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Masrour O, Personnic J, Amat F, Abou Taam R, Prevost B, Lezmi G, Gonsard A, Nathan N, Pirojoc A, Delacourt C, Wanin S, Drummond D. Objectives for algorithmic decision-making systems in childhood asthma: Perspectives of children, parents, and physicians. Digit Health 2024; 10:20552076241227285. [PMID: 38389509 PMCID: PMC10883132 DOI: 10.1177/20552076241227285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 02/24/2024] Open
Abstract
Objectives To identify with children, parents and physicians the objectives to be used as parameters for algorithmic decision-making systems (ADMSs) adapting treatments in childhood asthma. Methods We first conducted a qualitative study based on semi-structured interviews to explore the objectives that children aged 8-17 years, their parents, and their physicians seek to achieve when taking/giving/prescribing a treatment for asthma. Following the grounded theory approach, each interview was independently coded by two researchers; reconciled codes were used to assess code frequency, categories were defined, and the main objectives identified. We then conducted a quantitative study based on questionnaires using these objectives to determine how children/parents/physicians ranked these objectives and whether their responses were aligned. Results We interviewed 71 participants (31 children, 30 parents and 10 physicians) in the qualitative study and identified seven objectives associated with treatment uptake and five objectives associated with treatment modalities. We included 291 participants (137 children, 137 parents, and 17 physicians) in the quantitative study. We found little correlation between child, parent, and physician scores for each of the objectives. Each child's asthma history influenced the choice of scores assigned to each objective by the child, parents, and physician. Conclusion The identified objectives are quantifiable and relevant to the management of asthma in the short and long term. They can therefore be incorporated as parameters for future ADMS. Shared decision-making seems essential to achieve consensus among children, parents, and physicians when choosing the weight to assign to each of these objectives.
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Affiliation(s)
- Omar Masrour
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Johan Personnic
- Department of Pediatrics, University Hospital Ambroise Paré, AP-HP, Paris, France
| | - Flore Amat
- Department of Pediatric Pulmonology and Allergology, University Hospital Robert Debré, AP-HP, Paris, France
| | - Rola Abou Taam
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Blandine Prevost
- Department of Pediatric Pulmonology, University Hospital Armand Trousseau, AP-HP, Paris, France
| | - Guillaume Lezmi
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Apolline Gonsard
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Nadia Nathan
- Department of Pediatric Pulmonology, University Hospital Armand Trousseau, AP-HP, Paris, France
| | | | - Christophe Delacourt
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Stéphanie Wanin
- Department of Pediatric Allergology, University Hospital Armand Trousseau, APHP, Paris, France
| | - David Drummond
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- Inserm UMR 1138, HeKA team, Centre de Recherche des Cordeliers, Paris, France
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Implantation of a cardioverter-defibrillator in an 8-kg infant: a case report and literature review. Cardiol Young 2022; 32:2044-2045. [PMID: 35491719 DOI: 10.1017/s1047951122001111] [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] [Indexed: 12/16/2022]
Abstract
The use of an implantable cardioverter-defibrillator to prevent sudden cardiac death is an approved method. Experience is limited regarding implantation techniques in infants and low-weight children. We herein describe the implantation of an epicardial implantable cardioverter-defibrillator in a 15-month-old infant weighing 8 kg. We also briefly discuss implantable cardioverter-defibrillator implantation in paediatrics, particularly infants, hoping that our experience will be drawn upon in further such attempts.
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Freedenberg VA, Berul CI. Potential for shock leads to potential for stress. Heart Rhythm 2022; 19:1530-1531. [PMID: 35817253 DOI: 10.1016/j.hrthm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Vicki A Freedenberg
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia
| | - Charles I Berul
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia.
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Zahedivash A, Hanisch D, Dubin AM, Trela A, Chubb H, Motonaga KS, Goodyer WR, Maeda K, Reinhartz O, Ma M, Martin E, Ceresnak SR. Implantable Cardioverter Defibrillators in Infants and Toddlers: Indications, Placement, Programming, and Outcomes. Circ Arrhythm Electrophysiol 2022; 15:e010557. [PMID: 35089800 DOI: 10.1161/circep.121.010557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist regarding implantable cardioverter defibrillator (ICD) usage in infants and toddlers. This study evaluates ICD placement indications, procedural techniques, programming strategies, and outcomes of ICDs in infants and toddlers. METHODS This is a single-center retrospective review of all patients ≤3 years old who received an ICD from 2009 to 2021. RESULTS Fifteen patients received an ICD at an age of 1.2 years (interquartile range [IQR], 0.1-2.4; 12 [80%] women; weight, 8.2 kg [IQR, 4.2-12.6]) and were followed for a median of 4.28 years (IQR, 1.40-5.53) or 64.2 patient-years. ICDs were placed for secondary prevention in 12 patients (80%). Diagnoses included 8 long-QT syndromes (53%), 4 idiopathic ventricular tachycardias/ventricular fibrillations (VFs; 27%), 1 recurrent ventricular tachycardia with cardiomyopathy (7%), 1 VF with left ventricular noncompaction (7%), and 1 catecholaminergic polymorphic ventricular tachycardia (7%). All implants were epicardial, with a coil in the pericardial space. Intraoperative defibrillation safety testing was attempted in 11 patients (73%), with VF induced in 8 (53%). Successful restoration of sinus rhythm was achieved in all tested patients with a median of 9 (IQR, 7.3-11.3) J or 0.90 (IQR, 0.68-1.04) J/kg. Complications consisted of 1 postoperative chylothorax and 3 episodes of feeding intolerance. VF detection was programmed to 250 (IQR, 240-250) ms with first shock delivering 10 (IQR, 5-15) J or 1.1 (IQR, 0.8-1.4) J/kg. Three patients (20%) received appropriate shocks for ventricular tachycardia/VF. No patient received an inappropriate shock. There were 2 (13%) ventricular lead fractures (at 2.6 and 4.2 years post-implant), 1 (7%) pocket-site infection, and 2 (13%) generator exchanges. All patients were alive, and 1 patient (7%) received a heart transplant. CONCLUSIONS ICDs can be safely and effectively placed for sudden death prevention in infants and toddlers with good midterm outcomes.
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Affiliation(s)
- Aydin Zahedivash
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Debra Hanisch
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Anne M Dubin
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Anthony Trela
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Henry Chubb
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Kara S Motonaga
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA.,Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, University of Pennsylvania (K.S.M.)
| | - William Rowland Goodyer
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | | | - Olaf Reinhartz
- Department of Cardiothoracic Surgery (O.R., M.M., E.M.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Michael Ma
- Department of Cardiothoracic Surgery (O.R., M.M., E.M.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Elisabeth Martin
- Department of Cardiothoracic Surgery (O.R., M.M., E.M.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Scott R Ceresnak
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
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Garnreiter JM. Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients. J Innov Card Rhythm Manag 2017; 8:2898-2906. [PMID: 32494433 PMCID: PMC7252892 DOI: 10.19102/icrm.2017.081104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/18/2017] [Indexed: 11/06/2022] Open
Abstract
Although implantable cardioverter-defibrillators (ICDs) have proven to be life-saving devices, there are frequent complications associated with their use, especially in the pediatric and congenital heart disease populations. Inappropriate shocks are a particularly frequent complication in these groups. This review discusses the causes and implications of inappropriate ICD shocks, and presents potential interventions that may assist in safely reducing the rates of inappropriate shocks in pediatric and congenital heart disease patients with ICDs.
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Affiliation(s)
- Jason M Garnreiter
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA
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6
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AYKAN HAYRETTINHAKAN, KARAGOZ TEVFIK, GULGUN MUSTAFA, ERTUGRUL ILKER, AYPAR EBRU, OZER SEMA, ALEHAN DURSUN, CELIKER ALPAY, OZKUTLU SUHEYLA. Midterm Results of Implantable Cardioverter Defibrillators in Children and Young Adults from a Single Center in Turkey. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1225-1239. [DOI: 10.1111/pace.12954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 08/31/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Affiliation(s)
- HAYRETTIN HAKAN AYKAN
- Department of Pediatric Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - TEVFIK KARAGOZ
- Department of Pediatric Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - MUSTAFA GULGUN
- Department of Pediatric Cardiology; Gulhane Military Medical Academy; Ankara Turkey
| | - ILKER ERTUGRUL
- Department of Pediatric Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - EBRU AYPAR
- Department of Pediatric Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - SEMA OZER
- Department of Pediatric Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - DURSUN ALEHAN
- Department of Pediatric Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - ALPAY CELIKER
- Department of Pediatric Cardiology; Koc University; Istanbul Turkey
| | - SUHEYLA OZKUTLU
- Department of Pediatric Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
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7
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Lim TSE, Tan BY, Ho KL, Lim CYP, Teo WS, Ching CK. Initial experience of subcutaneous implantable cardioverter defibrillators in Singapore: a case series and review of the literature. Singapore Med J 2015; 56:580-5. [PMID: 26512151 DOI: 10.11622/smedj.2015154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Transvenous implantable cardioverter defibrillators are a type of implantable cardiac device. They are effective at reducing total and arrhythmic mortality in patients at risk of sudden cardiac death. Subcutaneous implantable cardioverter defibrillators (S-ICDs) are a new alternative that avoids the disadvantages of transvenous lead placement. In this case series, we report on the initial feasibility and safety of S-ICD implantation in Singapore.
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Affiliation(s)
| | - Boon Yew Tan
- Department of Cardiology, National Heart Centre, Singapore
| | - Kah Leng Ho
- Department of Cardiology, National Heart Centre, Singapore
| | | | - Wee Siong Teo
- Department of Cardiology, National Heart Centre, Singapore
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8
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Freedenberg VA, Thomas SA, Friedmann E. A pilot study of a mindfulness based stress reduction program in adolescents with implantable cardioverter defibrillators or pacemakers. Pediatr Cardiol 2015; 36:786-95. [PMID: 25519914 DOI: 10.1007/s00246-014-1081-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/05/2014] [Indexed: 11/25/2022]
Abstract
Adolescents with implantable cardioverter defibrillators (ICDs) or pacemakers (PMs) face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac devices and could potentially impact adolescents' adjustment to these devices. Mindfulness Based Stress Reduction (MBSR) is a structured psycho-educational program that includes meditation, yoga, and group support and has been studied extensively among adults. This study examined the feasibility of the MBSR program for adolescents with ICDs/PMs, a population previously unexamined in the research literature. The participants completed measures of anxiety and depression (Hospital Anxiety and Depression Scale) and coping (Responses to Stress Questionnaire) at baseline and after the six-session MBSR intervention. Mean age of the cohort (n = 10) was 15 ± 3 years, 6 were male, 6 had a PM, and 4 had an ICD. Feasibility was demonstrated by successful recruitment of 10 participants, 100 % participation and completion. Anxiety decreased significantly following the intervention, with a large effect size, t[9] = 3.67, p < .01, ŋ (2) = .59. Anxiety frequency decreased from baseline to post-intervention (Fisher's exact test p = .024), and 90 % of participants reported decreased anxiety scores post-intervention. Coping skills related negatively to anxiety (r = -.65, p = .04) and depression (r = -.88, p = .001). Post-intervention, the group independently formed their own Facebook group and requested to continue meeting monthly. Although generalizability is limited due to the small sample size, this successful pilot study paves the way for larger studies to examine the efficacy of MBSR interventions in adolescents with high-risk cardiac diagnoses.
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Affiliation(s)
- Vicki A Freedenberg
- Division of Cardiology, Children's National Health System, 111 Michigan Ave., N.W., Washington, DC, 20010, USA,
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9
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Lambiase PD, Barr C, Theuns DAMJ, Knops R, Neuzil P, Johansen JB, Hood M, Pedersen S, Kääb S, Murgatroyd F, Reeve HL, Carter N, Boersma L. Worldwide experience with a totally subcutaneous implantable defibrillator: early results from the EFFORTLESS S-ICD Registry. Eur Heart J 2014; 35:1657-65. [PMID: 24670710 PMCID: PMC4076663 DOI: 10.1093/eurheartj/ehu112] [Citation(s) in RCA: 367] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aims The totally subcutaneous implantable-defibrillator (S-ICD) is a new alternative to the conventional transvenous ICD system to minimize intravascular lead complications. There are limited data describing the long-term performance of the S-ICD. This paper presents the first large international patient population collected as part of the EFFORTLESS S-ICD Registry. Methods and results The EFFORTLESS S-ICD Registry is a non-randomized, standard of care, multicentre Registry designed to collect long-term, system-related, clinical, and patient reported outcome data from S-ICD implanted patients since June 2009. Follow-up data are systematically collected over 60-month post-implant including Quality of Life. The study population of 472 patients of which 241 (51%) were enrolled prospectively has a mean follow-up duration of 558 days (range 13–1342 days, median 498 days), 72% male, mean age of 49 ± 18 years (range 9–88 years), 42% mean left ventricular ejection fraction. Complication-free rates were 97 and 94%, at 30 and 360 days, respectively. Three hundred and seventeen spontaneous episodes were recorded in 85 patients during the follow-up period. Of these episodes, 169 (53%) received therapy, 93 being for Ventricular Tachycardia/Fibrillation (VT/VF). One patient died of recurrent VF and severe bradycardia. Regarding discrete VT/VF episodes, first shock conversion efficacy was 88% with 100% overall successful clinical conversion after a maximum of five shocks. The 360-day inappropriate shock rate was 7% with the vast majority occurring for oversensing (62/73 episodes), primarily of cardiac signals (94% of oversensed episodes). Conclusion The first large cohort of real-world data from an International patient S-ICD population demonstrates appropriate system performance with clinical event rates and inappropriate shock rates comparable with those reported for conventional ICDs. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier NCT01085435.
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Affiliation(s)
- Pier D Lambiase
- Cardiology Department, The Heart Hospital, Institute of Cardiovascular Science, University College London, 16-18 Westmoreland Street, W1G 8PH London, UK
| | - Craig Barr
- Cardiology Department, Russells Hall Hospital, Dudley, UK
| | - Dominic A M J Theuns
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Reinoud Knops
- Department of Cardiology and Electrophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Petr Neuzil
- Department of Cardiology, Homnolka Hospital, Prague, Czech Republic
| | - Jens Brock Johansen
- Department of Cardiology, Electrophysiology Section, Odense University Hospital, Odense, Denmark
| | | | - Susanne Pedersen
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Kääb
- Division of Electrophysiology, Campus Grosshadern, University of Munich, Munich, Germany
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CLAUSEN HENNING, PFLAUMER ANDREAS, KAMBERI SULEMAN, DAVIS ANDREW. Electrical Storm in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:391-401. [DOI: 10.1111/pace.12050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 09/16/2012] [Accepted: 09/26/2012] [Indexed: 01/24/2023]
Affiliation(s)
- HENNING CLAUSEN
- Department of Cardiology; Royal Children's Hospital; Parkville; Australia
| | | | - SULEMAN KAMBERI
- Department of Cardiology; Royal Children's Hospital; Parkville; Australia
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Elahi M, Poh CL, Krishna A, Grant P. Surgical Considerations for Large Asymptomatic Cardiac Fibromas in the context of Fatal Ventricular Arrhythmias. Heart Lung Circ 2012; 21:750-3. [DOI: 10.1016/j.hlc.2012.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 02/24/2012] [Accepted: 03/03/2012] [Indexed: 11/28/2022]
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12
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Uyeda T, Inoue K, Sato J, Mizukami A, Yoshikawa T, Wada N, Ando M, Takahashi Y, Umemura J, Park IS. Outcome of implantable cardioverter defibrillator therapy for congenital heart disease. Pediatr Int 2012; 54:379-82. [PMID: 22212537 DOI: 10.1111/j.1442-200x.2011.03556.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of implantable cardioverter defibrillator (ICD) therapy for congenital heart disease (CHD) has been increasing, but few studies have reported on the efficacy of ICD therapy in Japanese CHD patients. METHOD Twelve CHD patients (median age, 35 years) with first ICD implantation were examined. Median follow-up duration was 2.9 years. Demographic information, implant electrical parameters, appropriate and inappropriate discharge data and complications were recorded for all implants from 2003 to 2010. RESULTS Implant indication was primary prevention in two patients and secondary prevention in 10. Overall four patients received one or more discharges; three patients (25%) with secondary prevention received nine appropriate discharges. Inappropriate discharge attributed to sinus tachycardia occurred in two patients (16.7%). Only one patient experienced the late complication of skin erosion at the generator implantation site. CONCLUSIONS Patients with CHD experienced significant rates of appropriate discharges and lower complications. But given that the indications of ICD implantation were mostly for secondary prevention, the ratio of appropriate shocks might be lower than in previous studies. In the primary prevention patients, the benefit of ICD was not clear because no appropriate discharges were seen during follow up. Although ICD implantation for CHD is beneficial for preventing sudden cardiac death, careful decision making and a large, long-term prospective study is required for the determination of the efficacy of ICD therapy in Japanese patients with CHD.
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Affiliation(s)
- Tomomi Uyeda
- Department of Pediatric Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
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13
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RAHMAN BELINDA, MACCIOCCA IVAN, SAHHAR MARGARET, KAMBERI SULEMAN, CONNELL VANESSA, DUNCAN RONYE. Adolescents with Implantable Cardioverter Defibrillators: A Patient and Parent Perspective. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:62-72. [DOI: 10.1111/j.1540-8159.2011.03229.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hypoplastic coronary artery disease: A rare cause of sudden cardiac death and its treatment with an implantable defibrillator. J Cardiol Cases 2011; 4:e148-e151. [PMID: 30532882 DOI: 10.1016/j.jccase.2011.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 05/05/2011] [Accepted: 08/01/2011] [Indexed: 12/22/2022] Open
Abstract
A 21-year-old African American male presented to the emergency department after an episode of unexplained syncope. He had no significant past medical history. The initial physical examination was within normal limits, and his 12-lead electrocardiogram showed no signs of ischemia or evidence of chamber enlargement. The patient received a transthoracic echocardiogram which demonstrated mild global left ventricular dysfunction with an estimated ejection fraction of 45%. Coronary angiography was next performed and found no evidence of atherosclerotic coronary artery disease but did reveal hypoplasia of the left circumflex and right coronary arteries, with intraluminal diameters of approximately 1 mm. The left anterior descending coronary artery was small distally. Cardiac magnetic resonance imaging with gadolinium enhancement found no evidence of myocardial scar. The patient was ultimately diagnosed with aborted sudden cardiac death due to hypoplastic coronary artery disease (HCAD). The patient received an implantable cardioverter-defibrillator (ICD) prior to hospital discharge for secondary prevention of sudden cardiac death. One year after this presentation, the patient has been asymptomatic, with no ICD discharges.
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Celiker A, Olgun H, Karagoz T, Ozer S, Ozkutlu S, Alehan D. Midterm experience with implantable cardioverter-defibrillators in children and young adults. Europace 2010; 12:1732-8. [DOI: 10.1093/europace/euq340] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Garratt CJ, Elliott P, Behr E, Camm AJ, Cowan C, Cruickshank S, Grace A, Griffith MJ, Jolly A, Lambiase P, McKeown P, O'Callagan P, Stuart G, Watkins H. Heart Rhythm UK position statement on clinical indications for implantable cardioverter defibrillators in adult patients with familial sudden cardiac death syndromes. Europace 2010; 12:1156-75. [DOI: 10.1093/europace/euq261] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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17
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Feingold B, Arora G, Webber SA, Smith KJ. Cost-effectiveness of implantable cardioverter-defibrillators in children with dilated cardiomyopathy. J Card Fail 2010; 16:734-41. [PMID: 20797597 DOI: 10.1016/j.cardfail.2010.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 04/02/2010] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) improve survival and are cost-effective in adults with poor left ventricular function. Because of differences in heart failure etiology, sudden death rates, and ICD complication rates, these findings may not be applicable to children. METHODS AND RESULTS We developed a Markov model to compare typical management of childhood dilated cardiomyopathy with symptomatic heart failure to prophylactic ICD implantation plus typical management. Model costs included costs of outpatient care, medications, complications, and transplantation. Time horizon was up to 20 years from model entry. Total costs were $433,000 (ICD strategy) and $355,000 (typical management). Although quality adjusted survival was greater in the ICD group (6.78 versus 6.43 quality adjusted life-years [QALY]), the incremental cost-utility ratio was $281,622/QALY saved with the ICD strategy. In sensitivity analyses, the ICD strategy cost less than the $100,000/QALY benchmark for cost-effectiveness only when the annual probability of sudden death exceeded 13% or when strong, sustained benefits in quality of life from the ICD were assumed. CONCLUSIONS Prophylactic ICD use in children with dilated cardiomyopathy, poor ventricular function, and symptomatic heart failure does not appear to be cost-effective. This is likely due to lower sudden death rates in this population.
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Affiliation(s)
- Brian Feingold
- Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
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Obeyesekere MN, Kamberi S, Youngs N, Alison J. Long-term performance of submammary defibrillator system. Europace 2010; 12:1239-44. [DOI: 10.1093/europace/euq152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Botsch MP, Franzbach B, Opgen-Rhein B, Berger F, Will JC. ICD Therapy in Children and Young Adults: Low Incidence of Inappropriate Shock Delivery. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:734-41. [PMID: 20149121 DOI: 10.1111/j.1540-8159.2010.02695.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Micha P Botsch
- Department of Pediatric Cardiology and Congenital Heart Disease, Charité Universitaetsmedizin, Berlin, Germany.
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20
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Berul CI. Implantable cardioverter defibrillator criteria for primary and secondary prevention of pediatric sudden cardiac death. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 32 Suppl 2:S67-70. [PMID: 19602167 DOI: 10.1111/j.1540-8159.2009.02388.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The implantable cardioverter defibrillator is established as life-saving in specific adult populations. However, the precise indications and criteria for defibrillator implantation in children are less well defined. This article provides a succinct review of the indications and implantation criteria in pediatric populations at risk for sudden cardiac death, including specific disease substrates such as cardiomyopathies, inherited arrhythmias, and congenital heart disease.
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Affiliation(s)
- Charles I Berul
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
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21
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Sears SF, St Amant JB, Zeigler V. Psychosocial Considerations for Children and Young Adolescents with Implantable Cardioverter Defibrillators: An Update. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 2:S80-2. [PMID: 19602170 DOI: 10.1111/j.1540-8159.2009.02391.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina 27858, USA.
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22
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Sim DS, Jeong MH, Choi S, Yoon NS, Yoon HJ, Moon JY, Hong YJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Myocardial Infarction in a Young Man due to a Hypoplastic Coronary Artery. Korean Circ J 2009; 39:163-7. [PMID: 19949606 PMCID: PMC2771812 DOI: 10.4070/kcj.2009.39.4.163] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 11/04/2008] [Accepted: 11/12/2008] [Indexed: 11/13/2022] Open
Abstract
Hypoplastic coronary artery disease (HCAD) is a rare condition that may lead to myocardial infarction (MI) and sudden death. We discovered HCAD in a young man who developed chest pain after heavy drinking and who was found to have suffered an MI. His ECG showed ST-segment elevation with Q waves in the anterior leads, and echocardiography revealed apical dyskinesia with moderate left ventricular (LV) dysfunction. Coronary angiography showed hypoplasia of the left anterior descending (LAD) artery. 99mTc-tetrofosmin-gated myocardial perfusion scintigraphy showed a large, fixed perfusion defect in the anteroseptal and apical segments. Sixty-four-slice cardiac CT and cardiac MR imaging demonstrated thinning of the apical wall with calcification and delayed enhancement, supporting the diagnosis of long-standing MI. The patient was discharged symptom-free on medication for ischemic heart failure two weeks after admission. Although HCAD is very uncommon, it should be considered in children and young adults who suffer MI or sudden cardiac death.
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Affiliation(s)
- Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
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23
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KUGLER JOHND. Simpler is Better? Full Circle in Our Attempt to Decrease Cardioverter Defibrillator Inappropriate Shocks in the Young. J Cardiovasc Electrophysiol 2009; 20:291-2. [DOI: 10.1111/j.1540-8167.2008.01350.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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25
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Zellerhoff S, Pistulli R, Mönnig G, Hinterseer M, Beckmann BM, Köbe J, Steinbeck G, Kääb S, Haverkamp W, Fabritz L, Gradaus R, Breithardt G, Schulze-Bahr E, Böcker D, Kirchhof P. Atrial Arrhythmias in long-QT syndrome under daily life conditions: a nested case control study. J Cardiovasc Electrophysiol 2008; 20:401-7. [PMID: 19017345 DOI: 10.1111/j.1540-8167.2008.01339.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The long-QT syndromes (LQTS) are inherited electrical cardiomyopathies characterized by prolonged ventricular repolarization and ventricular arrhythmias. Several genetic reports have associated defects in LQTS-causing genes with atrial fibrillation (AF). We therefore studied whether atrial arrhythmias occur in patients with LQTS under daily-life conditions. METHODS We systematically assessed atrial arrhythmias in LQTS patients and matched controls using implanted defibrillators or pacemakers as monitors of atrial rhythm in a nested case-control study. Twenty-one LQTS patients (3 male; 39 +/- 18 years old; 18 on beta blocker, ICD therapy duration 6.3 +/- 2.7 years; 4 LQT1, 6 LQT2, 2 LQT3) were matched to 21 control subjects (13 male; 50 +/- 19 years old; 3 on beta blocker; pacemaker therapy duration 8.5 +/- 5.5 years; 19 higher-degree AV block, 2 others). LQTS patients were identified by a systematic search of the LQTS patient databases in Münster and Munich. RESULTS One-third (7 of 21) of the LQTS patients developed self-terminating atrial arrhythmias (atrial cycle lengths <250 ms). Only one control patient developed a single episode of postoperative AF (P < 0.05 vs LQTS). CONCLUSIONS LQTS patients at high risk for ventricular arrhythmias may develop short-lasting atrial arrhythmias under daily-life conditions, suggesting that prolonged atrial repolarization may contribute to the initiation of AF.
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Affiliation(s)
- Stephan Zellerhoff
- Department of Cardiology and Angiology, Hospital of the University of Münster, Germany
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26
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Triedman JK. Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD? Circ Arrhythm Electrophysiol 2008; 1:307-16; discussion 316. [DOI: 10.1161/circep.108.805903] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John K. Triedman
- From the Department of Cardiology, Children’s Hospital Boston, Boston, Mass
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27
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Molecular-targeted therapy for Duchenne muscular dystrophy: progress and potential. Mol Diagn Ther 2008; 12:99-108. [PMID: 18422374 DOI: 10.1007/bf03256275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Duchenne muscular dystrophy (DMD) is a lethal heritable childhood myodegenerative condition caused by a mutation within the gene encoding the dystrophin protein within the X chromosome. While, historically, patients with this condition rarely lived into their thirties, they are now living substantially longer as a result of new treatments based on multi-disciplinary care. Despite these advances, the prognosis for DMD patients is limited, and a progressive reduction in quality of life and early death in adulthood cannot be prevented using currently available treatment regimens. The best hopes for a cure lies with cellular and gene therapy approaches that target the underlying genetic defect. In the past several years, viral and nonviral gene therapy methodologies based on adeno-associated viruses, naked plasmid delivery, antisense oligonucleotides, and oligonucleotide-mediated gene editing have advanced to a high degree of sophistication, to the extent that research has moved from the laboratory setting to the clinic. Notwithstanding these accomplishments, shortcomings with each therapy remain, so more work is required to devise an appropriate therapeutic strategy for the management and eventual cure of this debilitating disease.
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28
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Berul CI, Van Hare GF, Kertesz NJ, Dubin AM, Cecchin F, Collins KK, Cannon BC, Alexander ME, Triedman JK, Walsh EP, Friedman RA. Results of a multicenter retrospective implantable cardioverter-defibrillator registry of pediatric and congenital heart disease patients. J Am Coll Cardiol 2008; 51:1685-91. [PMID: 18436121 DOI: 10.1016/j.jacc.2008.01.033] [Citation(s) in RCA: 259] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 01/16/2008] [Accepted: 01/26/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to determine the implications of implantable cardioverter-defibrillator (ICD) placement in children and patients with congenital heart disease (CHD). BACKGROUND There is increasing frequency of ICD use in pediatric and CHD patients. Until recently, prospective registry enrollment of ICD patients was not available, and children and CHD patients account for only a small percentage of ICD recipients. Therefore, we retrospectively obtained collaborative data from 4 pediatric centers, aiming to identify implant characteristics, shock frequency, and complications in this unique population. METHODS Databases from 4 centers were collated in a blinded fashion. Demographic information, implant electrical parameters, appropriate and inappropriate shock data, and complications were recorded for all implants from 1992 to 2004. RESULTS A total of 443 patients were included, with a median age of 16 years (range 0 to 54 years) and median weight of 61 kg (range 2 to 130 kg), with 69% having structural heart disease. The most common diagnoses were tetralogy of Fallot (19%) and hypertrophic cardiomyopathy (14%). Implant indication was primary prevention in 52%. Shock data were available on 409 patients, of whom 105 (26%) received appropriate shocks (mean 4 shocks/patient, range 1 to 29 shocks/patient). Inappropriate shocks occurred in 87 of 409 patients (21%), with a mean of 6 per patient (range 1 to 60), mainly attributable to lead failure (14%), sinus or atrial tachycardias (9%), and/or oversensing (4%). CONCLUSIONS Children and CHD ICD recipients have significant appropriate and inappropriate shock frequencies. Optimizing programming, medical management, and compliance may diminish inappropriate shocks. Despite concerns regarding generator recalls, lead failure remains the major cause of inappropriate shocks, complications, and system malfunction in children. Prospective assessment of ICD usage in this population may identify additional important factors in pediatric and CHD patients.
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Affiliation(s)
- Charles I Berul
- Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
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29
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Blom NA. Implantable cardioverter-defibrillators in children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31 Suppl 1:S32-4. [PMID: 18226032 DOI: 10.1111/j.1540-8159.2008.00952.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Implantable cardioverter-defibrillators (ICD) in adults have shown to be safe and effective for both primary and secondary prevention of sudden cardiac death (SCD). In children and patients with congenital heart disease prospective trials to evaluate the safety and efficacy of these devices are still lacking. This review will discuss the different aspects of ICD therapy in children with regard to current indications, effectiveness, problems related to size and growth, inappropriate shock therapy, and quality of life.
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Affiliation(s)
- Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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30
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Wagner KR, Lechtzin N, Judge DP. Current treatment of adult Duchenne muscular dystrophy. Biochim Biophys Acta Mol Basis Dis 2007; 1772:229-37. [PMID: 16887341 DOI: 10.1016/j.bbadis.2006.06.009] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 06/27/2006] [Accepted: 06/27/2006] [Indexed: 01/16/2023]
Abstract
Patients with Duchenne muscular dystrophy (DMD) are living longer into adulthood due to a variety of improvements in health care practices. This growing patient population presents new therapeutic challenges. In this article, we review the literature on current treatment of adult DMD as well as our own experience as a multidisciplinary team actively caring for 23 men ages 19-38 years of age. Approximately one quarter of our adult DMD patients have remained on moderate dose corticosteroids. Daily stretching exercises are recommended, particularly of the distal upper extremities. Cardiomyopathy is anticipated, detected, and treated early with afterload reduction. Oxygen saturation monitoring, noninvasive positive pressure ventilation and cough assist devices are routinely used. Other medical issues such as osteoporosis, gastrointestinal and urinary symptoms are addressed. Current and future therapies directed at prolonging the lifespan of those with DMD will result in further increases in this adult population with special needs and concerns. These needs are best addressed in a multidisciplinary clinic.
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Affiliation(s)
- Kathryn R Wagner
- Department of Neurology, The Johns Hopkins School of Medicine, Meyer 5-119, 600 N. Wolfe St., Baltimore, MD 21287, USA.
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Abstract
Hypoplastic coronary artery disease (HCAD) is a rare abnormality with a high rate of sudden death and poor outcome. HCAD was revealed by myocardial infarction in a teenager with objective evidence of silent ischaemia on myocardial scintigraphy. After four years of follow up, he suddenly collapsed during exercise and subsequently died. Although HCAD is very uncommon, it should be actively excluded in children and young adults who experience sudden cardiac death. Aggressive treatment such as implantable cardioverter-defibrillator or heart transplantation may be indicated for this rare coronary abnormality.
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Affiliation(s)
- N Amabile
- Département de cardiologie, Hôpital de la Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France
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Abstract
The use of implantable cardioverter defibrillators in children presents several unique challenges for the pediatric cardiologist. Size considerations and hardware limitations are important in the current generation of devices that are not designed with children in mind. Defibrillator devices are used to prolong life, which may have significant implications for leads and electrodes that are affixed to the heart in a child who has continued growth potential. A greater number of children with congenital heart defects are surviving into adulthood, many of whom have a risk of late sudden death following repair. These patients may also have unique anatomic considerations that may affect device placement. This article will address some of the issues faced when considering the use of implantable-defibrillator therapy in the pediatric population.
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Affiliation(s)
- Terrence U H Chun
- Division of Pediatric Cardiology, Stanford University, 750 Welch Road, Suite 305, Palo Alto, California 94305, USA.
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Sears SF, Conti JB. Implantable cardioverter-defibrillators for children and young adolescents: mortality benefit confirmed--what's next? Heart 2004; 90:241-2. [PMID: 14966029 PMCID: PMC1768134 DOI: 10.1136/hrt.2003.021295] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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