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Tseng WC, Wu MH, Lu CW, Wu KL, Wang JK, Lin MT, Chen CA, Chiu SN. Combination of Slow Pathway Late Activation Maps and Voltage Gradient Maps in Guidance of Atrioventricular Nodal Reentry Tachycardia Cryoablation. Heart Rhythm 2023:S1547-5271(23)02105-7. [PMID: 37075960 DOI: 10.1016/j.hrthm.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The optimal strategy for electroanatomic mapping-guided cryoablation of atrioventricular nodal reentry tachycardia (AVNRT) remains unclear. OBJECTIVE To investigate the effectiveness of slow pathway late activation mapping (SPLAM) and voltage gradient mapping for AVNRT cryoablation. METHODS From June 2020 to February 2022, all consecutive patients with AVNRT underwent SPLAM to define the wave collision point and voltage gradient mapping to define the low voltage bridge (LVB). Conventional procedures performed from August 2018 to May 2020 served as control. RESULTS The study and control groups comprised 36 (aged 16.5±8.2 years) and 37 patients (aged 15.5±7.3 years), respectively. Total procedural times were comparable, and acute success rates were 100% in both groups. Compared to controls, number of cryomapping attempts (median 3 vs. 5, p=0.012) and cryoablation applications (median 1 vs. 2, p<0.001) were significantly lower in the study group. At a median follow-up of 14.6 and 18.3 months, recurrence rates were 5.6% (2 patients) and 10.8% (4 patients) in the study and control groups (p=0.402), respectively. Mapping of Koch's triangle took 11.8±3.6 min, in which 1562±581 points were collected. In SPLAM, wave collision points were defined and compatible with the final successful lesion sites in all patients, including those with multiple slow pathways. LVB could not be defined in 6 patients (16.7%), and LVB was not compatible with the final successful lesion in another 6 (16.7%). CONCLUSIONS For AVNRT cryoablation, SPLAM could effectively guide the localization of slow pathway ablation sites and was particularly beneficial in patients with multiple slow pathways.
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan; Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Kun-Lang Wu
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan. No. 320, Xuguang Rd., Changhua City, Changhua County 500, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan.
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Quinn TA, Kohl P. Cardiac Mechano-Electric Coupling: Acute Effects of Mechanical Stimulation on Heart Rate and Rhythm. Physiol Rev 2020; 101:37-92. [PMID: 32380895 DOI: 10.1152/physrev.00036.2019] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The heart is vital for biological function in almost all chordates, including humans. It beats continually throughout our life, supplying the body with oxygen and nutrients while removing waste products. If it stops, so does life. The heartbeat involves precise coordination of the activity of billions of individual cells, as well as their swift and well-coordinated adaption to changes in physiological demand. Much of the vital control of cardiac function occurs at the level of individual cardiac muscle cells, including acute beat-by-beat feedback from the local mechanical environment to electrical activity (as opposed to longer term changes in gene expression and functional or structural remodeling). This process is known as mechano-electric coupling (MEC). In the current review, we present evidence for, and implications of, MEC in health and disease in human; summarize our understanding of MEC effects gained from whole animal, organ, tissue, and cell studies; identify potential molecular mediators of MEC responses; and demonstrate the power of computational modeling in developing a more comprehensive understanding of ‟what makes the heart tick.ˮ.
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Affiliation(s)
- T Alexander Quinn
- Department of Physiology and Biophysics and School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany; and CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Peter Kohl
- Department of Physiology and Biophysics and School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany; and CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
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Zaballos M, Del Blanco B, Sevilla R, De Diego C, Anadon MJ, Jimeno C, Almendral J. Differential effects of sevoflurane and propofol on swine cardiac conduction system. Vet Anaesth Analg 2019; 46:344-351. [PMID: 30833141 DOI: 10.1016/j.vaa.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/05/2018] [Accepted: 11/30/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the effects of sevoflurane and propofol on the porcine cardiac conduction system. STUDY DESIGN A prospective, comparative study of electrophysiological properties of anaesthetics agents in an experimental porcine model. ANIMALS A total of 36 hybrid Landrace-Large White pigs. METHODS After premedication with 20 mg kg-1 of intramuscular ketamine, anaesthesia was induced with 4.5 mg kg-1propofol intravenously. In 18 consecutive animals, anaesthesia was maintained with propofol (13 mg kg-1 hour-1) and in the remaining 18 animals with 2.66% sevoflurane. The femoral artery and vein were canalized for invasive monitoring, analytical blood gas sampling and intracardiac catheter insertion. Following instrumentation and after a period of stabilization, a customary electrophysiological evaluation was performed. We compared the electrophysiology of the sinus and atrioventricular node (AV) node under sevoflurane or propofol anaesthesia, and the effects of both anaesthetics on atrial and ventricular refractoriness. RESULTS There was a significant difference in sinus node recovery time between sevoflurane and propofol (907 ± 231 versus 753 ± 146 ms, p = 0.02). Sevoflurane in comparison with propofol significantly prolonged specialized AV conduction times, represented by an increased Wenckebach cycle length (272 ± 54 versus 235 ± 40 ms, p = 0.03) and AV nodal refractoriness (327 ± 34 versus 287 ± 30 ms, p = 0.002). In addition, sevoflurane prolonged ventricular refractoriness (298 ± 27 versus 255 ± 38 ms, p = 0.007) and the QT corrected interval (0.50 ± 0.05 versus 0.46 ± 0.09 ms, p = 0.005). CONCLUSIONS AND CLINICAL RELEVANCE Sevoflurane in comparison with propofol, depresses several parameters of sinus and AV nodal function and prolongs the ventricular refractoriness of the porcine cardiac conduction system. These findings should be taken into consideration for the choice of anaesthetic agents in clinical and experimental settings.
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Affiliation(s)
- Matilde Zaballos
- Department of Toxicology, Complutense University, Madrid, Spain; Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Brezo Del Blanco
- Department of Anaesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Raul Sevilla
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Carlos De Diego
- Department of Cardiology, Hospital Universitario de Torrevieja, Alicante, Spain
| | - Ma José Anadon
- Department of Toxicology, Complutense University, Madrid, Spain
| | - Concepción Jimeno
- Department of Anaesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Jesús Almendral
- Department of Medicine, CEU San Pablo University, Madrid, Spain; Department of Electrophysiology, Grupo Hospital de Madrid, Madrid, Spain
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Safety and Efficacy of Radiofrequency Catheter Ablation for Tachyarrhythmia in Children Weighing Less Than 10 kg. Pediatr Cardiol 2018; 39:384-389. [PMID: 29119214 PMCID: PMC5797753 DOI: 10.1007/s00246-017-1766-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/28/2017] [Indexed: 11/28/2022]
Abstract
An increasing number of children are undergoing radiofrequency catheter ablation (RFCA) for tachyarrhythmia. However, infants and toddlers undergoing RFCA are often resistant to medication or need to eliminate arrhythmia substrate, and the risks of RFCA complications are still high in infants and toddlers. From April 2008 and December 2016, 285 children who underwent radiofrequency catheter ablation (RFCA) were stratified according to body weight (group A, less than 10 kg, n = 22; group B, over 10 kg, n = 263) and the clinical features of RFCA were retrospectively reviewed in these groups. Indications for RFCA included drug-refractory tachyarrhythmia or symptomatic tachycardia and tachycardia-induced cardiomyopathy. The acute success rate in this group was 90.9%, with a relatively low recurrence rate (15.0%) after 7.0 ± 1.6 years follow-up. We performed RFCA using only 2-4 catheters in all cases. Major complications included complete right bundle branch block in one patient. No significant differences in rates of success, recurrence, or complications were noted between children weighing less and more than 10 kg. RFCA is safe and efficacious for tachyarrhythmia even in patients weighing less than 10 kg.
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Hyun MC. Radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia in children and adolescents: a single center experience. KOREAN JOURNAL OF PEDIATRICS 2017; 60:390-394. [PMID: 29302263 PMCID: PMC5752639 DOI: 10.3345/kjp.2017.60.12.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/27/2022]
Abstract
Purpose Atrioventricular nodal reentry tachycardia (AVNRT) is less common in pediatric patients than in adult patients. Thus, data for pediatric AVNRT patients are insufficient. Hence, we aimed to analyze the patient characteristics, treatment, and any recurrences in pediatric AVNRT patients. Methods We reviewed the records of 50 pediatric AVNRT patients who had undergone radiofrequency catheter ablation (RFCA) between January 1998 and December 2016 at a single regional center. The patients were aged ≤18 years. Results Among 190 pediatric patients who underwent RFCA for tachyarrhythmia, 50 (26.3%; mean age, 13.4±2.6 years) were diagnosed as having AVNRT by electrophysiological study. Twenty-five patients (25 of 50, 50%) were male. Twenty patients (20 of 50, 40%) used beta-blockers before RFCA. All patients had no structural heart disease except 1 patient with valvular aortic stenosis and coarctation of the aorta. RFCA was performed using the anatomic approach under fluoroscopic guidance. The most common successfully ablated region was the midseptal region (25 of 50, 50%). Slow pathway (SP) ablation and SP modulation were performed in 43 and 6 patients, respectively. Complication occurred in 1 patient with complete atrioventricular block. During follow-up, 6 patients had recurrence of supraventricular tachycardia, as confirmed by electrocardiography. Among them, 5 underwent successful ablation at the first procedure. In 1 patient, induction failed during the first procedure. Conclusion RFCA is safe and effective in pediatric AVNRT patients. However, further research is needed for establishing the endpoints of ablation in pediatric AVNRT patients and for identifying risk factors by evaluating data on AVNRT recurrence after RFCA.
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Affiliation(s)
- Myung Chul Hyun
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
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Wu MH, Chen HC, Kao FY, Huang SK. Postnatal cumulative incidence of supraventricular tachycardia in a general pediatric population: A national birth cohort database study. Heart Rhythm 2016; 13:2070-5. [DOI: 10.1016/j.hrthm.2016.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Indexed: 11/30/2022]
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Lu CW, Wu MH, Chen HC, Kao FY, Huang SK. Epidemiological profile of Wolff–Parkinson–White syndrome in a general population younger than 50years of age in an era of radiofrequency catheter ablation. Int J Cardiol 2014; 174:530-4. [DOI: 10.1016/j.ijcard.2014.04.134] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/25/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
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Zachariah JP, Walsh EP, Triedman JK, Berul CI, Cecchin F, Alexander ME, Bevilacqua LM. Multiple accessory pathways in the young: the impact of structural heart disease. Am Heart J 2013; 165:87-92. [PMID: 23237138 DOI: 10.1016/j.ahj.2012.10.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The presence of multiple accessory pathways (MultAP) is described in structural heart disease (SHD) such as Ebstein's anomaly and cardiomyopathies. Structural defects can impact the tolerability of tachyarrhythmia and can complicate both medical management and ablation. In a large cohort of pediatric patients with and without SHD undergoing invasive electrophysiology study, we examined the prevalence of MultAP and the effect of both MultAP and SHD on ablation outcomes. METHODS Accessory pathway number and location, presence of SHD, ablation success, and recurrence were analyzed in consecutive patients from our center over a 16-year period. RESULTS In 1088 patients, 1228 pathways (36% retrograde only) were mapped to the right side (TV) in 18%, septum (S) in 39%, and left side (MV) in 43%. MultAP were present in 111 pts (10%), involving 250 distinct pathways. SHD tripled the risk of MultAP (26% SHD vs 8% no SHD, P < .001). Multivariable adjusted risk factors for MultAP included Ebstein's (OR 8.7[4.4-17.5], P < .001) and cardiomyopathy (OR 13.3[5.1-34.5], P < .001). Of 1306 ablation attempts, 94% were acutely successful with an 8% recurrence rate. Ablation success was affected by SHD (85% vs 95% for no SHD, P < .01) but not by MultAP (91% vs 94% for single, P = .24). Recurrence rate was higher for SHD (17% SHD vs 8% no SHD, P < .05) and MultAP (19% MultAP vs 8% single, P < .001). CONCLUSIONS MultAP are found in 10% of pediatric patients, and are more common in SHD compared to those with normal hearts. Both the presence of MultAP and SHD negatively influence ablation outcomes.
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Kim YH, Park HS, Hyun MC, Kim YN. Pediatric tachyarrhythmia and radiofrequency catheter ablation: results from 1993 to 2011. Korean Circ J 2012; 42:735-40. [PMID: 23236324 PMCID: PMC3518706 DOI: 10.4070/kcj.2012.42.11.735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/27/2012] [Accepted: 06/04/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We performed a retrospective study to elucidate the frequency of tachycardia mechanisms and the characteristics of accessory pathways (APs), confirmed by radiofrequency catheter ablation (RFCA) in pediatric tachycardia. In addition, we analyzed the efficacy and safety of pediatric RFCA. SUBJECTS AND METHODS The authors retrospectively reviewed the records of a total of 260 patients (aged 2 to 18 years) who had undergone RFCA between August 1993 and July 2011 at two medical centers in Daegu. RESULTS Two hundred and sixty patients underwent 272 RFCAs at less than 18 years of age. Of these 260 patients, 9 patients (3%) were younger than 6 years, and 175 patients (67%) were older than 12 years. The tachycardia mechanisms observed were atrioventricular reentry tachycardia (AVRT) in 175 patients (65%), atrioventricular nodal reentry tachycardia (AVNRT) in 83 patients (30%), ventricular tachycardia in 12 patients (4%), and atrial tachycardia in 2 patients (0.7%). Among the patients with AVRT, there were 94 concealed APs and 81 manifest APs. Left-side APs were more common in concealed APs than in manifest APs (72/94, 77% vs. 33/81, 41%, p<0.001). Sixty-six percent (55/83) of AVNRT cases were located at the M1 and/or M2 sites. Four patients had multiple tachycardia mechanisms (AVNRT+AVRT) and 9 patients had multiple APs. The recurrence rate was 5% (13/272). Of these recurrent cases, 12 patients had AVRT. The overall success rate was 95%. CONCLUSION Pediatric RFCA provides a good success rate and an acceptable recurrence. In addition, we suggest that the APs location may be associated with concealed or manifest property of APs.
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Affiliation(s)
- Yeo Hyang Kim
- Department of Pediatrics, Keimyung University Dongsan Medical Center, Daegu, Korea
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Warpechowski P, dos Santos ATL, Pereira PJI, de Lima GG. Effects of Propofol on the Cardiac Conduction System. Braz J Anesthesiol 2010; 60:438-44. [DOI: 10.1016/s0034-7094(10)70054-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 04/04/2010] [Indexed: 10/26/2022] Open
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Chiu SN, Lu CW, Chang CW, Chang CC, Lin MT, Lin JL, Chen CA, Wang JK, Wu MH. Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Infants and Toddlers. Circ J 2009; 73:1717-21. [DOI: 10.1253/circj.cj-09-0123] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Chun-Wei Lu
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | | | | | - Ming-Tai Lin
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Jiunn-Lee Lin
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Chun-An Chen
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Jou-Kou Wang
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Mei-Hwan Wu
- Department of Pediatrics and Medicine, National Taiwan University Hospital
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Chiu SN, Wang JK, Wu MH, Chang CW, Chen CA, Lin MT, Wu ET, Hua YC, Lue HC. Cardiac conduction disturbance detected in a pediatric population. J Pediatr 2008; 152:85-9. [PMID: 18154906 DOI: 10.1016/j.jpeds.2007.05.044] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Revised: 03/12/2007] [Accepted: 05/25/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To delineate the prevalence and clinical implications of cardiac conduction disturbance (CCD) in school-age children. STUDY DESIGN Between 1999 and 2001, a citywide survey of 432,166 elementary and high school students had been performed in Taipei by questionnaire, electrocardiography, phonocardiography, and physical examination. Patients with any abnormalities on this survey were referred for final diagnosis. RESULTS After excluding those with congenital heart disease (CHD), the prevalence of CCD was 0.75%, higher in males than in females (0.78% vs 0.71%). Incomplete right bundle branch block (IRBBB; 0.32%), complete right bundle branch block (CRBBB; 0.11%), ventricular premature contraction (0.11%), and Wolff-Parkinson-White syndrome (0.067 %) were the most common diagnoses. Second-degree atrioventricular block, IRBBB, CRBBB, and intraventricular conduction delay were more common in males; and atrial premature contraction was more common in females. The prevalence of CCD increased with age, from 0.48% in elementary school students to 0.97% in high school students. After detection of CCD, 39 patients with previously undiagnosed atrial septal defect (ASD) and 15 high-risk patients were found. The sensitivity of IRBBB in screening for ASD was 34.67%. CONCLUSIONS The prevalence of CCD in children without CHD was 0.75%. Detection of CCD helped identify patients with unrecognized ASD and high-risk cardiac patients.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Lee PC, Hwang B, Chen SA, Tai CGT, Chen YJ, Chiang CE, Meng CCL. The Results of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:655-61. [PMID: 17461876 DOI: 10.1111/j.1540-8159.2007.00727.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiofrequency (RF) catheter ablation represents a major advance in the management of children with cardiac arrhythmias and has rapidly become the standard of care for the first-ling therapy of supraventricular tachycardias (SVTs). The purpose of this study was to investigate the results of the RF catheter ablation of SVTs in pediatric patients. METHODS From December 1989 to August 2005, a total of 228 pediatric patients (age: 9 +/- 7 years, range: 5-18 years; male:female = 117:111) with clinically documented SVT underwent an electrophysiologic study and RF catheter ablation at our institution. RESULTS The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 140, 61%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 66, 29%), atrial tachycardia (AT; n = 11, 5%), and atrial flutter (AFL; n = 11, 5%). The success rate of the RF catheter ablation was 92% for AVRT, 97% for AVNRT, 82% for AT, and 91% for AFL, respectively. Procedure-related complications were infrequent (8.7%; major complications: high grade AV block (2/231, 0.9%); minor complications: first degree AV block (6/231, 2.6%), reversible brachial plexus injury (2/231, 0.9%), and local hematomas or bruises (10/231, 4.3%)). The recurrence rate was 4.7% (10/212) during a follow-up period of 86 +/- 38 months (0.5-185 months). CONCLUSIONS The RF catheter ablation was a safe and effective method to manage children with paroxysmal and incessant tachycardia. The substrates of the arrhythmias differed between the pediatric and adult patients. However, the success rate of the ablation, complications, and recurrence during childhood were similar to those of adults.
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Affiliation(s)
- Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
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Warpechowski P, Lima GG, Medeiros CM, Santos ATL, Kruse M, Migloransa MH, Kalil RAK. Randomized Study of Propofol Effect On Electrophysiological Properties of the Atrioventricular Node in Patients with Nodal Reentrant Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1375-82. [PMID: 17201845 DOI: 10.1111/j.1540-8159.2006.00550.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) is probably the most common form of paroxysmal supraventricular tachycardia. Percutaneous catheter ablation is a technique to interrupt cardiac conduction pathways selectively. The anesthetist is challenged to provide a safe anesthetic which takes into account the electrophysiologist's requirements for minimal cardiac conduction interference. Propofol is an ideal drug. However, previous studies have shown that the infusion of propofol has sometimes been associated with bradyarrhythmias or conversion of arrhythmias to sinusal rhythm. The purpose of this report is to verify the interferences of propofol in the electrophysiological properties of the atrioventricular (AV) node conduction system in patients with AVNRT. METHODS Patients were randomly assigned to receive either a placebo or propofol at sedative doses. An electrophysiological study was performed consisting of measuring the anterograde (AERPFP) and retrograde effective refractory period of the fast (RERPFP) and the anterograde effective refractory period of the slow (AERPSP) AV nodal pathway. Reciprocating tachycardia was induced and the cycle length (CL) and atrial-His (AH), His-ventricular (HV), and ventriculoatrial (VA) intervals were measured. RESULTS Propofol did not cause alteration (P > 0.05) in the AERPFP or RERPFP and the AERPSP AV nodal pathway. The AH, HV, and VA intervals were not affected. Sustained reciprocating tachycardia could be induced in the all patients. All slow pathways were successfully identified and ablated. CONCLUSION Propofol has no effect on the electrophysiological properties of the AV node conduction system. It is thus a suitable anesthetic agent for use in patients undergoing ablative procedures.
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Affiliation(s)
- Paulo Warpechowski
- Institute of Cardiology of Rio Grande Do SUL/FUC, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Brazil.
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Abstract
PURPOSE OF REVIEW Radiofrequency (RF) ablation treatment for tachyarrhythmias has been available only for the past 15 years. The success rates have been excellent with a very low frequency of complications. Because of this efficacy, the use of RF ablation in children has become standard of care even though long-term data are unavailable. In this review, common tachyarrhythmias and their current treatments in children will be discussed. RECENT FINDINGS Novel electrophysiology technologies such as electroanatomic mapping and sophisticated ablating catheters have improved success rates and decreased complications. The improvement is also due to better understanding of the mechanisms and etiologies of tachyarrhythmias. Both have positively impacted success rates and have made more complicated tachyarrhythmias treatable with ablation. SUMMARY The technologic advances in ablation and improved understanding of tachyarrhythmias over the past 15 years have greatly improved outcomes in ablative treatment of tachyarrhythmias in children. In most cases this method of treatment is the preferred first-line approach to symptomatic tachyarrhythmias in children.
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Affiliation(s)
- Soraya M Samii
- Division of Cardiology, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Sacchetti A, Turco T, Carraccio C, Hasher W, Cho D, Gerardi M. Procedural sedation for children with special health care needs. Pediatr Emerg Care 2003; 19:231-9. [PMID: 12972819 DOI: 10.1097/01.pec.0000086232.54586.ce] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Children with special health care needs represent a growing percentage of pediatric patients treated in all emergency departments. Substantial literature exists concerning the medical treatment of these patients, but there is little written describing the management of procedural sedation or analgesia in this population. This article examines the unique anatomic and physiologic implications of procedural sedation or analgesia management in children with special health care needs.
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Affiliation(s)
- Alfred Sacchetti
- Department of Emergency Medicine, Our Lady of Lourdes Medical Center, Camden, NJ 08103, USA.
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Bernath MA, Sekarski N. Management of paediatric patients undergoing diagnostic and invasive cardiology procedures. Curr Opin Anaesthesiol 2001; 14:441-6. [PMID: 17019128 DOI: 10.1097/00001503-200108000-00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since diagnostic cardiac catheterization in children with congenital heart disease was first reported in 1947, echocardiography has been used as a non-invasive diagnostic tool in congenital heart disease, resulting in a decrease in diagnostic cardiac catheterizations. However, the total number of cardiac catheterizations remained at a steady level until the mid-1980s and has since increased progressively. This is a result of the introduction of interventional transcatheter techniques to improve or correct congenital heart malformations. Since the first description of balloon atrial septostomy, the range of indications for such techniques has steadily increased, particularly in the past 15 years. 'Deep' sedation or general anaesthesia is essential for the conduct of cardiac catheterization in children, particularly in the younger age group.
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Affiliation(s)
- M A Bernath
- Anesthesiology Department, CHUV, CH-1011 Lausanne, Switzerland.
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