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Suntratonpipat S, Pajunen K, Rosolowsky E, Escudero CA, Girgis R, Thompson RB, Pagano JJ, Tham EB. Cardiac MRI evaluation of aortic biophysical properties in paediatric Turner syndrome. Cardiol Young 2024:1-7. [PMID: 38606642 DOI: 10.1017/s1047951124000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Aortopathy in Turner syndrome is associated with aortic dilation, and the risk of dissection is increased when the aortic size index is ≥ 2-2.5 cm/m2. We evaluated the aortic biophysical properties in paediatric Turner syndrome using cardiac MRI to determine their relationship to aortic size index. METHODS Turner syndrome patients underwent cardiac MRI to evaluate ventricular function, aortic dimensions, and biophysical properties (aortic stiffness index, compliance, distensibility, pulse wave velocity, and aortic and left ventricular elastance). Spearman correlation examined correlations between these properties and aortic size index. Data was compared to 10 controls. RESULTS Of 25 Turner syndrome patients, median age 14.7 years (interquartile range: 11.0-16.8), height z score -2.7 (interquartile range: -2.92 - -1.54), 24% had a bicuspid aortic valve. Turner syndrome had increased diastolic blood pressure (p < 0.001) and decreased left ventricular end-diastolic (p < 0.001) and end-systolic (p = 0.002) volumes compared to controls. Median aortic size index was 1.81 cm/m2 (interquartile range: 1.45-2.1) and 7 had an aortic size index > 2 cm/m2. Aortic and left ventricular elastance were greater in Turner syndrome compared to controls (both p < 0.001). Increased aortic size index correlated with increased aortic elastance (r = 0.5, p = 0.01) and left ventricular elastance (r = 0.59, p = 0.002) but not aortic compliance. Higher ascending aortic areas were associated with increased aortic compliance (r = 0.44, p = 0.03) and left ventricular elastance (r = 0.49, p = 0.01). CONCLUSION Paediatric Turner syndrome with similar aortic size index to controls showed MRI evidence of abnormal aortic biophysical properties. These findings point to an underlying aortopathy and provide additional parameters that may aid in determining risk factors for aortic dissection.
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Affiliation(s)
- Somjate Suntratonpipat
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Kiera Pajunen
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Elizabeth Rosolowsky
- Division of Pediatric Endocrinology, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Carolina A Escudero
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Rose Girgis
- Division of Pediatric Endocrinology, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Joseph J Pagano
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Edythe B Tham
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
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Jiang R, Cheung CC, Garcia-Montero M, Davies B, Cao J, Redfearn D, Laksman ZM, Grondin S, Atallah J, Escudero CA, Cadrin-Tourigny J, Sanatani S, Steinberg C, Joza J, Avram R, Tadros R, Krahn AD. Deep Learning-Augmented ECG Analysis for Screening and Genotype Prediction of Congenital Long QT Syndrome. JAMA Cardiol 2024; 9:377-384. [PMID: 38446445 PMCID: PMC10918571 DOI: 10.1001/jamacardio.2024.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/07/2024] [Indexed: 03/07/2024]
Abstract
Importance Congenital long QT syndrome (LQTS) is associated with syncope, ventricular arrhythmias, and sudden death. Half of patients with LQTS have a normal or borderline-normal QT interval despite LQTS often being detected by QT prolongation on resting electrocardiography (ECG). Objective To develop a deep learning-based neural network for identification of LQTS and differentiation of genotypes (LQTS1 and LQTS2) using 12-lead ECG. Design, Setting, and Participants This diagnostic accuracy study used ECGs from patients with suspected inherited arrhythmia enrolled in the Hearts in Rhythm Organization Registry (HiRO) from August 2012 to December 2021. The internal dataset was derived at 2 sites and an external validation dataset at 4 sites within the HiRO Registry; an additional cross-sectional validation dataset was from the Montreal Heart Institute. The cohort with LQTS included probands and relatives with pathogenic or likely pathogenic variants in KCNQ1 or KCNH2 genes with normal or prolonged corrected QT (QTc) intervals. Exposures Convolutional neural network (CNN) discrimination between LQTS1, LQTS2, and negative genetic test results. Main Outcomes and Measures The main outcomes were area under the curve (AUC), F1 scores, and sensitivity for detecting LQTS and differentiating genotypes using a CNN method compared with QTc-based detection. Results A total of 4521 ECGs from 990 patients (mean [SD] age, 42 [18] years; 589 [59.5%] female) were analyzed. External validation within the national registry (101 patients) demonstrated the CNN's high diagnostic capacity for LQTS detection (AUC, 0.93; 95% CI, 0.89-0.96) and genotype differentiation (AUC, 0.91; 95% CI, 0.86-0.96). This surpassed expert-measured QTc intervals in detecting LQTS (F1 score, 0.84 [95% CI, 0.78-0.90] vs 0.22 [95% CI, 0.13-0.31]; sensitivity, 0.90 [95% CI, 0.86-0.94] vs 0.36 [95% CI, 0.23-0.47]), including in patients with normal or borderline QTc intervals (F1 score, 0.70 [95% CI, 0.40-1.00]; sensitivity, 0.78 [95% CI, 0.53-0.95]). In further validation in a cross-sectional cohort (406 patients) of high-risk patients and genotype-negative controls, the CNN detected LQTS with an AUC of 0.81 (95% CI, 0.80-0.85), which was better than QTc interval-based detection (AUC, 0.74; 95% CI, 0.69-0.78). Conclusions and Relevance The deep learning model improved detection of congenital LQTS from resting ECGs and allowed for differentiation between the 2 most common genetic subtypes. Broader validation over an unselected general population may support application of this model to patients with suspected LQTS.
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Affiliation(s)
- River Jiang
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Marta Garcia-Montero
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Cao
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Zachary M. Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steffany Grondin
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Julia Cadrin-Tourigny
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Shubhayan Sanatani
- Children’s Heart Centre, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Avram
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Rafik Tadros
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Andrew D. Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Robinson JA, Leclair G, Escudero CA. Pacing in Pediatric Patients with Postoperative Atrioventricular Block. Card Electrophysiol Clin 2023; 15:401-411. [PMID: 37865514 DOI: 10.1016/j.ccep.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Surgery for congenital heart disease may compromise atrioventricular (AV) nodal conduction, potentially resulting in postoperative AV block. In the majority of cases, AV nodal function recovers during the early postoperative period and may only require short-term pacing support, typically provided via temporary epicardial wires. Permanent pacing is indicated when the postoperative AV block persists for more than 7 to 10 days due to the risk of mortality if a pacemaker is not implanted. Although there is a subset of patients who may have late recovery of AV nodal function, those with continued postoperative AV block will need lifelong pacing therapy.
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Affiliation(s)
- Jeffrey A Robinson
- Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Pediatric Cardiac Electrophysiology, The Criss Heart Center, Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA
| | - Guillaume Leclair
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada; Stollery Children's Hospital, 4C1.19 WMC, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada
| | - Carolina A Escudero
- University of Alberta, Edmonton, Alberta, Canada; Pediatric Cardiology and Electrophysiology, Stollery Children's Hospital, Edmonton, Alberta, Canada.
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4
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Sheridan JA, Slim G, Foulds JL, Escudero CA. Paediatric residents painting 3D congenital heart disease models. Med Educ 2023; 57:1152-1153. [PMID: 37732334 DOI: 10.1111/medu.15210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023]
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Greidanus PG, Pagano JJ, Escudero CA, Thompson R, Tham EB. Regional Elevation of Liver T1 in Fontan Patients. CJC Pediatr Congenit Heart Dis 2023; 2:134-142. [PMID: 37969352 PMCID: PMC10642140 DOI: 10.1016/j.cjcpc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/08/2023] [Indexed: 11/17/2023]
Abstract
Background Fontan-associated liver disease (FALD) is characterized by hepatic congestion and progressive hepatic fibrosis in patients with the Fontan operation. This condition is generally clinically silent until late, necessitating techniques for early detection. Liver T1 mapping has been used to screen for FALD, but without consideration of regional variations in T1 values. Methods Liver T1 measured with a liver-specific T1 mapping sequence (PROFIT1) in Fontan patients was compared with cohorts of patients with biventricular congenital heart disease (BiV-CHD) and controls with normal cardiac function and anatomy. Results Liver T1 was significantly elevated in the Fontan cohort (n = 20) compared with patients with BiV-CHD (n = 12) and controls (n = 9) (781, 678, and 675 milliseconds, respectively; P < 0.001), with a consistent pattern of significantly elevated T1 values in the peripheral compared with central liver regions (ΔT1 = 54, 2, and 11 milliseconds; P < 0.001). PROFIT1 also yielded simultaneous T2∗ maps and fat fraction values that were similar in all groups. Fontan liver T1 values were also significantly elevated as compared with BiV-CHD and controls as measured with the cardiac (modified Look-Locker inversion) acquisitions (728, 583, and 583 milliseconds, respectively; P < 0.001) and values correlated with PROFIT1 liver T1 (R = 0.87, P < 0.001). Conclusions Fontan patients have globally increased liver T1 values and consistent spatial variations, with higher values in the peripheral liver regions as compared with spatially uniform values in BiV-CHD and controls. The spatial patterns may provide insight into the progression of FALD. Liver T1 mapping studies should include uniform spatial coverage to avoid bias based on slice locations in this population.
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Affiliation(s)
- Paul G. Greidanus
- Division of Pediatric Cardiology, Stollery Children’s Hospital & Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph J. Pagano
- Division of Pediatric Cardiology, Stollery Children’s Hospital & Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carolina A. Escudero
- Division of Pediatric Cardiology, Stollery Children’s Hospital & Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Edythe B. Tham
- Division of Pediatric Cardiology, Stollery Children’s Hospital & Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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6
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Tham EB, Harake DE, Lin LQ, Du KJ, Harris LE, Williams E, Ash AL, Escudero CA. Implementation of Virtual Fontan Heart Camps During a Pandemic. World J Pediatr Congenit Heart Surg 2023; 14:63-69. [PMID: 36847767 PMCID: PMC9975293 DOI: 10.1177/21501351221127289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Children with a Fontan operation represent a unique form of congenital heart disease (CHD) that requires multiple cardiac surgeries and procedures with an uncertain long-term outcome. Given the rarity of the types of CHD that require this procedure, many children with a Fontan do not know any others like them. METHODS With the cancelation of medically supervised heart camps due to the COVID-19 pandemic, we have organized several physician-led virtual day camps for children with a Fontan operation to connect with others in their province and across Canada. The aim of this study was to describe the implementation and evaluation of these camps via the use of an anonymous online survey immediately after the event and reminders on days 2 and 4 postevent. RESULTS Fifty-one children have participated in at least 1 of our camps. Registration data showed that 70% of participants did not know anyone else with a Fontan. Postcamp evaluations showed that 86% to 94% learned something new about their heart and 95% to 100% felt more connected to other children like them. CONCLUSION We have demonstrated the implementation of a virtual heart camp to expand the support network for children with a Fontan. These experiences may help to promote healthy psychosocial adjustments through inclusion and relatedness.
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Affiliation(s)
- Edythe B Tham
- Division of Pediatric Cardiology,
Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University
of Alberta, Edmonton, Canada,Edythe B Tham, MBBS, Division of Pediatric
Cardiology & Diagnostic Imaging, Stollery Children's Hospital, University of
Alberta, 4C2 WCM HSC, 8440 112 St NW, Edmonton, AB, Canada, T6G 2B7.
| | | | - Lily Q Lin
- Division of Pediatric Cardiology,
Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University
of Alberta, Edmonton, Canada
| | - Katie J Du
- Division of Pediatric Cardiology,
Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University
of Alberta, Edmonton, Canada
| | - Lucy E Harris
- Division of Pediatric Cardiology,
Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University
of Alberta, Edmonton, Canada
| | - Elina Williams
- Western Canadian Children's Heart
Network, Alberta Health Services, Alberta, Canada
| | - Alanna L Ash
- Division of Pediatric Cardiology,
Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University
of Alberta, Edmonton, Canada
| | - Carolina A Escudero
- Division of Pediatric Cardiology,
Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University
of Alberta, Edmonton, Canada
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7
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Escudero CA, Tan RBM, Beach CM, Dalal AS, LaPage MJ, Hill AC. Approach to Wide Complex Tachycardia in Paediatric Patients. CJC Pediatr Congenit Heart Dis 2022; 1:60-73. [PMID: 37969244 PMCID: PMC10642107 DOI: 10.1016/j.cjcpc.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2023]
Abstract
Wide complex tachycardia (WCT) is an infrequently encountered condition in paediatric patients and may be due to a variety of causes including supraventricular tachycardia with aberrant conduction, ventricular activation via an accessory pathway, ventricular pacing, or ventricular tachycardia. Immediate tachycardia termination is required in haemodynamically unstable patients. After stabilization or in those with haemodynamically tolerated WCT, a careful review of electrocardiographic tracings and diagnostic manoeuvres are essential to help elucidate the cause. Subacute and chronic management for WCT will depend on the underlying cause as well as features of the patient and the tachycardia presentation. This article will review the epidemiology, potential causes, and management of WCT in children. A detailed review of the pathophysiology, differential diagnosis, and diagnostic and treatment options is provided to enable the reader to develop a practical approach to managing this condition in young patients.
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Affiliation(s)
- Carolina A. Escudero
- Division of Cardiology, Department of Pediatrics, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Reina Bianca M. Tan
- Division of Cardiology, Department of Pediatrics, NYU Langone Health and Hassenfeld Children’s Hospital, New York, New York, USA
| | - Cheyenne M. Beach
- Section of Cardiology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Aarti S. Dalal
- Division of Cardiology, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Martin J. LaPage
- Division of Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison C. Hill
- Division of Cardiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Wei N, Lamba A, Franciosi S, Law IH, Ochoa LA, Johnsrude CL, Kwok SY, Tan TH, Dhillon SS, Fournier A, Seslar SP, Stephenson EA, Blaufox AD, Ortega MC, Bone JN, Sandhu A, Escudero CA, Sanatani S. Medical Management of Infants With Supraventricular Tachycardia: Results From a Registry and Review of the Literature. CJC Pediatr Congenit Heart Dis 2022; 1:11-22. [PMID: 37969556 PMCID: PMC10642123 DOI: 10.1016/j.cjcpc.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/17/2023]
Abstract
Background Several medication choices are available for acute and prophylactic treatment of refractory supraventricular tachycardia (SVT) in infants. There are almost no controlled trials, and medication choices are not necessarily evidence based. Our objective was to report the effectiveness of management strategies for infant SVT. Methods A registry of infants admitted to hospital with re-entrant SVT and no haemodynamically significant heart disease were prospectively followed at 11 international tertiary care centres. In addition, a systematic review of studies on infant re-entrant SVT in MEDLINE and EMBASE was conducted. Data on demographics, symptoms, acute and maintenance treatments, and outcomes were collected. Results A total of 2534 infants were included: n = 108 from the registry (median age, 9 days [0-324 days], 70.8% male) and n = 2426 from the literature review (median age, 14 days; 62.3% male). Propranolol was the most prevalent acute (61.4%) and maintenance treatment (53.8%) in the Registry, whereas digoxin was used sparingly (4.0% and 3.8%, respectively). Propranolol and digoxin were used frequently in the literature acutely (31% and 33.2%) and for maintenance (17.8% and 10.1%) (P < 0.001). No differences in acute or prophylactic effectiveness between medications were observed. Recurrence was higher in the Registry (25.0%) vs literature (13.4%) (P < 0.001), and 22 (0.9%) deaths were reported in the literature vs none in the Registry. Conclusion This was the largest cohort of infants with SVT analysed to date. Digoxin monotherapy use was rare amongst contemporary paediatric cardiologists. There was limited evidence to support one medication over another. Overall, recurrence and mortality rates on antiarrhythmic treatment were low.
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Affiliation(s)
- Nathan Wei
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Avani Lamba
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia Franciosi
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian H. Law
- Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Luis A. Ochoa
- Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Christopher L. Johnsrude
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Sit Yee Kwok
- Department of Pediatric Cardiology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Teng Hong Tan
- Cardiology Service, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Santokh S. Dhillon
- Division of Cardiology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Ste Justine Hospital, Montreal, Québec, Canada
| | - Stephen P. Seslar
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Elizabeth A. Stephenson
- Labbatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D. Blaufox
- Department of Pediatrics, Division of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York, USA
| | - Michel Cabrera Ortega
- Department of Arrhythmia and Cardiac Pacing, Cardiocentro Pediatrico William Soler, Havana, Cuba
| | - Jeffrey N. Bone
- Research Informatics, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Ash Sandhu
- Research Informatics, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Carolina A. Escudero
- Department of Pediatrics, Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Shubhayan Sanatani
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Escudero CA, Dubin AM, Etheridge SP, Saarel EV, Stephenson EA, Shah MJ. B-AB08-03 MIND THE GAP: SEX DISPARITY IN SALARIES AMONGST PEDIATRIC AND CONGENITAL CARDIAC ELECTROPHYSIOLOGISTS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Prutkin JM, Wang Y, Escudero CA, Stephenson EA, Minges KE, Curtis JP, Hsu JC. Defibrillation Safety Margin Testing in Patients With Congenital Heart Disease: Results From the NCDR. JACC Clin Electrophysiol 2021; 7:1145-1154. [PMID: 33933411 DOI: 10.1016/j.jacep.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study analyzed the predictors of defibrillation safety margin (DSM) testing at the time of implantable cardioverter-defibrillator (ICD) insertion and factors associated with inadequate DSM in patients with congenital heart disease (CHD). BACKGROUND There are few data about the prevalence and safety of DSM testing in those with CHD. METHODS A retrospective analysis was performed of all patients with atrial or ventricular septal defect, tetralogy of Fallot, transposition of the great vessels, Ebstein anomaly, or common ventricle undergoing a transvenous ICD procedure in the National Cardiovascular Data Registry (NCDR) ICD Registry from April 2010 to March 2016, and DSM testing was assessed. Inadequate DSM was defined as a lowest successful energy tested <10 J than the maximum output of the ICD generator. RESULTS Of all ICD recipients (N = 7,024), DSM testing was performed in 52.0% (n = 3,654). The mean lowest successful energy tested was 20.7 ± 7.3 J. Of those with DSM adequacy data available (n = 3,623), an inadequate DSM occurred in 13.8% (n = 501). After multivariable adjustment, DSM testing was not associated with in-hospital complications or death (odds ratio [OR]: 1.00; 95% confidence interval [CI]: 0.79 to 1.28) but was associated with lower odds of prolonged hospital stay (>3 days) (OR: 0.71; 95% CI: 0.60 to 0.84; p < 0.0001). An inadequate DSM was not associated with in-hospital death or complications (OR: 1.27; 95% CI: 0.79 to 2.04) or prolonged hospital stay (OR: 1.34; 95% CI: 0.995 to 1.81). CONCLUSIONS DSM testing is being performed less frequently over time and seems safe in those with CHD. An inadequate DSM was not associated with worse in-hospital outcomes.
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Affiliation(s)
- Jordan M Prutkin
- Division of Cardiology, Section of Electrophysiology, University of Washington, Seattle, Washington, USA.
| | - Yongfei Wang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Carolina A Escudero
- Division of Pediatric Cardiology, Section of Electrophysiology, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Karl E Minges
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Jeptha P Curtis
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Jonathan C Hsu
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Diego, La Jolla, California, USA
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11
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Tester MA, Riehm KE, Perry F, Franciosi S, Escudero CA, Maghrabi K, Sneddon P, Sanatani S. Paediatric supraventricular tachycardia patients potentially more at risk of developing psychological difficulties compared to healthy peers. Acta Paediatr 2021; 110:1017-1024. [PMID: 32865825 DOI: 10.1111/apa.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/04/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
AIM Assess executive and socio-emotional/behavioural functioning in paediatric supraventricular tachycardia (SVT) patients. METHODS SVT patients aged 7-17 who had not undergone catheter ablation were included. Parents completed the Child Behaviour Checklist (CBCL/6-18) and the Behavior Rating Inventory of Executive Functioning (BRIEF). Participants age 11-17 years completed the Youth Self-Report (YSR/11-18) and the BRIEF Self-Report (BRIEF-SR). One-sample z test was used to compare questionnaire results to the average t-score range (M = 50, SD = 10). RESULTS Thirty (18 female) children/adolescents participated (M = 12.6 years old, SD = 3.2 years) with a mean SVT onset age of 7 years (SD = 4.3 years). BRIEF and BRIEF-SR results suggested no difference in executive functioning from average. Mean t-scores of CBCL/6-18 and YSR/11-18 subscales Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems, Diagnostic and Statistical Manual of Mental Disorders (DSM) Affective Problems, DSM Anxiety Problems and DSM Somatic Problems were significantly elevated compared to average. YSR/11-18 subscales Social Problems, Attention Problems, Internalizing Problems, DSM ADHD Problems and DSM Oppositional Defiant Problems had elevated mean t-scores compared to average. Effect sizes were small to medium (0.2 ≤ d ≤ 0.8). CONCLUSION Paediatric patients with SVT potentially have a greater risk of developing behaviour, especially internalizing, problems compared to similarly aged children/adolescents without SVT.
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Affiliation(s)
- Matthew A. Tester
- Children’s Heart Centre BC Children’s Hospital Vancouver BC Canada
- Department of Paediatrics University of British Columbia Vancouver BC Canada
| | - Kira E. Riehm
- Department of Mental Health Bloomberg School of Public Health Johns Hopkins University Baltimore MD USA
| | - Frances Perry
- Children’s Heart Centre BC Children’s Hospital Vancouver BC Canada
- Department of Paediatrics University of British Columbia Vancouver BC Canada
| | - Sonia Franciosi
- Children’s Heart Centre BC Children’s Hospital Vancouver BC Canada
- Department of Paediatrics University of British Columbia Vancouver BC Canada
| | | | | | - Penny Sneddon
- Department of Paediatrics University of British Columbia Vancouver BC Canada
- Department of Psychology BC Children’s Hospital Vancouver BC Canada
| | - Shubhayan Sanatani
- Children’s Heart Centre BC Children’s Hospital Vancouver BC Canada
- Department of Paediatrics University of British Columbia Vancouver BC Canada
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12
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Dorfman TL, Ash AL, Meakins LT, Conway J, Escudero CA, Cunningham CR. Strategies to maintain a family-centered care approach in the era of COVID-19: Experiences of a Canadian pediatric cardiology program. Prog Pediatr Cardiol 2021; 61:101370. [PMID: 34025089 PMCID: PMC8128705 DOI: 10.1016/j.ppedcard.2021.101370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/13/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has resulted in strict provincial guidelines to prevent its spread. Physical distancing requirements, the postponement of elective pediatric cardiac surgeries and non-invasive cardiac interventions, and hospital visitor restrictions have significantly impacted services provided by our pediatric cardiac program. Rapid modifications to current inpatient and outpatient practices were required to maintain a family-centered care approach. Strategies our team used to maintain a family-centered care approach focused on six key areas including inpatient care, outpatient pediatric cardiology clinics, family meetings, discharge planning and teaching, the connection of inpatient pediatric patients to the outside world, and social support. The majority of our strategies are adaptable to other pediatric cardiology programs and some may prove useful after the pandemic and as restrictions lift. These strategies each have their own limitations and challenges that must be considered when adapting them to other pediatric cardiology programs and continuing their use after the pandemic has resolved.
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Affiliation(s)
- Tamara L Dorfman
- Pediatric Cardiology, Stollery Children's Hospital, Unit 4C3/4C4, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada
| | - Alanna L Ash
- Pediatric Cardiology, Stollery Children's Hospital, Unit 4C3/4C4, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada
| | - Leanne T Meakins
- Pediatric Cardiology, Stollery Children's Hospital, Unit 4C3/4C4, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada
| | - Jennifer Conway
- Pediatric Cardiology, Stollery Children's Hospital, Unit 4C3/4C4, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada.,Department of Pediatrics, Edmonton Clinic Health Academy, Faculty of Medicine and Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Carolina A Escudero
- Pediatric Cardiology, Stollery Children's Hospital, Unit 4C3/4C4, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada.,Department of Pediatrics, Edmonton Clinic Health Academy, Faculty of Medicine and Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Chentel R Cunningham
- Pediatric Cardiology, Stollery Children's Hospital, Unit 4C3/4C4, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada.,Faculty of Nursing, 4-141 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
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13
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Ghovanloo MR, Atallah J, Escudero CA, Ruben PC. Biophysical Characterization of a Novel SCN5A Mutation Associated With an Atypical Phenotype of Atrial and Ventricular Arrhythmias and Sudden Death. Front Physiol 2020; 11:610436. [PMID: 33414724 PMCID: PMC7783455 DOI: 10.3389/fphys.2020.610436] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
Background Sudden cardiac death (SCD) is an unexpected death that occurs within an hour of the onset of symptoms. Hereditary primary electrical disorders account for up to 1/3 of all SCD cases in younger individuals and include conditions such as catecholaminergic polymorphic ventricular tachycardia (CPVT). These disorders are caused by mutations in the genes encoding cardiac ion channels, hence they are known as cardiac channelopathies. We identified a novel variant, T1857I, in the C-terminus of Nav1.5 (SCN5A) linked to a family with a CPVT-like phenotype characterized by atrial tachy-arrhythmias and polymorphic ventricular ectopy occurring at rest and with adrenergic stimulation, and a strong family history of SCD. Objective Our goal was to functionally characterize the novel Nav1.5 variant and determine a possible link between channel gating and clinical phenotype. Methods We first used electrocardiogram recordings to visualize the patient cardiac electrical properties. Then, we performed voltage-clamp of transiently transfected CHO cells. Lastly, we used the ventricular/atrial models to visualize gating defects on cardiac excitability. Results Voltage-dependences of both activation and inactivation were right-shifted, the overlap between activation and inactivation predicted increased window currents, the recovery from fast inactivation was slowed, there was no significant difference in late currents, and there was no difference in use-dependent inactivation. The O’Hara-Rudy model suggests ventricular after depolarizations and atrial Grandi-based model suggests a slight prolongation of atrial action potential duration. Conclusion We conclude that T1857I likely causes a net gain-of-function in Nav1.5 gating, which may in turn lead to ventricular after depolarization, predisposing carriers to tachy-arrhythmias.
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Affiliation(s)
- Mohammad-Reza Ghovanloo
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, Burnaby, BC, Canada
| | - Joseph Atallah
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carolina A Escudero
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Peter C Ruben
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, Burnaby, BC, Canada
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14
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Escudero CA, Ceresnak SR, Collins KK, Pass RH, Aziz PF, Blaufox AD, Ortega MC, Cannon BC, Cohen MI, Dechert BE, Dubin AM, Motonaga KS, Epstein MR, Erickson CC, Fishberger SB, Gates GJ, Capone CA, Nappo L, Kertesz NJ, Kim JJ, Valdes SO, Kubuš P, Law IH, Maldonado J, Moore JP, Perry JC, Sanatani S, Seslar SP, Shetty I, Zimmerman FJ, Skinner JR, Marcondes L, Stephenson EA, Asakai H, Tanel RE, Uzun O, Etheridge SP, Janson CM. Loss of ventricular preexcitation during noninvasive testing does not exclude high-risk accessory pathways: A multicenter study of WPW in children. Heart Rhythm 2020; 17:1729-1737. [DOI: 10.1016/j.hrthm.2020.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
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15
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Cunningham T, Roston TM, Franciosi S, Liu MC, Atallah J, Escudero CA, Udupa S, Roberts JD, Dhillon S, Dallaire F, Fournier A, Fatah M, Hamilton R, Sanatani S. Initially unexplained cardiac arrest in children and adolescents: A national experience from the Canadian Pediatric Heart Rhythm Network. Heart Rhythm 2020; 17:975-981. [DOI: 10.1016/j.hrthm.2020.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/29/2020] [Indexed: 02/01/2023]
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16
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Bezzerides VJ, Walsh A, Martuscello M, Escudero CA, Gauvreau K, Lam G, Abrams DJ, Triedman JK, Alexander ME, Bevilacqua L, Mah DY. The Real-World Utility of the LINQ Implantable Loop Recorder in Pediatric and Adult Congenital Heart Patients. JACC Clin Electrophysiol 2020; 5:245-251. [PMID: 30784698 DOI: 10.1016/j.jacep.2018.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/11/2018] [Accepted: 09/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study sought to determine the practical use of the recently introduced LINQ implantable loop recorder (LINQ-ILR) in a cohort of pediatric and adult congenital arrhythmia patients. BACKGROUND Correlating symptoms to a causative arrhythmia is a key aspect of diagnosis and management in clinical electrophysiology. METHODS Retrospective review of clinical data, implantation indications, findings, and therapeutic decisions in patients who underwent LINQ-ILR implantation from April 1st, 2014 to January 30th, 2017 at Boston Children's Hospital. RESULTS A total of 133 patients were included, of which 76 (57%) were male. The mean age at implantation was 15.7 ± 9.1 years with a duration of follow-up of 11.8 months. Congenital heart disease was present in 34 patients (26%), a confirmed genetic diagnosis in 50 (38%), and cardiomyopathy in 22 (26%), and the remainder were without a previous diagnosis. Syncope was the most common indication for LINQ-ILR implantation, occurring in 59 patients (44%). The median time to diagnosis was 4.5 months, occurring in 78 patients (59%). Cardiac device placement occurred in 17 patients (22%), a medication change in 9 (12%), electrophysiology study/ablation in 5 (6%), or LINQ-ILR explantation in 42 (54%). Infection or erosion occurred in 5 patients. Syncope was correlated with a diagnostic transmission (54% vs. 31%, p = 0.01). CONCLUSIONS The LINQ-ILR is an important diagnostic tool, providing useful data in more than one-half of patients in <6 months. Adverse events are low. Patient selection is critical and undiagnosed syncope represents an important presenting indication for which a LINQ-ILR implant should be considered.
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Affiliation(s)
- Vassilios J Bezzerides
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Amy Walsh
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Maria Martuscello
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Kimberlee Gauvreau
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Geralyn Lam
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Dominic J Abrams
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - John K Triedman
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Mark E Alexander
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Laura Bevilacqua
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Douglas Y Mah
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
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17
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Shwayder MH, Escudero CA, Etheridge SP, Dechert BE, Law IH, Blaufox AD, Perry JC, Dubin AM, Sanatani S, Collins KK. Difficulties with invasive risk stratification performed under anesthesia in pediatric Wolff-Parkinson-White Syndrome. Heart Rhythm 2019; 17:282-286. [PMID: 31521806 DOI: 10.1016/j.hrthm.2019.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with Wolff-Parkinson-White Syndrome (WPW) are at risk for sudden death. The gold standard for risk stratification in this population is the shortest pre-excited RR interval during atrial fibrillation (SPERRI). OBJECTIVE The purpose of this study was to determine how closely measurements made in the electrophysiology laboratory in patients with WPW compared to SPERRI obtained during an episode of clinical pre-excited atrial fibrillation (Clinical-SPERRI). METHODS This was a subgroup analysis of a multicenter study of children with WPW. Subjects in our study (N = 49) were included if they had Clinical-SPERRI measured in addition to 1 or more of 3 surrogate measurements: SPERRI obtained during electrophysiological study (EP-SPERRI), accessory pathway effective refractory period (APERP), or shortest pre-excited paced cycle length with 1:1 conduction (SPPCL). RESULTS Seventy percent of electrophysiological measurements were made with patients under general anesthesia. Clinical-SPERRI moderately correlated with EP-SPERRI (r = 0.495; P = .012). However, 24% of our patients with Clinical-SPERRI ≤250 ms would have been misclassified as having a low-risk pathway based on EP-SPERRI >250 ms. Clinical-SPERRI did not correlate with APERP or SPPCL (r < 0.3; P >.1). Mean EP-SPERRI, APERP, and SPPCL all were greater than Clinical-SPERRI. CONCLUSION Electrophysiology laboratory measurements of pathway characteristics made with patients under general anesthesia do not correlate well with Clinical-SPERRI. Of APERP, SPPCL, and EP-SPERRI, only EP-SPERRI had moderate correlation with Clinical-SPERRI. This study questions the predictive ability of invasive risk stratification with patients under general anesthesia, given that 24% of patients with high-risk Clinical-SPERRI (≤250 ms) had EP-SPERRI that may be considered low risk (>250 ms).
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Affiliation(s)
- Mark H Shwayder
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Carolina A Escudero
- Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada
| | - Susan P Etheridge
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Brynn E Dechert
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Ian H Law
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Andrew D Blaufox
- Department of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - James C Perry
- Division of Cardiology, Department of Pediatrics, University of California San Diego-Rady Children's Hospital, San Diego, California
| | - Anne M Dubin
- Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, California
| | - Shubhayan Sanatani
- Division of Cardiology, Department of Pediatrics, British Colombia Children's Hospital, Vancouver, BC, Canada
| | - Kathryn K Collins
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colorado.
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18
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Escudero CA, Cabeza C, Moya-Alvarado G, Maloney MT, Flores CM, Wu C, Court FA, Mobley WC, Bronfman FC. c-Jun N-terminal kinase (JNK)-dependent internalization and Rab5-dependent endocytic sorting mediate long-distance retrograde neuronal death induced by axonal BDNF-p75 signaling. Sci Rep 2019; 9:6070. [PMID: 30988348 PMCID: PMC6465280 DOI: 10.1038/s41598-019-42420-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 03/25/2019] [Indexed: 02/01/2023] Open
Abstract
During the development of the sympathetic nervous system, signals from tropomyosin-related kinase receptors (Trks) and p75 neurotrophin receptors (p75) compete to regulate survival and connectivity. During this process, nerve growth factor (NGF)- TrkA signaling in axons communicates NGF-mediated trophic responses in signaling endosomes. Whether axonal p75 signaling contributes to neuronal death and how signaling endosomes contribute to p75 signaling has not been established. Using compartmentalized sympathetic neuronal cultures (CSCGs) as a model, we observed that the addition of BDNF to axons increased the transport of p75 and induced death of sympathetic neurons in a dynein-dependent manner. In cell bodies, internalization of p75 required the activity of JNK, a downstream kinase mediating p75 death signaling in neurons. Additionally, the activity of Rab5, the key GTPase regulating early endosomes, was required for p75 death signaling. In axons, JNK and Rab5 were required for retrograde transport and death signaling mediated by axonal BDNF-p75 in CSCGs. JNK was also required for the proper axonal transport of p75-positive endosomes. Thus, our findings provide evidence that the activation of JNK by p75 in cell bodies and axons is required for internalization to a Rab5-positive signaling endosome and the further propagation of p75-dependent neuronal death signals.
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Affiliation(s)
- C A Escudero
- Center for Aging and Regeneration (CARE UC) and Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Cabeza
- Center for Aging and Regeneration (CARE UC) and Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center of Cellular and Integrative Physiology, Faculty of Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - G Moya-Alvarado
- Center for Aging and Regeneration (CARE UC) and Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M T Maloney
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - C M Flores
- Center for Aging and Regeneration (CARE UC) and Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Wu
- Department of Neurosciences, University of California, San Diego, La Jolla, California, 92093, USA
| | - F A Court
- Center for Integrative Biology, Faculty of Sciences, Universidad Mayor, Santiago, Chile and FONDAP Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - W C Mobley
- Department of Neurosciences, University of California, San Diego, La Jolla, California, 92093, USA
| | - F C Bronfman
- Center for Aging and Regeneration (CARE UC) and Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.
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19
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Escudero CA, Potts JE, Lam PY, De Souza AM, Duff K, Mugford GJ, Sandor GGS. Echocardiographic Assessment of Ventricular Function During Exercise in Adolescent Female Patients With Anorexia Nervosa. J Am Soc Echocardiogr 2019; 32:394-403.e3. [PMID: 30638724 DOI: 10.1016/j.echo.2018.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with anorexia nervosa (AN) have altered physiologic responses to exercise. The aim of this study was to investigate exercise capacity and ventricular function during exercise in adolescent patients with AN. METHODS Sixty-six adolescent female patients with AN and 21 adolescent female control subjects who exercised to volitional fatigue on a semisupine ergometer, using an incremental step protocol of 20 W every 3 min, were retrospectively studied. Heart rate, blood pressure, and echocardiographic Doppler indices were measured at rest and during each stage of exercise. Fractional shortening, rate-corrected mean velocity of circumferential fiber shortening, stress at peak systole, cardiac output, and cardiac index were calculated. Minute ventilation, oxygen consumption, carbon dioxide production, and respiratory exchange ratio were measured using open-circuit spirometry. RESULTS Patients with AN had significantly lower body mass index (16.7 vs 19.7 kg/m2, P < .001), total work (1,126 vs 1,914 J/kg, P < .001), and test duration (13.8 vs 20.8 min, P < .001) compared with control subjects. Peak minute ventilation, oxygen consumption, and carbon dioxide production were significantly decreased in patients with AN. Heart rate, systolic blood pressure, cardiac index, fractional shortening, and rate-corrected mean velocity of circumferential fiber shortening demonstrated similar patterns of increase with progressive exercise between groups but were decreased at peak exercise in patients with AN. Body mass index percentile, age, peak oxygen consumption, and peak cardiac output were independently associated with exercise duration. CONCLUSIONS Adolescent patients with AN have reduced exercise capacity and peak cardiovascular indices compared with control subjects but normal patterns of cardiovascular response during progressive exercise. Systolic ventricular function is maintained during exercise in adolescents with AN.
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Affiliation(s)
- Carolina A Escudero
- Children's Heart Centre, British Columbia Children's Hospital, Canada; Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine, British Columbia Children's Hospital and Provincial Specialized Eating Disorders Program, Vancouver, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Canada
| | - Kathryn Duff
- Sports Science Program, Douglas College, New Westminster, British Columbia, Canada
| | - Gerald J Mugford
- Faculty of Medicine and Discipline of Psychiatry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, Canada.
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20
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Escudero CA, Mah DY, Miyake CY, Stephenson EA, LaPage MJ, Kubuš P, Cohen M, Atallah J. Riata lead failure in pediatric and congenital heart disease patients. J Cardiovasc Electrophysiol 2019; 30:320-325. [DOI: 10.1111/jce.13812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Carolina A. Escudero
- Department of Pediatrics, Division of Cardiology, University of Alberta and Stollery Children's HospitalEdmonton Canada
| | - Douglas Y. Mah
- Department of Cardiology, Boston Children's HospitalBoston Massachusetts
| | - Christina Y. Miyake
- Department of Pediatrics and Molecular Physiology & Biophysics, Baylor College of MedicineHouston Texas
| | | | - Martin J. LaPage
- Division of Pediatric Cardiology University of MichiganAnn Arbor Michigan
| | - Peter Kubuš
- Children's Heart Centre, Motol University HospitalPrague Czech Republic
| | - Mitchell Cohen
- Division of Cardiology, Phoenix Children's HospitalPhoenix Arizona
| | - Joseph Atallah
- Department of Pediatrics, Division of Cardiology, University of Alberta and Stollery Children's HospitalEdmonton Canada
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21
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Ebrahim MA, Escudero CA, Kantoch MJ, Vondermuhll IF, Atallah J. Insights on Atrial Fibrillation in Congenital Heart Disease. Can J Cardiol 2018; 34:1531-1533. [DOI: 10.1016/j.cjca.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022] Open
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22
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Etheridge SP, Escudero CA, Blaufox AD, Law IH, Dechert-Crooks BE, Stephenson EA, Dubin AM, Ceresnak SR, Motonaga KS, Skinner JR, Marcondes LD, Perry JC, Collins KK, Seslar SP, Cabrera M, Uzun O, Cannon BC, Aziz PF, Kubuš P, Tanel RE, Valdes SO, Sami S, Kertesz NJ, Maldonado J, Erickson C, Moore JP, Asakai H, Mill L, Abcede M, Spector ZZ, Menon S, Shwayder M, Bradley DJ, Cohen MI, Sanatani S. Life-Threatening Event Risk in Children With Wolff-Parkinson-White Syndrome. JACC Clin Electrophysiol 2018; 4:433-444. [DOI: 10.1016/j.jacep.2017.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
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23
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. Doppler Echocardiography Assessment of Aortic Stiffness in Female Adolescents with Anorexia Nervosa. J Am Soc Echocardiogr 2018; 31:784-790. [PMID: 29559196 DOI: 10.1016/j.echo.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with abnormalities in biomarkers of cardiovascular risk. Arterial stiffness, as measured by pulse-wave velocity (PWV), is also a risk factor for cardiovascular disease. The aims of this study were to determine the stiffness of the aorta in female adolescents with AN and to determine if either the severity or the type of AN was associated with PWV. METHODS This was a retrospective case-control study. Adolescent patients with a clinical diagnosis of AN were included. Aortic diameter and pulse-wave transit time over a portion of the thoracic aorta were measured using Doppler echocardiography, and PWV was calculated. RESULTS There were 94 female patients with AN and 60 adolescent female control subjects. There was no significant difference in age between patients with AN and control subjects (15.5 ± 1.7 vs 15.1 ± 2.6 years, P = .220). Body mass index (16.0 ± 2.4 vs 19.7 ± 2.7 kg/m2, P < .001) and body mass index percentile (9.4 ± 15.6 vs 45.5 ± 26.2, P < .001) were significantly lower for patients with AN than control subjects. PWV (443 ± 106 vs 383 ± 77 cm/sec, P < .001) was significantly higher in patients with AN than control subjects. Similar differences from control subjects were found in patients with AN with both lower and higher body mass index percentiles and also in patients with AN with the restrictive or the binge-purge subtype. CONCLUSIONS Female adolescents with AN have increased aortic stiffness compared with control subjects. This study suggests that patients with AN may be at increased risk for future cardiovascular disease. Future studies are required to determine the reversibility of these changes with weight restoration.
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Affiliation(s)
- Carolina A Escudero
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine, British Columbia Children's Hospital and Provincial Specialized Eating Disorders Program, Vancouver, British Columbia, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Gerald J Mugford
- Memorial University of Newfoundland, Faculty of Medicine and Discipline of Psychiatry, St. John's, Newfoundland, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Cote AT, Duff DK, Escudero CA, De Souza AM, Williams LD, Gill R, Zadorsky MT, Harris KC, Potts JE, Sandor GGS. A Doppler Echocardiographic Study of the Myocardial Inotropic Response to Peak Semisupine Exercise in Healthy Children: Development of a Simplified Index of Myocardial Reserve. J Am Soc Echocardiogr 2017; 30:790-796. [PMID: 28599828 DOI: 10.1016/j.echo.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Stress echocardiography has been advocated for the detection of abnormal myocardial function and unmasking diminished myocardial reserve in pediatric patients. The aim of this study was to create a simplified index of myocardial reserve, derived from the myocardial inotropic response to peak semisupine exercise in healthy children, and illustrate its applicability in a sample of pediatric oncology patients. METHODS In this prospective analysis, children (7-18 years of age) with normal cardiac structure and function performed semisupine stress echocardiography to volitional fatigue. The quotient of wall stress at peak systole and heart rate-corrected velocity of circumferential fiber shortening were calculated at baseline and at peak exercise, the difference of which was termed the index of myocardial reserve (IMR). The IMR was also calculated in a retrospective sample of pediatric oncology patients with normal resting left ventricular function who had received anthracycline treatment and had performed the same exercise protocol to illustrate utility. RESULTS Fifty healthy subjects (mean age, 13.2 ± 2.6 years) and 33 oncology patients (mean age, 12.7 ± 4.0 years) were assessed. In the healthy children at peak exercise, heart rate-corrected velocity of circumferential fiber shortening significantly increased (from 1.17 ± 0.17 to 1.58 ± 0.24 circ · sec-1, P < .001), while the quotient of wall stress at peak systole significantly decreased (from 75.3 ± 17.1 to 55.3 ± 13.8 g · cm-2, P < .001), shifting the plot of the relationship between the two parameters upward and to the left. The mean IMR was -30.8 ± 17.8, and the normal distribution ranged from -4.7 (fifth percentile) to -67.3 (95th percentile). The IMR was abnormal in 10 oncology patients who were treated with anthracyclines. CONCLUSIONS The authors have developed a novel IMR. Relative to the normal distribution of this IMR in healthy subjects, it is possible to identify patients with abnormal myocardial reserve. Thus, this study demonstrates the application of the IMR to aid in clinical decision making in individual patients.
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Affiliation(s)
- Anita T Cote
- Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - D Kathryn Duff
- School of Kinesiology, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Sport Science, Douglas College, New Westminster, British Columbia, Canada
| | - Carolina A Escudero
- Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Lindsey D Williams
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Raman Gill
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - M Terri Zadorsky
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - James E Potts
- Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - George G S Sandor
- Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Padfield GJ, Escudero CA, DeSouza AM, Steinberg C, Gibbs K, Puyat JH, Lam PY, Sanatani S, Sherwin E, Potts JE, Sandor G, Krahn AD. Characterization of Myocardial Repolarization Reserve in Adolescent Females With Anorexia Nervosa. Circulation 2016; 133:557-65. [PMID: 26769740 DOI: 10.1161/circulationaha.115.016697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with anorexia nervosa exhibit abnormal myocardial repolarization and are susceptible to sudden cardiac death. Exercise testing is useful in unmasking QT prolongation in disorders associated with abnormal repolarization. We characterized QT adaptation during exercise in anorexia. METHODS AND RESULTS Sixty-one adolescent female patients with anorexia nervosa and 45 age- and sex-matched healthy volunteers performed symptom-limited cycle ergometry during 12-lead ECG monitoring. Changes in the QT interval during exercise were measured, and QT/RR-interval slopes were determined by using mixed-effects regression modeling. Patients had significantly lower body mass index than controls; however, resting heart rates and QT/QTc intervals were similar at baseline. Patients had shorter exercise times (13.7±4.5 versus 20.6±4.5 minutes; P<0.001) and lower peak heart rates (159±20 versus 184±9 beats/min; P<0.001). The mean QTc intervals were longer at peak exercise in patients (442±29 versus 422±19 ms; P<0.001). During submaximal exertion at comparable heart rates (114±6 versus 115±11 beats/min; P=0.54), the QTc interval had prolonged significantly more in patients than controls (37±28 versus 24±25 ms; P<0.016). The RR/QT slope, best described by a curvilinear relationship, was more gradual in patients than in controls (13.4; 95% confidence interval, 12.8-13.9 versus 15.8; 95% confidence interval, 15.3-16.4 ms QT change per 10% change in RR interval; P<0.001) and steepest in patients within the highest body mass index tertile versus the lowest (13.9; 95% confidence interval, 12.9-14.9 versus 12.3; 95% confidence interval, 11.3-13.3; P=0.026). CONCLUSIONS Despite the absence of manifest QT prolongation, adolescent anorexic females have impaired repolarization reserve in comparison with healthy controls. Further study may identify impaired QT dynamics as a risk factor for arrhythmias in anorexia nervosa.
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Affiliation(s)
- Gareth J Padfield
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Carolina A Escudero
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Astrid M DeSouza
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Christian Steinberg
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Karen Gibbs
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Joseph H Puyat
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Pei Yoong Lam
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Shubhayan Sanatani
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Elizabeth Sherwin
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - James E Potts
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - George Sandor
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Andrew D Krahn
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.).
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. An Echocardiographic Study of Left Ventricular Size and Cardiac Function in Adolescent Females with Anorexia Nervosa. Eur Eat Disorders Rev 2015; 24:26-33. [DOI: 10.1002/erv.2409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - James E. Potts
- Children's Heart Centre; British Columbia Children's Hospital; Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine and Provincial Specialized Eating Disorders Program; British Columbia Children's Hospital; Canada
| | | | - Gerald J. Mugford
- Faculty of Medicine and Discipline of Psychiatry; Memorial University of Newfoundland; Canada
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Escudero CA, Sanatani S, Wong KK, Templeton CG. Electrocardiogram interpretation by Canadian general paediatricians: Examining practice, accuracy and confidence. Paediatr Child Health 2014; 19:77-83. [PMID: 24596480 DOI: 10.1093/pch/19.2.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Paediatric electrocardiograms (ECGs) are ordered and interpreted by general paediatricians; however, no previous studies have evaluated the accuracy of their ECG interpretations. OBJECTIVE To determine general paediatricians' practice and opinions regarding ECG use, accuracy of their interpretation of paediatric ECGs, and the relationship between accuracy and self-perceived confidence. METHODS In the present cross-sectional study, Canadian general paediatricians were asked to complete a questionnaire and interpret 18 paediatric ECGs. The questionnaire assessed characteristics of ECG use, self-perceived confidence and opinions regarding ECG use in general paediatric practice. For the ECGs provided, respondents were asked whether the ECG was normal or abnormal, what abnormality the ECG demonstrated and how confident they were in this interpretation. RESULTS ECG interpretation was performed by 124 general paediatricians. General paediatricians frequently use ECGs in their practice and regard this investigation as useful in patient assessment. The mean (± SD) accuracy of identifying ECGs as normal or abnormal, and identifying the specific abnormality was 80±12% and 56±20%, respectively. The sensitivity and specificity of identifying abnormal ECGs were 80% (95% CI 78% to 82%) and 79% (95% CI 75% to 83%), respectively. Correct ECG interpretation for isolated rhythm disturbances (73%) was significantly better than for abnormalities in axis (25%), chamber hypertrophy (41%) and ECG intervals (49%) (P<0.001). Overall confidence in ECG interpretation correlated with and was the only significant predictor of interpretation accuracy (r=0.396, P<0.001). CONCLUSION General paediatricians were adept at detecting abnormal ECGs, but were less able to identify the abnormalities. Further education in ECG interpretation may be important for this population.
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Affiliation(s)
| | | | | | - Christina G Templeton
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador
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