age may aid in determining an individual's risk for an AE with propafenone administration.
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Affiliation(s)
- Sudeep D Sunthankar
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Pediatric Precision Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Prince J Kannankeril
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Pediatric Precision Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology, & Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Andrew E Radbill
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank A Fish
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara L Van Driest
- Center for Pediatric Precision Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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Fujita S, Kabata E, Nishida K, Ueno K, Futatani T, Igarashi N, Murata A, Hatasaki K. The efficacy of pacemaker implantation for extracardiac total cavopulmonary connection in a pediatric patient with bradycardia-tachycardia syndrome. J Cardiol Cases 2022; 25:255-258. [DOI: 10.1016/j.jccase.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/03/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
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Carberry T, Tsao S, Chaouki AS. Patient-activated Anti-tachycardia pacing in adult congenital heart disease. Pacing Clin Electrophysiol 2022; 45:711-716. [PMID: 35266171 PMCID: PMC9314925 DOI: 10.1111/pace.14475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/07/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
Introduction In adults with congenital heart disease, intra‐atrial reentrant tachycardia (IART) is a common arrhythmia that causes significant morbidity and mortality. One treatment option for IART is antitachycardia pacing. Atrial antitachycardia pacing algorithms deliver therapy for IART with ≥2:1 conduction, but most algorithms will not recognize IART with 1:1 conduction. Temporary Patient Activated Rx (TPARx) is Medtronic software that can be installed in antitachycardia pacemakers allowing patients to deliver therapies on demand for IART with 1:1 conduction. Methods Retrospective chart review at a single institution of all patients who had TPARx installed into their pacemaker. Results Four adults with single ventricle congenital heart disease and IART underwent Fontan conversion, arrhythmia surgery, and placement of an epicardial dual‐chamber antitachycardia pacemaker. They had recurrent IART with a long cycle length and 1:1 conduction that failed to trigger antitachycardia pacing therapies. TPARx software was programmed into their pacemakers to allow recognition and treatment of IART with 1:1 conduction. Mean follow‐up duration after TPARx programming was 4.9 years. Each patient received at least one successful antitachycardia pacing therapy via TPARx – range 0.4–26 treated IART episodes per year. There were no atrial or ventricular arrhythmias induced with antitachycardia pacing. Two patients were able to discontinue anticoagulation after TPARx installation. Conclusion This series demonstrates the use of TPARx software as part of a long‐term IART management strategy in select patients with IART who have failed more conventional therapies.
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Affiliation(s)
- Thomas Carberry
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL, USA
| | - Sabrina Tsao
- Division of Cardiology, Hong Kong Children's Hospital, The University of Hong Kong, Shing Cheong Rd, Ngau Tau Kok, Hong Kong
| | - Ahmad Sami Chaouki
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL, USA
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Kawada S, Nishii N, Asada S, Nakagawa K, Morita H, Ito H. Successful ablation of a superior fast-slow atrioventricular reentrant tachycardia in a patient with congenitally corrected transposition of great arteries. HeartRhythm Case Rep 2021; 7:698-701. [PMID: 34712569 PMCID: PMC8530927 DOI: 10.1016/j.hrcr.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Saori Asada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 493] [Impact Index Per Article: 164.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Wang W, Jiang TF, Han WZ, Jin L, Zhao XJ, Guo Y. Efficacy and economic benefits of a modified Valsalva maneuver in patients with paroxysmal supraventricular tachycardia. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Wang W, Jiang TF, Han WZ, Jin L, Zhao XJ, Guo Y. Efficacy and economic benefits of a modified Valsalva maneuver in patients with paroxysmal supraventricular tachycardia. World J Clin Cases 2020; 8:5999-6008. [PMID: 33344598 PMCID: PMC7723698 DOI: 10.12998/wjcc.v8.i23.5999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/30/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A modified Valsalva maneuver (VM) has been suggested to be superior to the standard VM for conversion of paroxysmal supraventricular tachycardia (PSVT).
AIM To evaluate the efficacy and economic benefits of a modified VM in Chinese patients.
METHODS Patients with PSVT admitted to our center between October 2017 and September 2019 were randomly assigned to the modified and standard VM groups. Conversion via VM was performed up to three times. The primary outcome of the study was the success rate of PSVT conversion to sinus rhythm. The secondary outcomes included the incidence of adverse events, economic cost during the visit, and the degree of patient acceptance of the treatment.
RESULTS Overall, 361 patients were enrolled, with 180 allocated to the modified VM group and 181 to the standard VM group. Baseline characteristics were well matched in the groups. Overall, the modified VM group had higher success rates of PSVT conversion after single (47.78% vs 15.38%, P < 0.001) and multiple (62.22% vs 19.78%, P < 0.001) VM sessions. No significant differences in the incidences of adverse events and rates of patient acceptance were detected between the two groups (both P > 0.05). Moreover, the economic cost of the clinic visit was significantly lower for the modified VM group than for the standard VM group (P < 0.05).
CONCLUSION The modified VM may confer both therapeutic and economic benefits as compared with the standard VM for conversion of PSVT.
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Affiliation(s)
- Wei Wang
- Internal Medicine-Cardiovascular Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Teng-Fei Jiang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University
| | - Wei-Zhong Han
- Internal Medicine-Cardiovascular Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Lin Jin
- Internal Medicine-Cardiovascular Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Xiao-Jing Zhao
- Internal Medicine-Cardiovascular Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Ying Guo
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Kugamoorthy P, Spears DA. Management of tachyarrhythmias in pregnancy - A review. Obstet Med 2020; 13:159-173. [PMID: 33343692 DOI: 10.1177/1753495x20913448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/16/2020] [Indexed: 11/16/2022] Open
Abstract
The most common arrhythmias detected during pregnancy include sinus tachycardia, sinus bradycardia, and sinus arrhythmia, identified in 0.1% of pregnancies. Isolated premature atrial or ventricular arrhythmias are observed in 0.03% of pregnancies. Arrhythmias may become more frequent during pregnancy or may manifest for the first time.
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Affiliation(s)
| | - Danna A Spears
- University Health Network - Toronto General Hospital, Toronto, Canada
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Diagnostic and Therapeutic Approach to Arrhythmias in Adult Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:44. [PMID: 31342289 DOI: 10.1007/s11936-019-0749-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Adult survivors of congenital heart disease (CHD) are at increased risk of arrhythmia. The goal of this review is to outline diagnostic and therapeutic approaches to arrhythmia in adult CHD patients. RECENT FINDINGS Macro-reentrant atrial tachyarrhythmia is the most common arrhythmia encountered in adults with CHD. Approximately 25% of hospitalizations associated with arrhythmia. The risk of ventricular arrhythmia is estimated as high as 25-100 times that for the general population and increased after two decades. Routine ambulatory monitoring is important for arrhythmia risk assessment in adults with CHD. There are limitations, potential adverse effects, and risk of recurrence with antiarrhythmic drugs, catheter ablation, and surgical approaches. Adults with CHD suffer various forms of arrhythmia, are at increased risk of sudden death, and require special consideration for medical and interventional therapy.
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Faisaluddin M, Ashish K, Hajra A, Mondal S, Bandyopadhyay D. Etripamil: Self-management of supraventricular tachycardia is not far away? IJC HEART & VASCULATURE 2019; 22:82-83. [PMID: 30627628 PMCID: PMC6321861 DOI: 10.1016/j.ijcha.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | - Kumar Ashish
- Crozer-Chester Medical Center, Philadelphia, USA
| | | | - Samhati Mondal
- University of Maryland Medical Center, Baltimore, MD, USA
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Kramer CC, Maldonado JR, Olson MD, Gingerich JC, Ochoa LA, Law IH. Safety and efficacy of atrial antitachycardia pacing in congenital heart disease. Heart Rhythm 2018; 15:543-547. [DOI: 10.1016/j.hrthm.2017.12.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 11/26/2022]
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12
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Kramer CC, Maldonado JR, Olson MD, Gingerich JC, Ochoa LA, Law IH. Atrial Antitachycardia Pacing in Complex Congenital Heart Disease: A Case Series. J Innov Card Rhythm Manag 2018; 9:3079-3083. [PMID: 32477803 PMCID: PMC7252767 DOI: 10.19102/icrm.2018.090304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/29/2017] [Indexed: 11/06/2022] Open
Abstract
Among the congenital heart disease (CHD) population, intra-atrial reentrant tachycardia (IART) is a common sequela resulting from anatomical anomalies and surgical scars that significantly increases morbidity and mortality. Atrial antitachycardia pacing (ATP) delivered by atrial antitachycardia devices (ATDs) has been used to treat IART in the CHD population. However, there remains limited data on the safety and efficacy of ATP, as well as on comparisons of its effects amongst different CHD subtypes. The purpose of the current study is to describe the clinical history and ATP efficacy in three patients with unique forms of complex CHD. During this study, a single-center review of three patients with ATDs was performed. One patient with each of the following CHD anomalies was selected for inclusion: systemic left ventricle, systemic right ventricle, and single ventricle. Data collected included ATP success rates, medications in use, direct current (DC) cardioversions, and any complications related to the ATDs. Study findings revealed the patient with a systemic left ventricle had an ATD implanted for approximately 9.5 years, with 695 of 956 (73%) episodes successfully converted. Unsuccessfully treated episodes were generally asymptomatic and self-terminating in this patient. The patient with a systemic right ventricle had an ATD implanted for approximately 16 years, with 333 of 348 (96%) episodes being successfully converted. The patient with a single ventricle had an ATD implanted for approximately 12.5 years, with 404 of 416 (97%) episodes successfully converted. The patients with biventricular physiology were able to forgo DC cardioversion after receiving their ATDs. However, due to medical noncompliance as well as multiple episodes of IART, which presented with 1:1 conduction or low rates, the single-ventricle patient still required DC cardioversions post-ATD implantation. In conclusion, this study’s findings demonstrate that, while ATP can be effective in a wide variety of CHDs, experiences can vary based on individual arrhythmia substrates, cardiac anatomy, and medical compliance. Additionally, challenges remain in IART detection in patients with especially complex CHD anatomies.
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Affiliation(s)
- Collin C Kramer
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jennifer R Maldonado
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Mark D Olson
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Jean C Gingerich
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Luis A Ochoa
- University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Ian H Law
- University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
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