1
|
Weinreb SJ, Ampah SB, Okunowo O, Griffis H, Vetter VL. Longitudinal echocardiographic parameters before and after pacemaker placement in congenital complete heart block. Heart Rhythm 2024; 21:454-461. [PMID: 37981292 DOI: 10.1016/j.hrthm.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Congenital complete heart block (CCHB) is seen in 1:15,000-1:20,000 live births, with risk of left ventricular (LV) dysfunction or dilated cardiomyopathy in 7%-23% of subjects. OBJECTIVE The purpose of this study was to investigate serial changes in LV size and systolic function in paced CCHB subjects to examine the effect of time from pacemaker on echocardiographic parameters. METHODS Single-center retrospective cohort analysis of paced CCHB subjects was performed. Echocardiographic data were collected before and after pacemaker placement. Linear mixed effect regression of left ventricular end-diastolic dimension (LVEDD) z-score, left ventricular shortening fraction (LVSF), and left ventricular ejection fraction (LVEF) was performed, with slopes compared before and after pacemaker placement. RESULTS Of 114 CCHB subjects, 52 had echocardiographic data before and after pacemaker placement. Median age at CCHB diagnosis was 0.6 [interquartile range 0.0-3.5] years; age at pacemaker placement 3.4 [0.5-9.0] years; and pacing duration 10.8 [5.2-13.7] years. Estimated LVEDD z-score was 1.4 at pacemaker placement and decreased -0.08 per year (95% confidence interval [CI] -0.12 to -0.04; P = .002) to 0.2 (95% CI -0.3 to +0.3) 15 years postplacement. Estimated LVSF decreased -1.1% per year (95% CI -1.7% to -0.6%; P <.001) from 6 months prepacemaker placement to 34% (95% CI 32%-37%) 4 years postplacement. There was no significant change in LVSF between 4 and 15 years postplacement. Estimated LVEF did not change significantly after pacemaker placement, with estimated LVEF 59% (95% CI 55%-62%) 15 years postplacement. CONCLUSION In 52 paced CCHB subjects, estimated LVEDD z-score decreased significantly after pacemaker placement, and estimated LVSF and LVEF remained within normal limits at 15 years postpacemaker placement.
Collapse
Affiliation(s)
- Scott J Weinreb
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Steve B Ampah
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Oluwatimilehin Okunowo
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, California
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Victoria L Vetter
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Weinreb S, Shah MJ. A Not-So-Natural History of Nonsurgical Complete Atrioventricular Block in Children in the Current Era. JACC Clin Electrophysiol 2023; 9:1390-1392. [PMID: 37354186 DOI: 10.1016/j.jacep.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Scott Weinreb
- The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maully J Shah
- The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
3
|
Abstract
Congenital complete heart block (CCHB) defines atrioventricular conduction abnormalities diagnosed in utero or within the first 27 days of life. Maternal autoimmune disease and congenital heart defects are most commonly responsible. Recent genetic discoveries have highlighted our understanding of the underlying mechanism. Hydroxychloroquine shows promise in preventing autoimmune CCHB. Patients may develop symptomatic bradycardia and cardiomyopathy. The presence of these and other specific findings warrants placement of a permanent pacemaker to relieve symptoms and prevent catastrophic events. The mechanisms, natural history, evaluation, and treatment of patients with or at risk for CCHB are reviewed.
Collapse
Affiliation(s)
- Leonard Steinberg
- Pediatric Cardiology, Children's Heart Center, Ascension St. Vincent, 8333 Naab Rd, Ste 320, Indianapolis, IN 46260, USA.
| |
Collapse
|
4
|
Chou HH, Lin JY, Shen GT, Huang CY. Validation of an Automated Cardiothoracic Ratio Calculation for Hemodialysis Patients. Diagnostics (Basel) 2023; 13:diagnostics13081376. [PMID: 37189477 DOI: 10.3390/diagnostics13081376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
Cardiomegaly is associated with poor clinical outcomes and is assessed by routine monitoring of the cardiothoracic ratio (CTR) from chest X-rays (CXRs). Judgment of the margins of the heart and lungs is subjective and may vary between different operators. METHODS Patients aged > 19 years in our hemodialysis unit from March 2021 to October 2021 were enrolled. The borders of the lungs and heart on CXRs were labeled by two nephrologists as the ground truth (nephrologist-defined mask). We implemented AlbuNet-34, a U-Net variant, to predict the heart and lung margins from CXR images and to automatically calculate the CTRs. RESULTS The coefficient of determination (R2) obtained using the neural network model was 0.96, compared with an R2 of 0.90 obtained by nurse practitioners. The mean difference between the CTRs calculated by the nurse practitioners and senior nephrologists was 1.52 ± 1.46%, and that between the neural network model and the nephrologists was 0.83 ± 0.87% (p < 0.001). The mean CTR calculation duration was 85 s using the manual method and less than 2 s using the automated method (p < 0.001). CONCLUSIONS Our study confirmed the validity of automated CTR calculations. By achieving high accuracy and saving time, our model can be implemented in clinical practice.
Collapse
Affiliation(s)
- Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 413305, Taiwan
| | - Jin-Yi Lin
- Innovation and Incubation Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan
| | - Guan-Ting Shen
- Innovation and Incubation Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan
| | - Chih-Yuan Huang
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan
- Department of Sport Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan 717301, Taiwan
| |
Collapse
|
5
|
2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
6
|
Weinreb SJ, Okunowo O, Griffis H, Vetter V. Incidence of Morbidity and Mortality in a Cohort of Congenital Complete Heart Block Patients Followed Over 40 Years. Heart Rhythm 2022; 19:1149-1155. [PMID: 35217197 DOI: 10.1016/j.hrthm.2022.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Congenital Complete Heart Block (CCHB), seen in 1:15,000-20,000 births, commonly requires pacemaker placement by young adulthood. There is limited understanding of cardiac morbidity and mortality. OBJECTIVE Determine long-term incidence of cardiac morbidity and mortality in subjects with CCHB and identify associated risk factors. METHODS Retrospective cohort analysis of subjects with CCHB at Children's Hospital of Philadelphia between 1976-2018. The primary outcome is a composite of death, left ventricular systolic dysfunction, heart failure, cardiomyopathy, or cardiac resynchronization therapy (CRT). Cox proportional hazard models assessed independent risk factors for the primary outcome and its components (death, heart failure and/or cardiomyopathy, CRT). RESULTS One-hundred-fourteen subjects (58% female, median age at last visit 15.2 years) were included. Eighty-eight (77%) underwent pacemaker implantation, with median age at placement 1.9 years (IQR, 0.1-8.0 years). Twenty-six subjects (23%) reached the primary outcome - 7 (6%) died and 14 (12%) were diagnosed with heart failure and/or cardiomyopathy. Median time from diagnosis to primary outcome was 3.1 years (IQR, 0.0-10.8 years). There were no significant associations between age at diagnosis less than 1-year (hazard ratio [HR]: 1.5, 95% CI 0.6-3.9), fetal diagnosis (HR: 2.3, 0.96-5.6), or maternal antibody positivity (HR: 2.4, 0.9-6.6) and the primary outcome. Fetal diagnosis had a higher associated hazard of heart failure and/or cardiomyopathy (HR: 4.5, 1.3-15.0). CONCLUSION In 114 subjects with CCHB, 23% reached the composite outcome of cardiac morbidity and mortality, with no significant association between age at diagnosis, fetal diagnosis, and maternal antibody status with composite cardiac morbidity and mortality.
Collapse
Affiliation(s)
- Scott J Weinreb
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19146.
| | - Oluwatimilehin Okunowo
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19146
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19146
| | - Victoria Vetter
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19146; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19146
| |
Collapse
|
7
|
Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
8
|
Lazzaroni MG, Crisafulli F, Moschetti L, Semeraro P, Cunha AR, Neto A, Lojacono A, Ramazzotto F, Zanardini C, Zatti S, Airò P, Tincani A, Franceschini F, Andreoli L. Reproductive Issues and Pregnancy Implications in Systemic Sclerosis. Clin Rev Allergy Immunol 2022; 64:321-342. [PMID: 35040084 DOI: 10.1007/s12016-021-08910-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 12/26/2022]
Abstract
Systemic sclerosis (SSc) is a rare systemic autoimmune disease that can influence reproductive health. SSc has a strong female predominance, and the disease onset can occur during fertility age in almost 50% of patients. Preconception counseling, adjustment of treatment, and close surveillance during pregnancy by a multidisciplinary team, are key points to minimize fetal and maternal risks and favor successful pregnancy outcomes. The rates of spontaneous pregnancy losses are comparable to those of the general obstetric population, except for patients with diffuse cutaneous SSc and severe internal organ involvement who may carry a higher risk of abortion. Preterm birth can frequently occur in women with SSc, as it happens in other rheumatic diseases. Overall disease activity generally remains stable during pregnancy, but particular attention should be paid to women with major organ disease, such as renal and cardiopulmonary involvement. Women with such severe involvement should be thoroughly informed about the risks during pregnancy and possibly discouraged from getting pregnant. A high frequency of sexual dysfunction has been described among SSc patients, both in females and in males, and pathogenic mechanisms of SSc may play a fundamental role in determining this impairment. Fertility is overall normal in SSc women, while no studies in the literature have investigated fertility in SSc male patients. Nevertheless, some considerations regarding the impact of some immunosuppressive drugs should be done with male patients, referring to the knowledge gained in other rheumatic diseases.
Collapse
Affiliation(s)
- Maria-Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Liala Moschetti
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Paolo Semeraro
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Ana-Rita Cunha
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Agna Neto
- Rheumatology Department, Hospital Central do Funchal, Madeira, Portugal
| | - Andrea Lojacono
- Obstetrics and Gynaecology Unit, ASST Garda Ospedale of Desenzano, Desenzano del Garda, Italy
| | | | - Cristina Zanardini
- Obstetrics and Gynaecology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Sonia Zatti
- Obstetrics and Gynaecology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
| |
Collapse
|
9
|
Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
10
|
Seitler S, Rafiq I, Behar J. Long term clinical outcomes in patients requiring cardiac pacing due to congenital complete heart block. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
11
|
Abstract
Congenital complete heart block (CCHB) defines atrioventricular conduction abnormalities diagnosed in utero or within the first 27 days of life. Maternal autoimmune disease and congenital heart defects are most commonly responsible. Recent genetic discoveries have highlighted our understanding of the underlying mechanism. Hydroxychloroquine shows promise in preventing autoimmune CCHB. Patients may develop symptomatic bradycardia and cardiomyopathy. The presence of these and other specific findings warrants placement of a permanent pacemaker to relieve symptoms and prevent catastrophic events. The mechanisms, natural history, evaluation, and treatment of patients with or at risk for CCHB are reviewed.
Collapse
|
12
|
Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 791] [Impact Index Per Article: 263.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
13
|
Truszkiewicz K, Poręba R, Gać P. Radiological Cardiothoracic Ratio in Evidence-Based Medicine. J Clin Med 2021; 10:jcm10092016. [PMID: 34066783 PMCID: PMC8125954 DOI: 10.3390/jcm10092016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
The cardiothoracic ratio (CTR), expressing the relationship between the size of the heart and the transverse dimension of the chest measured on a chest PA radiograph, is a commonly used parameter in the assessment of cardiomegaly with a cut-off value of 0.5. A value of >0.5 should be interpreted as enlargement of the heart. The following review describes the current state of available knowledge in terms of contentious issues, limitations and useful aspects regarding the CTR. The review was carried out on the basis of an analysis of scientific articles available in the PubMed database, searched for using the following keywords: “CTR”, “cardiothoracic ratio”, “cardiopulmonary ratio”, “cardiopulmonary index”, and “heart-lung ratio”. According to the accumulated knowledge, the CTR can still be used as an important parameter that can be easily determined in establishing enlargement of the heart. However, an increased CTR does not directly relate to heart function. In the era following the development of diagnostic methods such as computed tomography, magnetic resonance imaging, and ultrasonography, CTR modifications based on these methods are used with varying clinical usefulness. It is important to consider the definition of the CTR and remember to base measurements on PA radiographs, as attempts to mark it in other projections face many limitations.
Collapse
Affiliation(s)
- Krystian Truszkiewicz
- Center for Diagnostic Imaging, University Clinical Hospital in Wrocław, Borowska 213, PL 50-556 Wroclaw, Poland;
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland;
| | - Paweł Gać
- Centre for Diagnostic Imaging, 4th Military Hospital, Weigla 5, PL 50-981 Wroclaw, Poland
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland
- Correspondence:
| |
Collapse
|
14
|
Congenital heart block: Pace earlier (Childhood) than later (Adulthood). Trends Cardiovasc Med 2019; 30:275-286. [PMID: 31262557 DOI: 10.1016/j.tcm.2019.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022]
Abstract
Congenital complete heart block (CCHB) occurs in 2-5% of pregnancies with positive anti-Ro/SSA and/or anti-La/SSB antibodies, and has a recurrence rate of 12-25% in a subsequent pregnancy. After trans-placental passage, these autoantibodies attack and destroy the atrioventricular (AV) node in susceptible fetuses with the highest-risk period observed between 16 and 28 weeks' gestational age. Many mothers are asymptomatic carriers, while <1/3 have a preexisting diagnosis of a rheumatic disease. The mortality of CCHB is predominant in utero and in the first months of life, reaching 15-30%. The diagnosis of CCHB can be confirmed by fetal echocardiography before birth and by electrocardiography after birth. Whether early in-utero detection and treatment might prevent or reverse this condition remains controversial. In addition to autoantibody-associated CCHB, there is also an isolated (absent structural heart disease) nonimmune early- or late-onset heart block detected later in childhood that may be associated with specific genetic markers or other pathogenic mechanisms. In isolated immune or non-immune CCHB, cardiac pacemakers are implanted in symptomatic patients, however, data on the natural history of CCHB in the adult life indicate that all patients, even if asymptomatic, should receive a pacemaker when first diagnosed. However, important issues have emerged in these patients wherein life-long conventional right ventricular apical pacing may produce left ventricular dysfunction (pacing-induced cardiomyopathy) necessitating a priori alternate site pacing or subsequent upgrading to biventricular pacing. All these issues are herein reviewed and two algorithms are proposed for diagnosis and management of CCHB in the fetus and in the older individual.
Collapse
|
15
|
Michael A, Radwan AA, Ali AK, Abd-Elkariem AY, Shazly SA. Use of antenatal fluorinated corticosteroids in management of congenital heart block: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100072. [PMID: 31517303 PMCID: PMC6728741 DOI: 10.1016/j.eurox.2019.100072] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 01/18/2023] Open
Abstract
Objective To evaluate outcomes of fluorinated corticosteroids, with or without other medications, for treatment of congenital heart block in-utero. Study design A search was conducted through MEDLINE, EMBASE, WEB OF SCIENCE and SCOPUS from inception to October 2017. Only comparative studies are considered eligible. Outcomes include fetal death, downgrade of heart block, neonatal death, need for neonatal pacing, fetal and maternal complications. Random effects model was used. Results Out of 923 articles, 12 studies were eligible. Compared to no treatment, there was no significant difference in incidence of fetal death (OR 1.10, 95%CI 0.65–1.84), neonatal death (OR 0.98, 95%CI 0.41–2.33), or need for pacing (OR 1.46, 95%CI 0.78–2.74). Heart block downgrade was significantly higher in treatment group (9.48%vs.1.76%, OR 3.27, 95%CI 1.23–8.71). Conclusion antenatal fluorinated corticosteroids do not improve fetal/neonatal morbidity or mortality of congenital heart block and are associated with higher incidence of fetal and maternal complications.
Collapse
|
16
|
Hernández-Madrid A, Paul T, Abrams D, Aziz PF, Blom NA, Chen J, Chessa M, Combes N, Dagres N, Diller G, Ernst S, Giamberti A, Hebe J, Janousek J, Kriebel T, Moltedo J, Moreno J, Peinado R, Pison L, Rosenthal E, Skinner JR, Zeppenfeld K, Sticherling C, Kautzner J, Wissner E, Sommer P, Gupta D, Szili-Torok T, Tateno S, Alfaro A, Budts W, Gallego P, Schwerzmann M, Milanesi O, Sarquella-Brugada G, Kornyei L, Sreeram N, Drago F, Dubin A. Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE. Europace 2018; 20:1719-1753. [DOI: 10.1093/europace/eux380] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Antonio Hernández-Madrid
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Robert-Koch-Str. 40, Göttingen, Germany
| | - Dominic Abrams
- PACES (Pediatric and Congenital Electrophysiology Society) Representative, Department of Cardiology, Boston Childreńs Hospital, Boston, MA, USA
| | - Peter F Aziz
- HRS Representative, Pediatric Electrophysiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Academical Medical Center, Amsterdam, The Netherlands
| | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre-University Hospital, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicolas Combes
- Arrhythmia Unit, Department of Pediatric and Adult Congenital Heart Disease, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig Heart Center, Leipzig, Germany
| | | | - Sabine Ernst
- Royal Brompton and Harefield Hospital, London, UK
| | - Alessandro Giamberti
- Congenital Cardiac Surgery Unit, Policlinico San Donato, University and Research Hospital, Milan, Italy
| | - Joachim Hebe
- Center for Electrophysiology at Heart Center Bremen, Bremen, Germany
| | - Jan Janousek
- 2nd Faculty of Medicine, Children's Heart Centre, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Thomas Kriebel
- Westpfalz-Klinikum Kaiserslautern, Children’s Hospital, Kaiserslautern, Germany
| | - Jose Moltedo
- SOLAECE Representative, Head Pediatric Electrophysiology, Section of Pediatric Cardiology Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Javier Moreno
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Rafael Peinado
- Department of Cardiology, Arrhythmia Unit, Hospital la Paz, Madrid, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Eric Rosenthal
- Consultant Paediatric and Adult Congenital Cardiologist, Evelina London Children's Hospital, Guy's and St Thomas' Hospital Trust, London, UK
| | - Jonathan R Skinner
- APHRS Representative, Paediatric and Congenital Cardiac Services Starship Childreńs Hospital, Grafton, Auckland, New Zealand
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joseph Kautzner
- Institute For Clinical and Experimental Medicine, Prague, Czech Republic
| | - Erik Wissner
- University of Illinois at Chicago, 840 S. Wood St., 905 S (MC715), Chicago, IL, USA
| | - Philipp Sommer
- Heart Center Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Dhiraj Gupta
- Consultant Electrophysiologist Liverpool Heart and Chest Hospital, Honorary Senior Lecturer Imperial College London and University of Liverpool, Liverpool, UK
| | | | - Shigeru Tateno
- Chiba Cerebral and Cardiovascular Center, Tsurumai, Ichihara, Chiba, Japan
| | | | - Werner Budts
- UZ Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | | | - Markus Schwerzmann
- INSELSPITAL, Universitätsspital Bern, Universitätsklinik für Kardiologie, Zentrum für angeborene Herzfehler ZAH, Bern, Switzerland
| | - Ornella Milanesi
- Department of Woman and Child's Health, University of Padua, Padua Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Electrophysiology and Sudden Death Unit, Department of Cardiology, Hospital Sant Joan de Déu, Barcelona - Universitat de Barcelona, Passeig Sant Joan de Déu, 2, Esplugues, Barcelona, Catalunya, Spain
| | - Laszlo Kornyei
- Gottsegen Gyorgy Orszagos Kardiologiai, Pediatric, Haller U. 29, Budapest, Hungary
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, University Hospital Of Cologne, Kerpenerstrasse 62, Cologne, Germany
| | - Fabrizio Drago
- IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Roma
| | - Anne Dubin
- Division of Pediatric Cardiology, 750 Welch Rd, Suite 321, Palo Alto, CA, USA
| | | |
Collapse
|
17
|
Late Outcome and Predictors of Adverse Events Related to the Implantation of a Permanent Pacemaker in Patients with Isolated Congenital Atrioventricular Block. Pediatr Cardiol 2016; 37:1319-27. [PMID: 27335082 DOI: 10.1007/s00246-016-1437-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
Isolated congenital atrioventricular block (ICAVB) is a rare, and pacemaker implantation is the only effective treatment. We sought to identify the predictive factors of adverse events related to pacemaker implantation in ICAVB. This is a cohort study of patients diagnosed with ICAVB who underwent pacemaker implantation from 1980 to 2014 in a single center. During the studied period, a total of 647 patients underwent implantation of their first permanent cardiac pacemaker before 30 years of age. Of these, only 62 (9.5 %) were diagnosed with ICAVB. This condition was diagnosed in utero in 15 (24.2 %) cases, 5 (8.1 %) in the neonatal period, 32 (51.6 %) during childhood, and 10 (16.1 %) during adolescence and young adulthood. The presence of autoantibodies (anti-Ro/SSA) was observed in 41 % of mothers who underwent serological evaluation. Age at the time of the initial pacemaker implant was 9.8 ± 9 years. During a mean follow-up time of 15 years, 1 (1.7 %) death occurred due to infectious endocarditis. Complications related to pacemaker implant were reported in 24 patients (38.7 %). The number of complications was significantly higher in the group with an epimyocardial implantation site (HR 6; CI 2.45-14.95). Ventricular dysfunction occurred in 6 (11.7 %) patients; however, we were not able to identify any predictors of it. Our results showed a low mortality rate after permanent therapy. However, these patients exhibited high morbidity related to the pacemaker system, and the epimyocardial implant site was an independent predictor of complications. Predictors of left ventricular dysfunction were not found in the present study.
Collapse
|
18
|
Abstract
Extrapolating cardiac resynchronization therapy (CRT) to pediatric patients with heart failure has at times been difficult given the heterogeneity of pediatric cardiomyopathies, varying congenital heart disease (CHD) substrates, and the fact that most pediatric heart failure patients have right bundle branch block (RBBB) as opposed to LBBB. Yet, despite these limitations a number of multi-center retrospective studies in North America and Europe have identified some data to suggest that certain sub-populations tend to respond positively to CRT. In order to address some of the heterogeneity it is helpful to subdivide pediatric and young adult patients with CHD into four potential groups: (1) CRT for chronic RV pacing, (2) dilated cardiomyopathies, (3) pulmonary right ventricles, and (4) systemic right ventricles. The chronic RV paced group, especially long-standing RV apical pacing, with ventricular dyssynchrony has consistently shown to be the group that best responds to a proactive resynchronization course. CRT therapy in pulmonary right ventricles such as post-op tetralogy of Fallot have shown some promise and may be considered especially if there is evidence of concomitant left ventricular dysfunction with an electrical dyssynchrony. Patients with systemic right ventricles such as post-atrial baffle surgery or congenitally corrected transposition reportedly do well with CRT in the presence of both inter-ventricular and intra-ventricular dyssynchrony. There is little doubt that moving forward to best way to identify which pediatric patients with heart failure will respond to CRT, will require a collaborative effort between the electrophysiologist and the echocardiographer to identify appropriate candidates with electrical and mechanical dyssynchrony.
Collapse
|
19
|
Oliveira Júnior RMD, Silva KRD, Kawauchi TS, Alves LBDO, Crevelari ES, Martinelli Filho M, Costa R. Functional capacity of patients with pacemaker due to isolated congenital atrioventricular block. Arq Bras Cardiol 2014; 104:67-77. [PMID: 25387405 PMCID: PMC4387613 DOI: 10.5935/abc.20140168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/24/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Isolated congenital atrioventricular block (CAVB) is a rare condition with multiple clinical outcomes. Ventricular remodeling can occur in approximately 10% of the patients after pacemaker (PM) implantation. OBJECTIVES To assess the functional capacity of children and young adults with isolated CAVB and chronic pacing of the right ventricle (RV) and evaluate its correlation with predictors of ventricular remodeling. METHODS This cross-sectional study used a cohort of patients with isolated CAVB and RV pacing for over a year. The subjects underwent clinical and echocardiographic evaluation. Functional capacity was assessed using the six-minute walk test. Chi-square test, Fisher's exact test, and Pearson correlation coefficient were used, considering a significance level of 5%. RESULTS A total of 61 individuals were evaluated between March 2010 and December 2013, of which 67.2% were women, aged between 7 and 41 years, who were using PMs for 13.5 ± 6.3 years. The percentage of ventricular pacing was 97.9 ± 4.1%, and the duration of the paced QRS complex was 153.7 ± 19.1 ms. Majority of the subjects (95.1%) were asymptomatic and did not use any medication. The mean distance walked was 546.9 ± 76.2 meters and was strongly correlated with the predicted distance (r = 0.907, p = 0.001) but not with risk factors for ventricular remodeling. (Arq Bras Cardiol. 2014; [online].ahead print, PP.0-0) CONCLUSIONS: The functional capacity of isolated CAVB patients with chronic RV pacing was satisfactory but did not correlate with risk factors for ventricular remodeling.
Collapse
Affiliation(s)
| | - Kátia Regina da Silva
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Tatiana Satie Kawauchi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Roberto Costa
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
20
|
Silvetti MS, Di Carlo D, Ammirati A, Placidi S, Di Mambro C, Rava L, Drago F. Left ventricular pacing in neonates and infants with isolated congenital complete or advanced atrioventricular block: short- and medium-term outcome. Europace 2014; 17:603-10. [DOI: 10.1093/europace/euu180] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 06/10/2014] [Indexed: 11/14/2022] Open
|
21
|
DA SILVA KÁTIAREGINA, COSTA ROBERTO, DE OLIVEIRA ROBERTOMÁRCIO, LACERDA MARIANNASOBRAL, UN HUANG ADRIANAI, ROSSI MARINABERTELLI, CREVELARI ELIZABETHSARTORI, TAMAKI WAGNERTETSUJI, FILHO MARTINOMARTINELLI, PIETROBON RICARDO. Quality of Life and Functional Capacity after Long-Term Right Ventricular Pacing in Pediatrics and Young Adults with Congenital Atrioventricular Block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1539-49. [DOI: 10.1111/pace.12258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/06/2013] [Accepted: 07/18/2013] [Indexed: 11/28/2022]
Affiliation(s)
- KÁTIA REGINA DA SILVA
- Department of Surgery, Duke University Medical Center, Durham; North Carolina
- Department of Cardiovascular Surgery; Heart Institute (InCor)-Clinics Hospital of the University of São Paulo Medical School; São Paulo Brazil
| | - ROBERTO COSTA
- Department of Cardiovascular Surgery; Heart Institute (InCor)-Clinics Hospital of the University of São Paulo Medical School; São Paulo Brazil
| | | | - MARIANNA SOBRAL LACERDA
- Heart Institute (InCor)-Clinics Hospital of the University of São Paulo Medical School; São Paulo Brazil
| | - ADRIANA I UN HUANG
- Heart Institute (InCor)-Clinics Hospital of the University of São Paulo Medical School; São Paulo Brazil
| | - MARINA BERTELLI ROSSI
- Heart Institute (InCor)-Clinics Hospital of the University of São Paulo Medical School; São Paulo Brazil
| | - ELIZABETH SARTORI CREVELARI
- Department of Cardiovascular Surgery; Heart Institute (InCor)-Clinics Hospital of the University of São Paulo Medical School; São Paulo Brazil
| | - WAGNER TETSUJI TAMAKI
- Department of Cardiovascular Surgery; Heart Institute (InCor)-Clinics Hospital of the University of São Paulo Medical School; São Paulo Brazil
| | - MARTINO MARTINELLI FILHO
- Department of Cardiology; Heart Institute (InCor)-Clinics Hospital of the University of São Paulo Medical School; São Paulo Brazil
| | - RICARDO PIETROBON
- Department of Surgery, Duke University Medical Center, Durham; North Carolina
| |
Collapse
|
22
|
Yan J, Varma SK, Malhotra A, Menahem S. Congenital complete heart block: single tertiary centre experience. Heart Lung Circ 2012; 21:666-70. [PMID: 22749374 DOI: 10.1016/j.hlc.2012.05.784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 05/20/2012] [Accepted: 05/22/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenital complete heart block (CCHB) is an uncommon although important and potentially serious condition contributing to neonatal morbidity and mortality. AIMS To study the characteristics and outcomes of infants born with CCHB at a single tertiary centre. METHODS A retrospective review of all infants with CCHB over the last 20 years was carried out to determine the outcomes, and the indications and timing of pacemaker insertion. RESULTS Fifteen live born infants (10 male, 5 female) with CCHB were identified. Their mean (and SD) gestation and birth weight were 37 (3.3) weeks and 3100 (448) grams respectively. Maternal systemic lupus erythematosus (SLE) antibodies were present in eight (53%) pregnancies and two infants had congenitally corrected transposition of the great arteries (cCTGA). The median heart rate/minute at birth was 60 (range 40-80). Thirteen (87%) patients to date required a pacemaker. The median age of insertion of a pacemaker device was six months (range 2 days-16 years). All patients were paced epicardially - six initially with a single chamber and five with a dual chamber pacemaker. At the time of generator change, dual chamber pacemakers were used. The median life of an implanted pacemaker was six years (3-10 years). Except for a patient with cCTGA who has undergone a double switch procedure, all the patients had good systemic ventricular function. There was one death in the group unrelated to CCHB. CONCLUSIONS CCHB is a uncommon but potentially serious condition in infancy. While a significant number of infants need a pacemaker, the overall outcome of infants with CCHB in our experience is good.
Collapse
|
23
|
Zartner PA, Toussaint-Goetz N, Photiadis J, Wiebe W, Schneider MB. Telemonitoring with implantable electronic devices in young patients with congenital heart diseases. Europace 2012; 14:1030-7. [DOI: 10.1093/europace/eur434] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
24
|
Abstract
An increasing number of pediatric patients with permanent pacemakers and implantable cardioverter defibrillators (ICDs) require cardiac and noncardiac surgery. It is critical that the anesthesiologist caring for these patients understands the management of the device and the underlying heart disease. Children with these devices are more vulnerable to lead failure and inappropriate shocks compared with the adult population. Preoperative assessment and appropriate reprogramming of the device, in addition to minimizing sources of electromagnetic interference, are keystones in the perioperative care of these patients. Prior consultation with qualified programmers is recommended to enable timely optimization of the device. Magnets may be used in emergency situations but it is important to appreciate the limitations of magnet use on different models of pacemakers and ICDs. Safe and successful perioperative care is dependent upon a well-organized and coordinated multidisciplinary team approach.
Collapse
Affiliation(s)
- Manchula Navaratnam
- Department of Anesthesia, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
| | | |
Collapse
|
25
|
Silvetti MS, Drago F, Rava L. Determinants of early dilated cardiomyopathy in neonates with congenital complete atrioventricular block. Europace 2010; 12:1316-21. [DOI: 10.1093/europace/euq258] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
26
|
Controversies in the therapy of isolated congenital complete heart block. J Cardiovasc Med (Hagerstown) 2010; 11:426-30. [PMID: 20421761 DOI: 10.2459/jcm.0b013e3283397801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Controversies in the therapy of congenital complete heart block are reviewed in terms of the timing of pacemaker implantation, the type and complications of pacing and its role in the presence of myocardial dysfunction. Drug treatment may be useful in selected cases in the presence of pleural effusions, ascites and hydrops of the fetus, but have no effect on complete heart block. Administration of fluorinated steroids in anti-Ro antibody-positive mothers with the aim of preventing complete heart block has given controversial results. Because of the variety of the clinical presentations, especially in regard to pacing therapy, it is mandatory to refer patients with congenital complete heart block to specialized centers with adequate resources and experienced personnel.
Collapse
|
27
|
Ro PS, Chan DP, Ackley T, Fenstermaker B, Hayes J, Cua CL. Tissue doppler changes in pediatric complete heart block patients who are chronically paced. CONGENIT HEART DIS 2009; 4:448-53. [PMID: 19925538 DOI: 10.1111/j.1747-0803.2009.00342.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pediatric patients with complete heart block (CHB) often require pacemaker therapy. Adult studies have shown chronic right ventricular pacemaker therapy may be associated with decreased echocardiographic parameters and increased brain natriuretic peptide (BNP) values. The goal of this study was to determine if there are echocardiographic or BNP changes in a pediatric population that is chronically paced. METHODS Patients were recruited if they had CHB and had a pacemaker. Patients were excluded if they had congenital structural heart disease. Standard two-dimensional echocardiograms, including tissue Doppler imaging (TDI), were performed. BNP values were obtained. Nonparametric Spearman's rank correlation was used for analysis. Rho < or = 0.05 was considered significant. RESULTS Eighteen patients (16.4 +/- 7.3 years) with CHB were studied. Age at implant was 8.6 +/- 6.6 years and length of pacing was 7.8 +/- 6.6 years. Pacing mode was VDD, DDD, DDDR, or VVIR. All patients were ventricularly paced >95% of the time. Ejection fraction was 58.5 +/- 7.5%. All BNP values were <40 pg/mL. There was no correlation between ejection fraction or BNP level with the length of pacing years. Pacing years significantly correlated with mitral and tricuspid E/A ratios (rho =-0.56, -0.56, respectively). Pacing years also correlated with right ventricular and interventricular TDI a wave (rho = 0.61 and 0.68, respectively). Furthermore, pacing years correlated with right ventricular TDI e/a ratio (rho =-0.58). CONCLUSIONS Ejection fraction and BNP levels were not sensitive parameters in evaluating pediatric patients who are chronically paced. Subtle diastolic changes, especially of the right ventricle, were detected by TDI.
Collapse
Affiliation(s)
- Pamela S Ro
- Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH 43205-2696, USA
| | | | | | | | | | | |
Collapse
|
28
|
Breur JMPJ, Kapusta L, Stoutenbeek P, Visser GHA, van den Berg P, Meijboom EJ. Isolated congenital atrioventricular block diagnosed in utero: natural history and outcome. J Matern Fetal Neonatal Med 2008; 21:469-76. [PMID: 18570127 DOI: 10.1080/14767050802052786] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Isolated congenital atrioventricular block (CAVB) diagnosed in utero is associated with a high morbidity and mortality. Prognosis is especially poor when heart rate drops below 55 beats per minute (bpm) and when fetal hydrops develops. We describe the natural history and outcome of 24 infants with isolated CAVB diagnosed in utero, review the literature, and assess the risk factors that could predict outcome. METHODS This was a retrospective multicenter study of 24 patients with isolated CAVB diagnosed in utero. RESULTS CAVB was detected at a mean gestational age (GA) of 24.7 +/- 5.1 weeks. Ten fetuses initially presented with complete heart block. Low heart rate or incomplete heart block was the first documentation of bradyarrhythmia in the other 14 fetuses. In 11 of them, CAVB developed during pregnancy after a median time of 3 (range 1-16) weeks. Fetal hydrops developed in 10 of 24 (42%) fetuses at a mean GA of 27.6 +/- 5.1 weeks. Hydropic fetuses showed lower heart rates during pregnancy (47 +/- 10 bpm) than non-hydropic fetuses (57 +/- 10 bpm). There were three intrauterine deaths; all were hydropic and female. Nine viable females and 12 males were born at a mean GA of 37.1 +/- 6.1 weeks with an average birth weight of 3097 +/- 852 g. Fifteen CAVB patients required pacemaker (PM) intervention, 10 of them immediately after birth. Dilated cardiomyopathy (DCM) developed in three infants of whom two died of congestive heart failure, shortly after the diagnosis was made; one is still alive. Mortality before or after birth was 21%, and was associated with heart rates below 50 bpm and development of fetal hydrops. Poor outcome, defined as death, PM implantation, or development of DCM, occurred in 83% of cases and was associated with heart rates below 60 bpm during pregnancy. CONCLUSIONS Isolated CAVB diagnosed in utero is associated with high morbidity and mortality. Patients who develop fetal hydrops show lower heart rates during pregnancy than patients who do not. A fetal heart rate below 50 bpm and development of fetal hydrops is associated with increased mortality. Rates below 60 bpm are associated with PM requirement and/or DCM.
Collapse
|
29
|
ZARTNER PETER, HANDKE RONALD, PHOTIADIS JOACHIM, BRECHER ANNEM, SCHNEIDER MARTINB. Performance of an Autonomous Telemonitoring System in Children and Young Adults with Congenital Heart Diseases. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1291-9. [DOI: 10.1111/j.1540-8159.2008.01180.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Chun T. Pacemaker and defibrillator therapy in pediatrics and congenital heart disease. Future Cardiol 2008; 4:469-79. [DOI: 10.2217/14796678.4.5.469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pacemakers and defibrillators have a growing use in pediatrics and in patients with congenital heart disease, but they present unique problems and implications for their implantation and follow-up. Congenital and surgically acquired rhythm disturbances are common, but the efficacy of device therapy is not well established in these patient groups. The diversity and complexity of pediatric patients and congenital heart disease make device management a highly individualized art. There are technical issues related to device implantation that have necessitated novel approaches to using leads and device that were not designed with children specifically in mind. The current guidelines and indications for implantable device therapy for children and congenital heart disease are reviewed, as well as some of the specific limitations and problems encountered.
Collapse
Affiliation(s)
- Terrence Chun
- University of Washington School of Medicine, Children’s Heart Center G-0035, Children’s Hospital & Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| |
Collapse
|
31
|
Dolara A, Cammelli D, Chiodi L, Favilli S. Acute cardiac failure following pacing in an adult patient with congenital complete heart block. J Cardiovasc Med (Hagerstown) 2008; 9:301-3. [PMID: 18301153 DOI: 10.2459/jcm.0b013e328277f1ec] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A case of an adult patient with congenital complete heart block is reported in whom acute heart failure followed pacemaker implantation. It is uncertain whether the associated cardiomyopathy was present since birth, although right ventricular pacing was probably responsible for further deterioration of myocardial function. Synchronous pacing of both ventricles might be recommended in these patients.
Collapse
|
32
|
Villain E. Indications for Pacing in Patients with Congenital Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31 Suppl 1:S17-20. [DOI: 10.1111/j.1540-8159.2008.00948.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
33
|
BEAUFORT-KROL GERTIEC, SCHASFOORT-VAN LEEUWEN MIEKJ, STIENSTRA YMKJE, BINK-BOELKENS MARGREETT. Longitudinal Echocardiographic Follow-Up in Children with Congenital Complete Atrioventricular Block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1339-43. [DOI: 10.1111/j.1540-8159.2007.00868.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Dual-chamber epicardial pacing in neonates with congenital heart block. J Thorac Cardiovasc Surg 2007; 134:1188-92. [DOI: 10.1016/j.jtcvs.2007.04.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 04/05/2007] [Accepted: 04/16/2007] [Indexed: 11/17/2022]
|
35
|
Kim JJ, Friedman RA, Eidem BW, Cannon BC, Arora G, Smith EO, Fenrich AL, Kertesz NJ. Ventricular Function and Long-Term Pacing in Children with Congenital Complete Atrioventricular Block. J Cardiovasc Electrophysiol 2007; 18:373-7. [PMID: 17394451 DOI: 10.1111/j.1540-8167.2006.00741.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the sequela of right ventricular pacing in children with congenital complete atrioventricular block. BACKGROUND Pacing is a well-accepted therapy for patients with congenital complete atrioventricular block. The long-term sequela of right ventricular pacing in this population has not been well described. METHODS We performed a cohort study on all patients with congenital complete atrioventricular block who underwent pacemaker implantation at our institution from 1972 to 2004. Patients with associated congenital heart disease or ventricular dysfunction prior to pacemaker implantation were excluded. RESULTS A total of 63 patients were included in the study. The median age at pacemaker implantation was 6.5 years, with an average follow-up of 9.9 years. The cumulative dysfunction free survival at 20 years was 92%. In total, four patients (6%) were noted to develop LV dysfunction an average of 15.1 years after pacemaker implantation. Of 30 patients who were paced for >10 years, only three (10%) developed echocardiographic evidence of LV dysfunction. Right ventricular apex pacing and prolonged QRS duration were found to be predictive of decreased long-term LV systolic function (P < 0.05). CONCLUSIONS Left ventricular dysfunction in patients with congenital complete atrioventricular block is a rare finding, even in those who have been paced for more than 10 years. Right ventricular apex pacing and prolonged QRS duration may be associated with decreased ventricular function over time. At this time, with such a low incidence of cardiac dysfunction, right ventricular pacing should be considered an acceptable first-line therapy in this population.
Collapse
Affiliation(s)
- Jeffrey J Kim
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Shalganov TN, Paprika D, Vatasescu R, Kardos A, Mihalcz A, Kornyei L, Szatmari A, Szili-Torok T. Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease. Cardiovasc Ultrasound 2007; 5:13. [PMID: 17352821 PMCID: PMC1845152 DOI: 10.1186/1476-7120-5-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 03/12/2007] [Indexed: 11/23/2022] Open
Abstract
Background Chronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction. Methods A group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block. The remaining 56 patients (34 males) had pacing indication in the presence of structural heart disease. Thirty-two of them (21 males) had isolated structural heart disease and the remaining 24 (13 males) had complex congenital heart disease. Patients were followed up for an average of 53 ± 41.4 months with 12-lead electrocardiogram and transthoracic echocardiography. Left ventricular shortening fraction was used as a marker of ventricular function. QRS duration was assessed using leads V5 or II on standard 12-lead electrocardiogram. Results Left ventricular shortening fraction did not change significantly after pacemaker implantation compared to preimplant values overall and in subgroups. In patients with complex congenital heart malformations shortening fraction decreased significantly during the follow up period. (0.45 ± 0.07 vs 0.35 ± 0.06, p = 0.015). The correlation between the change in left ventricular shortening fraction and the mean increase of paced QRS duration was not significant. Six patients developed dilated cardiomyopathy, which was diagnosed 2 months to 9 years after pacemaker implantation. Conclusion Chronic right ventricular pacing in pediatric patients with or without structural heart disease does not necessarily result in decline of left ventricular function. In patients with complex congenital heart malformations left ventricular shortening fraction shows significant decrease.
Collapse
Affiliation(s)
- Tchavdar Nikolov Shalganov
- Department of Pacing and Clinical Electrophysiology, Gottsegen Gyorgy National Institute of Cardiology, Budapest, Hungary
| | - Dora Paprika
- Department of Pacing and Clinical Electrophysiology, Gottsegen Gyorgy National Institute of Cardiology, Budapest, Hungary
| | - Radu Vatasescu
- Department of Pacing and Clinical Electrophysiology, Gottsegen Gyorgy National Institute of Cardiology, Budapest, Hungary
| | - Attila Kardos
- Department of Pacing and Clinical Electrophysiology, Gottsegen Gyorgy National Institute of Cardiology, Budapest, Hungary
| | - Attila Mihalcz
- Department of Pacing and Clinical Electrophysiology, Gottsegen Gyorgy National Institute of Cardiology, Budapest, Hungary
| | - Laszlo Kornyei
- Center for Pediatric Cardiology, Gottsegen Gyorgy National Institute of Cardiology, Budapest, Hungary
| | - Andras Szatmari
- Center for Pediatric Cardiology, Gottsegen Gyorgy National Institute of Cardiology, Budapest, Hungary
| | - Tamas Szili-Torok
- Department of Pacing and Clinical Electrophysiology, Gottsegen Gyorgy National Institute of Cardiology, Budapest, Hungary
| |
Collapse
|
37
|
Vatasescu R, Shalganov T, Paprika D, Kornyei L, Prodan Z, Bodor G, Szatmari A, Szili-Torok T. Evolution of left ventricular function in paediatric patients with permanent right ventricular pacing for isolated congenital heart block: a medium term follow-up. ACTA ACUST UNITED AC 2007; 9:228-32. [PMID: 17350983 DOI: 10.1093/europace/eum008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS We aimed to assess the evolution of left ventricular (LV) systolic function in children with right ventricular apical (RVA) pacing for isolated congenital heart block (ICHB) and to identify possible predictors of LV function deterioration. Right ventricular apical pacing can be detrimental to LV function in a significant number of adults. Effects in children are still controversial. METHODS AND RESULTS Left ventricular shortening fraction (LV SF) and QRS duration were retrospectively assessed in 45 children with RVA pacing for ICHB: before pacemaker (PM) implantation, immediately after and then regularly during a follow-up of 58.69 +/- 45.23 months. Patients were categorized as stable or deteriorators according to an arbitrarily chosen cut-off point of > or =7% decrease in LV SF. Lupus status was unknown. Overall LV SF did not change significantly (41.42% +/- 8.21 before pacing, 39.77% +/- 7.03 immediately after PM implant, 37.43% +/- 9.91 with chronic pacing, P = NS). Deteriorators (n = 13) had significantly higher baseline heart rate (57.5 +/- 8.7 vs. 46.9 +/- 10.5 bpm, P < 0.05) and baseline LV SF (46.17 +/- 8.13 vs. 38.4 +/- 6.4%; P < 0.05), a significantly higher proportion of them being implanted before 2 years of age: 8 of 13 (61.5%) vs. 5 of 25 (20%) in the stable group (P < 0.05). Deteriorators had a higher incidence of an initial epicardial lead and narrower native QRS. CONCLUSION Permanent RVA pacing for ICHB does not necessarily affect LV function in children. The risk of deterioration of LV function seems to be higher in children with higher baseline heart rate and better baseline LV SF, especially with pacing at a younger age, a narrower native QRS and RVA epicardial pacing site.
Collapse
Affiliation(s)
- Radu Vatasescu
- Hungarian Institute of Cardiology, Haller u. 29, 1096-H, Budapest, Hungary
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Vukomanovic V, Stajevic M, Kosutic J, Stojanov P, Rakic S, Velinovic M, Sehic I, Milovanovic V. Age-related role of ambulatory electrocardiographic monitoring in risk stratification of patients with complete congenital atrioventricular block. Europace 2007; 9:88-93. [PMID: 17227810 DOI: 10.1093/europace/eul174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of the paper was to assess the importance of 24 h electrocardiographic Holter monitoring in determining predictive factors for Adams-Stokes (AS) attacks and heart failure (HF) in children and adolescents with complete congenital atrioventricular block (CCAVB). METHODS AND RESULTS Forty-five patients were divided into two groups according to the presence of AS attacks and HF and six age-related subgroups. The following parameters of 24 h electrocardiographic Holter monitoring were analysed: (i) minimum heart rate (HR), (ii) maximum HR, (iii) average HR, (iv) daytime HR (v) rhythm and conduction disturbance. Adams-Stokes attacks and HF occurred in 10 and 8 patients, respectively (40%). Five of six neonates with HF had maximum HR < 74 bpm and daytime HR < 58 bpm. Maximum HR below 68 bpm and daytime HR below 52 bpm were recorded in all the children up to 8 years of age with AS attacks and HF and only in 3 of 14 asymptomatic patients. All the patients above 8 years of age with AS attacks had maximum HR below 62 bpm. Of 6 patients with daytime HR < 50 bpm AS attacks were present in two. Episodes of marked ventricular slowing during sleep were registered in 4 of 10 (40%) patients and in 3 of 27 (11%) symptomless patients. CONCLUSION Risk factors for development of AS attacks and HF in patients with CCAVB include: (i) maximum HR < 74 bpm in neonates, <68 bpm up to the age of 8 and <62 bpm at ages above 8, (ii) daytime HR <58 bpm in neonates and < 52 bpm till the age of 8, and (iiii) abrupt pauses in ventricular rate that are at least twice the basic cycle length after the neonatal period.
Collapse
Affiliation(s)
- Vladislav Vukomanovic
- Department of Paediatric Cardiology, Mother and Child Health Institute 'Dr Vukan Cupić', Radoja Dakica 6-8 street, Belgrade, Serbia, Serbia and Montenegro.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Breur JMPJ, Udink ten Cate FEA, Kapusta L, Boramanand N, Cohen MI, Crosson JE, Lubbers LJ, Friedman AH, Brenner JI, Vetter VL, Meijboom EJ. Potential additional indicators for pacemaker requirement in isolated congenital atrioventricular block. Pediatr Cardiol 2006; 27:564-8. [PMID: 16933076 DOI: 10.1007/s00246-004-0629-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Accepted: 07/21/2004] [Indexed: 10/24/2022]
Abstract
Low heart rate is the predominantly used indication for pacemaker intervention in patients with isolated congenital atrioventricular block (CAVB). The aim of this study was to compare the difference in heart rates recorded with ECG and Holter monitoring between paced (PM) and nonpaced (NPM) patients with isolated CAVB before pacemaker implantation to identify additional predictors for future PM need. Retrospective evaluation of atrial and ventricular rates (electrocardiography) and minimal and maximal (Holter) heart rates in 129 CAVB patients prior to PM implantation (n = 93) was performed, and results are expressed in V adjusted for age and sex. The average V score for the atrial rate was 0.51 (n = 50) in the PM group and 0.60 (n = 22) in the NPM group (not-significant). The average z score for the ventricular (average) rate was -0.91 (n = 83) in the PM group and -0.93 (n = 33) in the NPM group (not-significant). Minimal heart rate was -0.94 (n = 61) in the PM group and -0.86 (n = 25) in the NPM group (not significant). Maximal heart rate was -0.96 (n = 61) in the PM group and -0.95 (n = 26) in the NPM group (not significant). Initial recordings of the average heart rate and the minimal and maximal heart rate recorded during Holter monitoring do not seem to predict future pacemaker need in patients with CAVB. Studies with exercise stress tests are needed to confirm these findings.
Collapse
Affiliation(s)
- J M P J Breur
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Congenital complete atrioventricular block (CCAVB) is a rare potentially lethal disease with an estimated incidence of 1 every 15.000 to 20.000 live born infants.IN STRUCTURALLY NORMAL HEARTS TWO KINDS OF CONGENITAL HEART BLOCK CAN BE IDENTIFIED: one usually diagnosed in utero associated with the circulating maternal anti-SS-A/Ro and anti-SS-B/La antibodies, the other kind is detected later in the neonatal period or during the infancy or childhood and present no clear relation with maternal antibodies. Nowadays, the diagnosis can be made in utero as early as between week 16 and 28 of gestation by foetal echocardiography.The mortality in isolated CCAVB is estimated between 8 and 16% and between 4 and 8% in children and adults. The mortality and morbidity of patients diagnosed outside the neonatal period is significantly lower than those with a in utero diagnosis.Risk factors for worse outcome in CCAVB are the foetal diagnosis, the presence of hydrops fetalis, delivery at 32 weeks gestation, and a ventricular rate <55 beats/min in early pregnancy (13,18).Aim of this review is to delineate the current knowledge on CCAVB presenting in children without structural heart disease including aetiology, outcome and management. Also outlined in this review are some of the problems still debated in this issue.
Collapse
Affiliation(s)
- Laura Vitali Serdoz
- Arrhythmias and Electrophysiology Center, Policlinico San Donato, University of Milan - Italy
| | | |
Collapse
|
41
|
Serdoz LV, Cappato R. Congenital Complete Atrioventricular Block in the Early Pediatric Population. Heart Int 2006. [DOI: 10.1177/182618680600200101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Laura Vitali Serdoz
- Arrhythmias and Electrophysiology Center, Policlinico San Donato, University of Milan - Italy
| | - Riccardo Cappato
- Arrhythmias and Electrophysiology Center, Policlinico San Donato, University of Milan - Italy
| |
Collapse
|
42
|
Ammann J, Winter J, Sunderdiek U, Loer SA. Anesthetic management of neonates with congenital complete atrioventricular heart block undergoing pacemaker implantation. J Cardiothorac Vasc Anesth 2005; 19:212-6. [PMID: 15868531 DOI: 10.1053/j.jvca.2005.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jan Ammann
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | | | | |
Collapse
|
43
|
Breur JMPJ, Oudijk MA, Stoutenbeek P, Visser GHA, Meijboom EJ. Transient Non-Autoimmune Fetal Heart Block. Fetal Diagn Ther 2005; 20:81-5. [PMID: 15692198 DOI: 10.1159/000082427] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Accepted: 01/07/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Fetal heart block is a rare and irreversible condition associated with structural heart defects or maternal autoantibodies (SS-A/Ro and SS-B/La) resulting in permanent damage of the atrioventricular (AV) node. This is the first report of 4 cases with a transient fetal heart block in structurally normal hearts without maternal autoantibodies. METHODS A report on 4 patients seen within a 14-year period at one center with fetal heart block without intracardiac abnormalities or maternal autoantibodies. RESULTS Three patients were referred to our center with a fetal bradycardia (heart rate 70-85 bpm), between 20 and 33 weeks' gestational age, and 1 for a 'triple' test at 16 weeks' gestational age. Echocardiography showed a complete heart block in 2 fetuses, and a second-degree AV block in the other 2. Heart block had completely resolved at all following visits. Postnatal ECG recordings showed normal sinus rhythm in all patients. Echocardiographic evaluation at presentation and follow-up showed normal cardiac anatomy, without signs of hydrops or cardiac decompensation in all patients. All mothers tested negative on SS-A/Ro and SS-B/La autoantibodies. CONCLUSIONS Fetal heart block can occur in the absence of structural heart defects and maternal autoantibodies to SS-A/Ro and SS-B/La. The origin of such heart block is unknown, but its course seems benign: none of the patients ever showed ventricular heart rates <55 bpm, signs of congestive heart failure or fetal hydrops. Heart block resolved spontaneously in all patients.
Collapse
Affiliation(s)
- Johannes M P J Breur
- Department of Obstetrics, Wilhelmina Children's Hospital/U MC, Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
44
|
Abstract
There are special challenges associated with the use of transvenous pacemakers in children. For example, a child's chest cavity or vascular dimensions could be too small to host the generator and leads available or required. If leads are implanted, they may stretch as the child grows. This increases the risk that the leads will later dislodge or fracture. Moreover, children requiring pacemakers often have coexisting congenital heart defects and the structural abnormalities of those could hinder easy placement of the pacing system. This article will first review the indications for permanent pacing in children and will then describe the unique challenges associated with such use.
Collapse
Affiliation(s)
- Charles I Berul
- Department of Cardiology, Children's Hospital Boston, MA 02115, USA.
| | | |
Collapse
|
45
|
Janousek J, Tomek V, Chaloupecky V, Gebauer RA. Dilated Cardiomyopathy Associated with Dual-Chamber Pacing in Infants:. Improvement Through Either Left Ventricular Cardiac Resynchronization or Programming the Pacemaker Off Allowing Intrinsic Normal Conduction. J Cardiovasc Electrophysiol 2004; 15:470-4. [PMID: 15089999 DOI: 10.1046/j.1540-8167.2004.03481.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The etiology of dilated cardiomyopathy associated with congenital complete AV block has not yet been clarified. Two infants with AV block of autoimmune and surgical etiology, respectively, had received a dual-chamber right ventricular-based pacemaker and developed dilated cardiomyopathy with severe septal to left ventricular free-wall dyssynchrony 3.4 (0.9) years later. After 4 weeks of biventricular pacing and spontaneous junctional narrow QRS rhythm, respectively, both children showed significant improvement in left ventricular function along with reverse remodeling. Thus, electromechanical dyssynchrony associated with conventional right-ventricular-based DDD pacing may play a significant role in the development of dilated cardiomyopathy in the young.
Collapse
Affiliation(s)
- Jan Janousek
- Kardiocentrum, University Hospital Motol, V úvalu 84, 150-06 Prague, Czech Republic.
| | | | | | | |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW This review is intended to highlight major clinical advances over the past year related to (1). biventricular pacing as a treatment for dilated myopathy, (2). growing clinical experience with implantable cardioverter defibrillators in pediatrics, (3). technical advances in standard antibradycardia pacing, and (4). an appraisal of the newly updated ACC/AHA/NASPE guidelines for device implant in children and adolescents. RECENT FINDINGS Complex rhythm devices are being used more frequently in children. Biventricular pacing to improve ventricular contractility is a rapidly evolving technology that has now been applied to children and young adults with intraventricular conduction delay, such as bundle branch block after cardiac surgery. Implantable defibrillators are also being used for an expanding list of conditions, although lead dysfunction is seen as a fairly common complication in active young patients. Guidelines for device implantation have been developed, but the weight of evidence remains somewhat limited by the paucity of pediatric data in this field. SUMMARY Thanks to refinements in lead design and generator technology, coupled with rapidly expanding clinical indications, pacemakers and implantable defibrillators have become increasingly important components of cardiac therapy for young patients. Expanded multicenter clinical studies will be needed to develop more objective guidelines for use of this advanced technology.
Collapse
Affiliation(s)
- Edward P Walsh
- Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | |
Collapse
|