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Verheul LM, Hoeksema WF, Groeneveld SA, Mulder BA, Bootsma M, Alings M, Evertz R, Blank AC, Kammeraad JAE, Clur SAB, Yap SC, Postema PG, Wilde AAM, Volders PGA, Hassink RJ. Comparing adolescent- and adult-onset unexplained cardiac arrest: Results from the Dutch Idiopathic VF Registry. Heart Rhythm 2024:S1547-5271(24)00276-5. [PMID: 38493994 DOI: 10.1016/j.hrthm.2024.03.031] [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: 12/12/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Current cohorts of patients with idiopathic ventricular fibrillation (IVF) primarily include adult-onset patients. Underlying causes of sudden cardiac arrest vary with age; therefore, underlying causes and disease course may differ for adolescent-onset vs adult-onset patients. OBJECTIVE The purpose of this study was to compare adolescent-onset with adult-onset patients having an initially unexplained cause of VF. METHODS The study included 39 patients with an index event aged ≤19 years (adolescent-onset) and 417 adult-onset patients from the Dutch Idiopathic VF Registry. Data on event circumstances, clinical characteristics, change in diagnosis, and arrhythmia recurrences were collected and compared between the 2 groups. RESULTS In total, 42 patients received an underlying diagnosis during follow-up (median 7 [2-12] years), with similar yields (15% adolescent-onset vs 9% adult-onset; P = .16). Among the remaining unexplained patients, adolescent-onset patients (n = 33) had their index event at a median age of 17 [16-18] years, and 72% were male. The youngest patient was aged 13 years. In comparison with adults (n = 381), adolescent-onset patients more often had their index event during exercise (P <.01). Adolescent-onset patients experienced more appropriate implantable cardioverter-defibrillator (ICD) therapy during follow-up compared with adults (44% vs 26%; P = .03). Inappropriate ICD therapy (26% vs 17%; P = .19), ICD complications (19% vs 14%; P = .41), and deaths (3% vs 4%; P = 1) did not significantly differ between adolescent-onset and adult-onset patients. CONCLUSION IVF may occur during adolescence. Adolescent-onset patients more often present during exercise compared with adults. Furthermore, they are more vulnerable to ventricular arrhythmias as reflected by a higher incidence of appropriate ICD therapy.
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Affiliation(s)
- Lisa M Verheul
- University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Wiert F Hoeksema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | | | - Bart A Mulder
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Reinder Evertz
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Janneke A E Kammeraad
- Erasmus MC-Sophia Children's Hospital, Cardiovascular Institute, Department of Pediatric Cardiology, Rotterdam, The Netherlands
| | - Sally-Ann B Clur
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Sing-Chien Yap
- Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Pieter G Postema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Arthur A M Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Paul G A Volders
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"; Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rutger J Hassink
- University Medical Center Utrecht, Utrecht, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
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2
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Kaski JP, Kammeraad JAE, Blom NA, Happonen JM, Janousek J, Klaassen S, Limongelli G, Östman-Smith I, Sarquella Brugada G, Ziolkowska L. Indications and management of implantable cardioverter-defibrillator therapy in childhood hypertrophic cardiomyopathy: A position statement from the AEPC Working Group on Basic Science, Genetics and Myocardial Disease and the AEPC Working Group on Cardiac Dysrhythmias and Electrophysiology - ERRATUM. Cardiol Young 2024; 34:469. [PMID: 38247360 DOI: 10.1017/s1047951123004237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
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3
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Peltenburg PJ, van den Heuvel LM, Kallas D, Bell C, Denjoy I, Behr ER, Field E, Kammeraad JAE, Yap SC, Probst V, Ackerman MJ, Blom NA, Wilde AAM, Clur SAB, van der Werf C. Insights into adherence to medication and lifestyle recommendations in an international cohort of patients with catecholaminergic polymorphic ventricular tachycardia. Europace 2024; 26:euae044. [PMID: 38349347 PMCID: PMC10886442 DOI: 10.1093/europace/euae044] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
AIMS In patients with catecholaminergic polymorphic ventricular tachycardia (CPVT), a rare inherited arrhythmia syndrome, arrhythmic events can be prevented by medication and lifestyle recommendations. In patients who experience breakthrough arrhythmic events, non-adherence plays an essential role. We aimed to investigate the incidence and potential reasons for non-adherence to medication and lifestyle recommendations in a large, international cohort of patients with CPVT. METHODS AND RESULTS An online multilingual survey was shared with CPVT patients worldwide by their cardiologists, through peer-recruitment, and on social media from November 2022 until July 2023. Self-reported non-adherence was measured using the validated Medication Adherence Rating Scale (MARS) and a newly developed questionnaire about lifestyle. Additionally, validated questionnaires were used to assess potential reasons for medication non-adherence. Two-hundred-and-eighteen patients completed the survey, of whom 200 (92%) were prescribed medication [122 (61%) female; median age 33.5 years (interquartile range: 22-50)]. One-hundred-and-three (52%) were prescribed beta-blocker and flecainide, 85 (43%) beta-blocker, and 11 (6%) flecainide. Thirty-four (17%) patients experienced a syncope, aborted cardiac arrest or appropriate implantable cardioverter defibrillator shock after diagnosis. Nineteen (13.4%) patients were exercising more than recommended. Thirty (15%) patients were non-adherent to medication. Female sex [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.3-12.0, P = 0.019], flecainide monotherapy compared to combination therapy (OR 6.8, 95% CI 1.6-31.0, P = 0.010), and a higher agreement with statements regarding concerns about CPVT medication (OR 1.2, 95% CI 1.1-1.3, P < 0.001) were independently associated with non-adherence. CONCLUSION The significant rate of non-adherence associated with concerns regarding CPVT-related medication, emphasizes the potential for improving therapy adherence by targeted patient education.
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Affiliation(s)
- Puck J Peltenburg
- Deparment of Clinical and Exprimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieke M van den Heuvel
- Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Dania Kallas
- Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Cheyanne Bell
- Windland Smith Rice Sudden Death Genomics Laboratory, Division of Heart Rhythm Services and Pediatric Cardiology, Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Isabelle Denjoy
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat APHP, Université de Paris, Paris, France
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, Molecular and Clinical Sciences Research Institute, St. George’s, University of London, St. George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London, UK
| | - Ella Field
- Department of Pediatric Cardiology, Great Ormond Street Hospital, London, UK
| | | | - Sing-Chien Yap
- Department of Cardiology, Cardiovascular Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Vincent Probst
- Service de cardiologie, Université de Nantes, CNRS, INSERM, l’institut du thorax, Nantes, France
| | - Michael J Ackerman
- Windland Smith Rice Sudden Death Genomics Laboratory, Division of Heart Rhythm Services and Pediatric Cardiology, Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Willem-Alexander Children’s Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Arthur A M Wilde
- Deparment of Clinical and Exprimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sally-Ann B Clur
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian van der Werf
- Deparment of Clinical and Exprimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Albrecht M, de Jonge RCJ, Dulfer K, Van Gils-Frijters APJM, de Hoog M, Hunfeld M, Kammeraad JAE, Moors XRJ, Nadkarni VM, Buysse CMP. Trends in community response and long-term outcomes from pediatric cardiac arrest: A retrospective observational study. Resuscitation 2024; 194:110045. [PMID: 37952576 DOI: 10.1016/j.resuscitation.2023.110045] [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] [Received: 08/04/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
AIM This study aimed to investigate trends over time in pre-hospital factors for pediatric out-of-hospital cardiac arrest (pOHCA) and long-term neurological and neuropsychological outcomes. These have not been described before in large populations. METHODS Non-traumatic arrest patients, 1 day-17 years old, presented to the Sophia Children's Hospital from January 2002 to December 2020, were eligible for inclusion. Favorable neurological outcome was defined as Pediatric Cerebral Performance Categories (PCPC) 1-2 or no difference with pre-arrest baseline. The trend over time was tested with multivariable logistic and linear regression models with year of event as independent variable. FINDINGS Over a nineteen-year study period, the annual rate of long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, increased significantly (OR 1.10, 95%-CI 1.03-1.19), adjusted for confounders. Concurrently, annual automated external defibrillator (AED) use and, among adolescents, initial shockable rhythm increased significantly (OR 1.21, 95% CI 1.10-1.33 and OR 1.15, 95% CI 1.02-1.29, respectively), adjusted for confounders. For generalizability purposes, only the total intelligence quotient (IQ) was considered for trend analysis of all tested domains. Total IQ scores and bystander basic life support (BLS) rate did not change significantly over time. INTERPRETATION Long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, improved significantly over the study period. Total IQ scores did not significantly change over time. Furthermore, AED use (OR 1.21, 95%CI 1.10-1.33) and shockable rhythms among adolescents (OR1.15, 95%CI 1.02-1.29) increased over time.
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Affiliation(s)
- M Albrecht
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - R C J de Jonge
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - K Dulfer
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - A P J M Van Gils-Frijters
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M de Hoog
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M Hunfeld
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - J A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - X R J Moors
- Department of Pediatric Anesthesiology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Helicopter Emergency Medical Services, Erasmus MC, Rotterdam, the Netherlands
| | - V M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA., United States
| | - C M P Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
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Bakker AM, Albrecht M, Verkaik BJ, de Jonge RCJ, Buysse CMP, Blom NA, Rammeloo LAJ, Verhagen JMA, Riedijk MA, Yap SC, Tan HL, Kammeraad JAE. Sudden cardiac arrest in infants and children: proposal for a diagnostic workup to identify the etiology. An 18-year multicenter evaluation in the Netherlands. Eur J Pediatr 2024; 183:335-344. [PMID: 37889292 PMCID: PMC10858117 DOI: 10.1007/s00431-023-05301-9] [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: 08/22/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023]
Abstract
Sudden cardiac arrest (SCA) studies are often population-based, limited to sudden cardiac death, and excluding infants. To guide prevention opportunities, it is essential to be informed of pediatric SCA etiologies. Unfortunately, etiologies frequently remain unresolved. The objectives of this study were to determine paediatric SCA etiology, and to evaluate the extent of post-SCA investigations and to assess the performance of previous cardiac evaluation in detecting conditions predisposing to SCA. In a retrospective cohort (2002-2019), all children 0-18 years with out-of-hospital cardiac arrest (OHCA) referred to Erasmus MC Sophia Children's Hospital or the Amsterdam UMC (tertiary-care university hospitals), with cardiac or unresolved etiologies were eligible for inclusion. SCA etiologies, cardiac and family history and etiologic investigations in unresolved cases were assessed. The etiology of arrest could be determined in 52% of 172 cases. Predominant etiologies in children ≥ 1 year (n = 99) were primary arrhythmogenic disorders (34%), cardiomyopathies (22%) and unresolved (32%). Events in children < 1 year (n = 73) were largely unresolved (70%) or caused by cardiomyopathy (8%), congenital heart anomaly (8%) or myocarditis (7%). Of 83 children with unresolved etiology a family history was performed in 51%, an autopsy in 51% and genetic testing in 15%. Pre-existing cardiac conditions presumably causative for SCA were diagnosed in 9%, and remained unrecognized despite prior evaluation in 13%. CONCLUSION SCA etiology remained unresolved in 83 of 172 cases (48%) and essential diagnostic investigations were often not performed. Over one-fifth of SCA patients underwent prior cardiac evaluation, which did not lead to recognition of a cardiac condition predisposing to SCA in all of them. The diagnostic post-SCA approach should be improved and the proposed standardized pediatric post-SCA diagnostics protocol may ensure a consistent and systematic evaluation process increasing the diagnostic yield. WHAT IS KNOWN • Arrests in infants remain unresolved in most cases. In children > 1 year, predominant etiologies are primary arrhythmia disorders, cardiomyopathy and myocarditis. • Studies investigating sudden cardiac arrest are often limited to sudden cardiac death (SCD) in 1 to 40 year old persons, excluding infants and successfully resuscitated children. WHAT IS NEW • In patients with unresolved SCA events, the diagnostic work up was often incompletely performed. • Over one fifth of victims had prior cardiac evaluation before the arrest, with either a diagnosed cardiac condition (9%) or an unrecognized cardiac condition (13%).
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Affiliation(s)
- Ashley M Bakker
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Postbus 2060, 3000 CB, Rotterdam, The Netherlands
| | - Marijn Albrecht
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bas J Verkaik
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rogier C J de Jonge
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Corinne M P Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nico A Blom
- The Center for Congenital Heart Disease Amsterdam-Leiden, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Lukas A J Rammeloo
- The Center for Congenital Heart Disease Amsterdam-Leiden, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Judith M A Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maaike A Riedijk
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sing C Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Hanno L Tan
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Postbus 2060, 3000 CB, Rotterdam, The Netherlands.
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Kaski JP, Kammeraad JAE, Blom NA, Happonen JM, Janousek J, Klaassen S, Limongelli G, Östman-Smith I, Sarquella Brugada G, Ziolkowska L. Indications and management of implantable cardioverter-defibrillator therapy in childhood hypertrophic cardiomyopathy. Cardiol Young 2023; 33:681-698. [PMID: 37102324 DOI: 10.1017/s1047951123000872] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Sudden cardiac death is the most common mode of death during childhood and adolescence in hypertrophic cardiomyopathy, and identifying those individuals at highest risk is a major aspect of clinical care. The mainstay of preventative therapy is the implantable cardioverter-defibrillator, which has been shown to be effective at terminating malignant ventricular arrhythmias in children with hypertrophic cardiomyopathy but can be associated with substantial morbidity. Accurate identification of those children at highest risk who would benefit most from implantable cardioverter-defibrillator implantation while minimising the risk of complications is, therefore, essential. This position statement, on behalf of the Association for European Paediatric and Congenital Cardiology (AEPC), reviews the currently available data on established and proposed risk factors for sudden cardiac death in childhood-onset hypertrophic cardiomyopathy and current approaches for risk stratification in this population. It also provides guidance on identification of individuals at risk of sudden cardiac death and optimal management of implantable cardioverter-defibrillators in children and adolescents with hypertrophic cardiomyopathy.
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Affiliation(s)
- Juan Pablo Kaski
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, University College London Institute of Cardiovascular Science, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Janneke A E Kammeraad
- Erasmus MC - Sophia Children's Hospital, Department of Paediatric Cardiology, Rotterdam, the Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, University of Leiden, Leiden, the Netherlands
- Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Juha-Matti Happonen
- Department of Paediatric Cardiology, Helsinki University Children's Hospital, Helsinki, Finland
| | - Jan Janousek
- Children's Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Sabine Klaassen
- Department of Pediatric Cardiology, Charite-Universitatsmedizin Berlin, Berlin, Germany
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, AO dei Colli Monaldi Hospital, Universita della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingegerd Östman-Smith
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Peltenburg PJ, Hoedemaekers YM, Clur SAB, Blom NA, Blank AC, Boesaard EP, Frerich S, van den Heuvel F, Wilde AAM, Kammeraad JAE. Screening, diagnosis and follow-up of Brugada syndrome in children: a Dutch expert consensus statement. Neth Heart J 2023; 31:133-137. [PMID: 36223066 PMCID: PMC9554382 DOI: 10.1007/s12471-022-01723-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 10/26/2022] Open
Abstract
Brugada syndrome (BrS) is a rare inherited arrhythmia syndrome. Affected children may experience life-threatening symptoms, mainly during fever. The percentage of SCN5A variant carriers in children is higher than in adults. Current diagnostic and follow-up policies for children with (a family history of) BrS vary between centres. Here, we present a consensus statement based on the current literature and expert opinions to standardise the approach for all children with BrS and those from BrS families in the Netherlands. In summary, BrS is diagnosed in patients with a spontaneous type 1 electrocardiogram (ECG) pattern or with a Shanghai score ≥ 3.5 including ≥ 1 ECG finding. A sodium channel-blocking drug challenge test should only be performed after puberty with a few exceptions. A fever ECG is indicated in children with suspected BrS, in children with a first-degree family member with definite or possible BrS according to the Shanghai criteria with a SCN5A variant and in paediatric SCN5A variant carriers. In-hospital rhythm monitoring during fever is indicated in patients with an existing type 1 ECG pattern and in those who develop such a pattern. Genetic testing should be restricted to SCN5A. Children with BrS and children who carry an SCN5A variant should avoid medication listed at www.brugadadrugs.org and fever should be suppressed. Ventricular arrhythmias or electrical storms should be treated with isoproterenol infusion.
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Affiliation(s)
- P J Peltenburg
- Department of Paediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam University Medical Centres, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.
| | - Y M Hoedemaekers
- Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S A B Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - N A Blom
- Department of Paediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Department of Paediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - A C Blank
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - E P Boesaard
- Department of Paediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Frerich
- Department of Paediatric Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F van den Heuvel
- Department of Paediatric Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - A A M Wilde
- Amsterdam University Medical Centres, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J A E Kammeraad
- Department of Paediatric Cardiology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
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8
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Ramdat Misier NL, Taverne YJHJ, van Schie MS, Kharbanda RK, van Leeuwen WJ, Kammeraad JAE, Bogers AJJC, de Groot NMS. Unravelling early sinus node dysfunction after pediatric cardiac surgery: a pre-existing arrhythmogenic substrate. Interact Cardiovasc Thorac Surg 2022; 36:ivac262. [PMID: 36321962 PMCID: PMC10021071 DOI: 10.1093/icvts/ivac262] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/15/2022] [Accepted: 10/30/2022] [Indexed: 03/19/2023] Open
Abstract
Early post-operative sinus node dysfunction (SND) is common in paediatric patients undergoing surgical correction of congenital heart defects (CHD). At present, the pathophysiology of these arrhythmias is incompletely understood. In this case series, we present three paediatric patients in whom we performed intraoperative epicardial mapping and who developed early post-operative SND. All patients had either an inferior or multiple sinoatrial node (SAN) exit sites, in addition to extensive conduction disorders at superior and inferior right atrium. Our findings contribute to the hypothesis that pre-existing alterations in SAN exit sites in combination with atrial conduction disorders may predispose paediatric patients with CHD for early post-operative SND. Such insights in the development of arrhythmias are crucial as it may be the first step in identifying high-risk patients.
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Affiliation(s)
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Rohit K Kharbanda
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Wouter J van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
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Peltenburg PJ, Kallas D, Bos JM, Lieve KVV, Franciosi S, Roston TM, Denjoy I, Sorensen KB, Ohno S, Roses-Noguer F, Aiba T, Maltret A, LaPage MJ, Atallah J, Giudicessi JR, Clur SAB, Blom NA, Tanck M, Extramiana F, Kato K, Barc J, Borggrefe M, Behr ER, Sarquella-Brugada G, Tfelt-Hansen J, Zorio E, Swan H, Kammeraad JAE, Krahn AD, Davis A, Sacher F, Schwartz PJ, Roberts JD, Skinner JR, van den Berg MP, Kannankeril PJ, Drago F, Robyns T, Haugaa KH, Tavacova T, Semsarian C, Till J, Probst V, Brugada R, Shimizu W, Horie M, Leenhardt A, Ackerman MJ, Sanatani S, van der Werf C, Wilde AAM. An International Multi-Center Cohort Study on β-blockers for the Treatment of Symptomatic Children with Catecholaminergic Polymorphic Ventricular Tachycardia. Circulation 2021; 145:333-344. [PMID: 34874747 DOI: 10.1161/circulationaha.121.056018] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Symptomatic children with catecholaminergic polymorphic ventricular tachycardia (CPVT) are at risk for recurrent arrhythmic events. Beta-blockers (BBs) decrease this risk, but studies comparing individual BBs in sizeable cohorts are lacking. We aimed to assess the association between risk for arrhythmic events and type of BB in a large cohort of symptomatic children with CPVT. Methods: From two international registries of patients with CPVT, RYR2 variant-carrying symptomatic children (defined as syncope or sudden cardiac arrest prior to BB initiation and age at start of BB therapy <18 years), treated with a BB were included. Cox-regression analyses with time-dependent covariates for BB and potential confounders were used to assess the hazard ratio (HR). The primary outcome was the first occurrence of sudden cardiac death, sudden cardiac arrest, appropriate implantable cardioverter-defibrillator shock, or syncope. The secondary outcome was the first occurrence of any of the primary outcomes except syncope. Results: We included 329 patients (median age at diagnosis 12 [interquartile range, 7-15] years, 35% females). Ninety-nine (30.1%) patients experienced the primary and 74 (22.5%) experienced the secondary outcome during a median follow-up of 6.7 [interquartile range, 2.8-12.5] years. Two-hundred sixteen patients (66.0%) used a non-selective BB (predominantly nadolol [n=140] or propranolol [n=70]) and 111 (33.7%) used a β1-selective BB (predominantly atenolol [n=51], metoprolol [n=33], or bisoprolol [n=19]) as initial BB. Baseline characteristics did not differ. The HR for both the primary and secondary outcomes were higher for β1-selective compared with non-selective BBs (HR, 2.04 95% CI, 1.31-3.17; and HR, 1.99; 95% CI, 1.20-3.30, respectively). When assessed separately, the HR for the primary outcome was higher for atenolol (HR, 2.68; 95% CI, 1.44-4.99), bisoprolol (HR, 3.24; 95% CI, 1.47-7.18), and metoprolol (HR, 2.18; 95% CI, 1.08-4.40) compared with nadolol, but did not differ from propranolol. The HR of the secondary outcome was only higher in atenolol compared with nadolol (HR, 2.68; 95% CI, 1.30-5.55). Conclusions: B1-selective BBs were associated with a significantly higher risk for arrhythmic events in symptomatic children with CPVT compared with non-selective BBs, specifically nadolol. Nadolol, or propranolol if nadolol is unavailable, should be the preferred BB for treating symptomatic children with CPVT.
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Affiliation(s)
- Puck J Peltenburg
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | | | - Johan M Bos
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics; Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN
| | - Krystien V V Lieve
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Sonia Franciosi
- BC Childrenâs Hospital, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Thomas M Roston
- BC Childrenâs Hospital, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada; Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Isabelle Denjoy
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Université de Paris, Paris, France; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Katrina B Sorensen
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics; Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN
| | - Seiko Ohno
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan; Department of Bioscience and Genetics, National Cerebral and Cardiovascular Centre, National Cerebral and Cardiovascular Centre, Suita, Japan
| | | | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Alice Maltret
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Université de Paris, Paris, France
| | - Martin J LaPage
- Department of Pediatrics, Division of Cardiology, University of Michigan, Ann Arbor, MI
| | - Joseph Atallah
- Cardiology, Faculty of Medicine and Dentistry - Pediatrics Dept., Stollery Children's Hospital, Edmonton, Canada
| | - John R Giudicessi
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics; Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN
| | - Sally-Ann B Clur
- Department of Pediatric Cardiology, Emma Childrenâs Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Childrenâs Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;Department of Pediatric Cardiology, Willem-Alexander Childrenâs Hospital, Leiden University Medical Centre, Leiden, The Netherlands; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Michael Tanck
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Fabrice Extramiana
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Université de Paris, Paris, France; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Koichi Kato
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Julien Barc
- Université de Nantes, CNRS, INSERM, lâinstitut du thorax, Nantes, France; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Martin Borggrefe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, Molecular and Clinical Sciences Research Institute, St. Georgeâs, University of London, London, UK; St. Georgeâs University Hospitals NHS Foundation Trust, Cranmer Terrace, London, UK
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Spain; Medical Science Department, School of Medicine, Universitat de Girona, Spain; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Esther Zorio
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Heikki Swan
- Heart and Lung Centre, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Andrew Davis
- The Royal Children's Hospital, Melbourne, Australia; Murdoch Childrenâs Research Institute and Department of Paediatrics, Melbourne University, Melbourne, Australia
| | - Frederic Sacher
- LIRYC Institute, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group New Zealand, Green Lane Paediatric and Congenital Cardiac Services, Starship Childrenâs Hospital, Auckland, New Zealand; Department of Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Maarten P van den Berg
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Prince J Kannankeril
- Department of Pediatrics, Monroe Carell Jr Childrenâs Hospital at Vanderbilt, Vanderbilt University Medical Centre, Nashville, TN
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Palidoro-Rome, Italy; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Tomas Robyns
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Belgium; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Kristina H Haugaa
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Terezia Tavacova
- Department of Pediatric Cardiology, Childrenâs Heart Centre, Second Faculty of Medicine, Charles University in Prague; Motol University Hospital, Prague, Czech Republic
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jan Till
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Vincent Probst
- Université de Nantes, CHU Nantes, CNRS, INSERM, lâinstitut du thorax, Nantes, France; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), University of Girona, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain; Cardiology Service, Hospital Josep Trueta, Girona, Spain
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Antoine Leenhardt
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Université de Paris, Paris, France; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics; Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN
| | - Shubhayan Sanatani
- BC Childrenâs Hospital, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Christian van der Werf
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
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10
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Noten AME, Kammeraad JAE, Ramdat Misier NL, Wijchers S, van Beynum IM, Dalinghaus M, Krasemann TB, Yap SC, de Groot NMS, Szili-Torok T. Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation. Int J Cardiol Heart Vasc 2021; 37:100881. [PMID: 34646933 PMCID: PMC8495098 DOI: 10.1016/j.ijcha.2021.100881] [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] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/17/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
Background Catheter ablation (CA) is the first-choice treatment for tachyarrhythmia in children. Currently available CA techniques differ in mechanism of catheter navigation and energy sources. There are no large studies comparing long-term outcomes between available CA techniques in a pediatric population with atrioventricular reentry tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms. Objective This study aimed to compare procedural and long-term outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO). Methods This single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT performed in children without structural heart disease from 2008 to 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was long-term recurrence of tachyarrhythmia. Results In total, we included 223 patients, aged 14 (IQR 12-16) years; weighting 56 (IQR 47-65) kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using CRYO. RMN had significantly lower recurrence rates compared to MAN and CRYO at mean follow-up of 5.5 ± 2.9 years (AVRT: 4.3% versus 15.6% versus 54.5%, P < 0.001; AVNRT: 7.7% versus 8.3% versus 35.7%, P = 0.008; for RMN versus MAN versus CRYO respectively). In AVNRT ablation, RMN had significantly lower fluoroscopy doses compared to CRYO [30 (IQR 20-41) versus 45 (IQR 29-65) mGy, P = 0.040). Conclusion In pediatric patients without structural heart disease who underwent their first AV(N)RT ablation, RMN has superior long-term outcomes compared to MAN and CRYO, in addition to favorable fluoroscopy doses.
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Key Words
- AP, accessory pathway
- AVNRT, atrioventricular nodal reentry tachycardia
- AVRT, atrioventricular reentry tachycardia
- Atrioventricular nodal reentry tachycardia
- Atrioventricular reentry tachycardia
- CA, catheter ablation
- CHD, congenital heart defect
- CRYO, cryoablation
- Catheter ablation
- Cryoablation
- DAP, dose area product
- EAM, electro-anatomic mapping
- ECG, electrocardiogram
- MAN, manual
- Pediatrics
- RF, radiofrequency
- RMN, remote magnetic navigation
- Radiofrequency ablation
- Remote magnetic navigation
- SVT, supraventricular tachycardia
- Supraventricular tachycardia
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Affiliation(s)
- Anna M E Noten
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Nawin L Ramdat Misier
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sip Wijchers
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ingrid M van Beynum
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Thomas B Krasemann
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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11
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Kharbanda RK, van Schie MS, Ramdat Misier NL, van Leeuwen WJ, Taverne YJHJ, van de Woestijne PC, Kammeraad JAE, Bartelds B, Bogers AJJC, de Groot NMS. First Evidence of Atrial Conduction Disorders in Pediatric Patients With Congenital Heart Disease. JACC Clin Electrophysiol 2021; 6:1739-1743. [PMID: 33357569 DOI: 10.1016/j.jacep.2020.09.028] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
This study sought to investigate whether pediatric patients with congenital heart disease (CHD) already have atrial conduction disorders early in life. The authors conducted first-in-children epicardial mapping in 10 pediatric patients with CHD undergoing primary open heart surgery. Areas of conduction delay (CD) and block (CB) were present in all patients and were particularly observed at Bachmann's bundle (CD: 4.9%; CB: 2.3%), followed by the right atrium (CD: 3.7%; CB: 1.6%) and, to a lesser degree, the left atrium (CD: 1.8%; CB: 1.0%). Conduction abnormalities may by aggravated over time (e.g., aging, residual lesions, or valvular dysfunction), predisposing these patients to atrial arrhythmias early in life.
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Affiliation(s)
- Rohit K Kharbanda
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Wouter J van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Janneke A E Kammeraad
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Beatrijs Bartelds
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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12
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Webster G, Aburawi EH, Chaix MA, Chandler S, Foo R, Islam AKMM, Kammeraad JAE, Rioux JD, Al-Gazali L, Sayeed MZ, Xiao T, Zhang H, Xie L, Hou C, Ing A, Yap KL, Wilde AAM, Bhuiyan ZA. Life-threatening arrhythmias with autosomal recessive TECRL variants. Europace 2021; 23:781-788. [PMID: 33367594 DOI: 10.1093/europace/euaa376] [Citation(s) in RCA: 9] [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: 05/13/2020] [Accepted: 11/23/2020] [Indexed: 02/05/2023] Open
Abstract
AIMS Sudden death and aborted sudden death have been observed in patients with biallelic variants in TECRL. However, phenotypes have only begun to be described and no data are available on medical therapy after long-term follow-up. METHODS AND RESULTS An international, multi-centre retrospective review was conducted. We report new cases associated with TECRL variants and long-term follow-up from previously published cases. We present 10 cases and 37 asymptomatic heterozygous carriers. Median age at onset of cardiac symptoms was 8 years (range 1-22 years) and cases were followed for an average of 10.3 years (standard deviation 8.3), right censored by death in three cases. All patients on metoprolol, bisoprolol, or atenolol were transitioned to nadolol or propranolol due to failure of therapy. Phenotypes typical of both long QT syndrome and catecholaminergic polymorphic ventricular tachycardia (CPVT) were observed. We also observed divergent phenotypes in some cases despite identical homozygous variants. None of 37 heterozygous family members had a cardiac phenotype. CONCLUSION Patients with biallelic pathogenic TECRL variants present with variable cardiac arrhythmia phenotypes, including those typical of long QT syndrome and CPVT. Nadolol and propranolol may be superior beta-blockers in this setting. No cardiac disease or sudden death was present in patients with a heterozygous genotype.
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Affiliation(s)
- Gregory Webster
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elhadi H Aburawi
- Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Marie A Chaix
- Adult Congenital Centre, Department of Medicine, Montreal Heart institute, Université de Montréal, Montreal, Québec, Canada
| | - Stephanie Chandler
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roger Foo
- Department of Cardiology, National University Hospital, Singapore 119074
| | - A K M Monwarul Islam
- Department of Noninvasive Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - John D Rioux
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada.,Research Center, Department of Medicine, Montreal Heart Institute, Montreal, Québec, Canada
| | - Lihadh Al-Gazali
- Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Md Zahidus Sayeed
- Department of Cardiology, Rajshahi Medical College, Rajshahi, Bangladesh
| | - Tingting Xiao
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai 200062, China
| | - Han Zhang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai 200062, China
| | - Lijian Xie
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai 200062, China
| | - Cuilan Hou
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai 200062, China
| | - Alexander Ing
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kai Lee Yap
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam University Medical Centres, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Zahurul A Bhuiyan
- Unit of Cardiogenetics Research, Division of Genetic Medicine, University Hospital Lausanne (CHUV), Lausanne, Switzerland
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13
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Kharbanda RK, van Schie MS, van Leeuwen WJ, Taverne YJHJ, Houck CA, Kammeraad JAE, Bogers AJJC, de Groot NMS. First-in-children epicardial mapping of the heart: unravelling arrhythmogenesis in congenital heart disease. Interact Cardiovasc Thorac Surg 2021; 32:137-140. [PMID: 33156915 DOI: 10.1093/icvts/ivaa233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/02/2020] [Revised: 08/21/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
Patients with congenital heart disease (CHD) are prone to develop atrial and ventricular arrhythmias. Multiple factors throughout life contribute to arrhythmogenicity substrate such as (i) (longstanding) volume and/or pressure overload, (ii) scar tissue, (iii) ageing-related structural remodelling, (iv) cardiovascular risk factors and (v) tachycardia-induced remodelling. At present, it is unknown whether, and to what extent, paediatric patients with CHD have atrial or ventricular conduction disorders early in life and whether there is a correlation between duration of volume/pressure overload and extensiveness of conduction disorders. To investigate this, we initiated high-resolution intraoperative epicardial mapping in paediatric patients with CHD undergoing primary open-heart surgery.
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Affiliation(s)
- Rohit K Kharbanda
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Wouter J van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Charlotte A Houck
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Janneke A E Kammeraad
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
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14
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Albrecht M, de Jonge RCJ, Nadkarni VM, de Hoog M, Hunfeld M, Kammeraad JAE, Moors XRJ, van Zellem L, Buysse CMP. Association between shockable rhythms and long-term outcome after pediatric out-of-hospital cardiac arrest in Rotterdam, the Netherlands: An 18-year observational study. Resuscitation 2021; 166:110-120. [PMID: 34082030 DOI: 10.1016/j.resuscitation.2021.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Shockable rhythm following pediatric out-of-hospital cardiac arrest (pOHCA) is consistently associated with hospital and short-term survival. Little is known about the relationship between shockable rhythm and long-term outcomes (>1 year) after pOHCA. The aim was to investigate the association between first documented rhythm and long-term outcomes in a pOHCA cohort over 18 years. METHODS All children aged 1 day-18 years who experienced non-traumatic pOHCA between 2002-2019 and were subsequently admitted to the emergency department (ED) or pediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital were included. Data was abstracted retrospectively from patient files, (ground) ambulance and Helicopter Emergency Medical Service (HEMS) records, and follow-up clinics. Long-term outcome was determined using a Pediatric Cerebral Performance Category (PCPC) score at the longest available follow-up interval through august 2020. The primary outcome measure was survival with favorable neurologic outcome, defined as PCPC 1-2 or no difference between pre- and post-arrest PCPC. The association between first documented rhythm and the primary outcome was calculated in a multivariable regression model. RESULTS 369 children were admitted, nine children were lost to follow-up. Median age at arrest was age 3.4 (IQR 0.8-9.9) years, 63% were male and 14% had a shockable rhythm (66% non-shockable, 20% unknown or return of spontaneous circulation (ROSC) before emergency medical service (EMS) arrival). In adolescents (aged 12-18 years), 39% had shockable rhythm. 142 (39%) of children survived to hospital discharge. On median follow-up interval of 25 months (IQR 5.1-49.6), 115/142 (81%) of hospital survivors had favorable neurologic outcome. In multivariable analysis, shockable rhythm was associated with survival with favorable long-term neurologic outcome (OR 8.9 [95%CI 3.1-25.9]). CONCLUSION In children with pOHCA admitted to ED or PICU shockable rhythm had significantly higher odds of survival with long-term favorable neurologic outcome compared to non-shockable rhythm. Survival to hospital discharge after pOHCA was 39% over the 18-year study period. Of survivors to discharge, 81% had favorable long-term (median 25 months, IQR 5.1-49.6) neurologic outcome. Efforts for improving outcome of pOHCA should focus on early recognition and treatment of shockable pOHCA at scene.
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Affiliation(s)
- M Albrecht
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - R C J de Jonge
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - V M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - M de Hoog
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Hunfeld
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - X R J Moors
- Department of Pediatric Anesthesiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Helicopter Emergency Medical Services, Erasmus MC, Rotterdam, The Netherlands
| | - L van Zellem
- Department of Youth Health Care, Public Health Service (GGD), Amsterdam, The Netherlands
| | - C M P Buysse
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Bertels RA, Kammeraad JAE, Zeelenberg AM, Filippini LH, Knobbe I, Kuipers IM, Blom NA. The Efficacy of Anti-Arrhythmic Drugs in Children With Idiopathic Frequent Symptomatic or Asymptomatic Premature Ventricular Complexes With or Without Asymptomatic Ventricular Tachycardia: a Retrospective Multi-Center Study. Pediatr Cardiol 2021; 42:883-890. [PMID: 33515328 PMCID: PMC8110481 DOI: 10.1007/s00246-021-02556-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/15/2021] [Indexed: 11/26/2022]
Abstract
The aim of the study is to compare the efficacy of flecainide, beta-blockers, sotalol, and verapamil in children with frequent PVCs, with or without asymptomatic VT. Frequent premature ventricular complexes (PVCs) and asymptomatic ventricular tachycardia (VT) in children with structurally normal hearts require anti-arrhythmic drug (AAD) therapy depending on the severity of symptoms or ventricular dysfunction; however, data on efficacy in children are scarce. Both symptomatic and asymptomatic children (≥ 1 year and < 18 years of age) with a PVC burden of 5% or more, with or without asymptomatic runs of VT, who had consecutive Holter recordings, were included in this retrospective multi-center study. The groups of patients receiving AAD therapy were compared to an untreated control group. A medication episode was defined as a timeframe in which the highest dosage at a fixed level of a single drug was used in a patient. A total of 35 children and 46 medication episodes were included, with an overall change in PVC burden on Holter of -4.4 percentage points, compared to -4.2 in the control group of 14 patients. The mean reduction in PVC burden was only significant in patients receiving flecainide (- 13.8 percentage points; N = 10; p = 0.032), compared to the control group and other groups receiving beta-blockers (- 1.7 percentage points; N = 18), sotalol (+ 1.0 percentage points; N = 7), or verapamil (- 3.9 percentage points; N = 11). The efficacy of anti-arrhythmic drug therapy on frequent PVCs or asymptomatic VTs in children is very limited. Only flecainide appears to be effective in lowering the PVC burden.
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Affiliation(s)
- Robin A Bertels
- Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands.
| | - Janneke A E Kammeraad
- Sophia Children's Hospital-Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, the Netherlands
| | - Anna M Zeelenberg
- Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands
| | - Luc H Filippini
- Juliana Children's Hospital-HAGA Hospital, Els Borst-Eilersplein 275, The Hague, the Netherlands
| | - Ingmar Knobbe
- VU Medical Center-Amsterdam UMC, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Irene M Kuipers
- Emma Children's Hospital-Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands
| | - Nico A Blom
- Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands
- Emma Children's Hospital-Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands
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Peltenburg PJ, Blom NA, Vink AS, Kammeraad JAE, Breur HJMPJ, Rammeloo LAJ, Wilde AAM, Clur SAB. In Children and Adolescents From Brugada Syndrome-Families, Only SCN5A Mutation Carriers Develop a Type-1 ECG Pattern Induced By Fever. Circulation 2020; 142:89-91. [PMID: 32628552 DOI: 10.1161/circulationaha.120.045720] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Puck J Peltenburg
- Department of Pediatric Cardiology, Emma Children's Hospital (P.J.P, N.A.B., A.S.V., S.-A.B.C.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands.,Heart Center (P.J.P., A.S.V., A.A.M.W.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Children's Hospital (P.J.P, N.A.B., A.S.V., S.-A.B.C.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands.,Department of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, The Netherlands (N.A.B.)
| | - Arja S Vink
- Department of Pediatric Cardiology, Emma Children's Hospital (P.J.P, N.A.B., A.S.V., S.-A.B.C.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands.,Heart Center (P.J.P., A.S.V., A.A.M.W.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands (J.A.E.K.)
| | - Hans J M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, UMC Utrecht, The Netherlands (H.J.M.P.J.B.)
| | - Lukas A J Rammeloo
- Department of Pediatric Cardiology, Amsterdam UMC, location Vrije Universiteit Medical Centre, The Netherlands (L.A.J.R.)
| | - Arthur A M Wilde
- Heart Center (P.J.P., A.S.V., A.A.M.W.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands
| | - Sally-Ann B Clur
- Department of Pediatric Cardiology, Emma Children's Hospital (P.J.P, N.A.B., A.S.V., S.-A.B.C.), Amsterdam University Medical Center, location Academic Medical Center (AMC), The Netherlands
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17
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Houck CA, Evertz R, Teuwen CP, Roos-Hesselink JW, Kammeraad JAE, Duijnhouwer AL, de Groot NMS, Bogers AJJC. Dysrhythmias in patients with a complete atrioventricular septal defect: From surgery to early adulthood. CONGENIT HEART DIS 2018; 14:280-287. [PMID: 30485659 PMCID: PMC7379716 DOI: 10.1111/chd.12724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/25/2018] [Revised: 09/25/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
Objective Outcomes after surgical repair of complete atrioventricular septal defect (cAVSD) have improved. With advancing age, the risk of development of dysrhythmias may increase. The aims of this study were to (1) examine development of sinus node dysfunction (SND), atrial and ventricular tachyarrhythmias, and (2) study progression of atrioventricular conduction abnormalities in young adult patients with repaired cAVSD. Study design In this retrospective multicenter study, 74 patients (68% female) with a cAVSD repaired in childhood were included. Patients’ medical files were evaluated for occurrence of SND, atrioventricular conduction block (AVB), atrial and ventricular tachyarrhythmias. Results Median age at repair was 6 months (interquartile range 3‐10) and median age at last follow‐up was 24 years (interquartile range 21‐28). SND occurred after a median of 17 years (interquartile range 11‐19) after repair in 23% of patients, requiring pacemaker implantation in two patients (12%). Regular supraventricular tachycardia was observed in three patients (4%). Atrial fibrillation and ventricular tachyarrhythmias were not observed. Twenty‐seven patients (36%) had first‐degree AVB, which was self‐limiting in 16 (59%) and persistent in 10 (37%) patients. One patient developed third‐degree AVB 7 days after left atrioventricular valve replacement. Spontaneous type II second‐degree AVB occurred in a 28‐year‐old patient. Both patients underwent pacemaker implantation. Conclusions Clinically significant dysrhythmias were uncommon in young adult patients after cAVSD repair. However, three patients required pacemaker implantation for either progression of SND or spontaneous type II second‐degree AVB. Longer follow‐up should point out whether dysrhythmias will progress or become more prevalent with increasing age.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Natasja M S de Groot
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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18
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Vos LM, Kammeraad JAE, Freund MW, Blank AC, Breur JMPJ. Response to letter to the editor from F. Jacques et al. Europace 2018; 20:1227. [DOI: 10.1093/europace/eux239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Laura M Vos
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, EA, Utrecht, The Netherlands
| | - Janneke A E Kammeraad
- Department of Paediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Centre, Wytemaweg 80, CN, Rotterdam, The Netherlands
| | - Matthias W Freund
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, EA, Utrecht, The Netherlands
| | - Andreas C Blank
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, EA, Utrecht, The Netherlands
| | - Johannes M P J Breur
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, EA, Utrecht, The Netherlands
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19
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Vos LM, Kammeraad JAE, Freund MW, Blank AC, Breur JMPJ. Long-term outcome of transvenous pacemaker implantation in infants: a retrospective cohort study. Europace 2017; 19:581-587. [PMID: 28431056 DOI: 10.1093/europace/euw031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Received: 07/29/2015] [Accepted: 02/02/2016] [Indexed: 11/14/2022] Open
Abstract
AIM Evaluation of long-term outcome of transvenous pacemaker (PM) implantation in infants. METHODS AND RESULTS A retrospective analysis of all transvenous PM implantations in infants <10 kg between September 1997 and October 2001 was made. Indications for PM implantation, age at implantation, and determinants of long-term outcome including cardiac function, PM function, and PM (system) complications were noted. Seven patients underwent transvenous VVI(R) PM implantation. Median age at implantation was 3 days (range: 1 day to 14 months), median weight 3.5 kg (range: 2.3-8.7 kg), and median follow-up 14 years (range: 12.3-16.3 years). Pacemaker indications were congenital complete atrioventricular block (n = 4), long QT syndrome with heart block (n = 2), and post-operative complete atrioventricular block with sinus node dysfunction (n = 1). No procedural complications were noted. Today all patients are alive and symptom free with good PM and cardiac function. Two patients underwent PM generator relocation for imminent skin necrosis and skin traction. Two patients suffered from asymptomatic left subclavian vein occlusion and developed thrombosis on the PM electrode. Three patients were converted to an epicardial PM system, due to atrial perforation after upgrading procedure (n = 1), syncope with need for implantable cardioverter defibrillator implantation (n = 1), and systolic dysfunction with development of dilated cardiomyopathy, which normalized under cardiac resynchronization therapy pacing (n = 1). Two patients needed atrioventricular (AV) valve repair for severe insufficiency. Two patients underwent repositioning of dysfunctional PM leads. In five patients, transvenous leads were removed. Indications were elective lead replacement (n = 1), atrial perforation (n = 1), and switch to an epicardial system (n = 3). CONCLUSION Transvenous PM implantation in infants (<10 kg) is associated with a high incidence of vascular occlusion, thrombosis, and severe atrioventricular valve regurgitation during long-term follow-up. We advocate an epicardial approach for PM implantation in small children.
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Affiliation(s)
- Laura M Vos
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Janneke A E Kammeraad
- Department of Paediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Matthias W Freund
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Andreas C Blank
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johannes M P J Breur
- Division of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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20
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Bergmans B, Kammeraad JAE, van Adrichem LNA, Staals LM. Craniosynostosis surgery in an infant with a complex cyanotic cardiac defect. Paediatr Anaesth 2014; 24:788-90. [PMID: 24684484 DOI: 10.1111/pan.12390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Accepted: 02/21/2014] [Indexed: 11/28/2022]
Abstract
We report on a case where craniosynostosis surgery for a left-sided coronal synostosis was performed successfully on an 11-month old infant with a hypoplastic left ventricle with a dysplastic mitral valve, double outlet right ventricle, transposition of the great arteries, atrial septal defect, multiple ventricular septal defects, and surgically applied pulmonary banding. Craniosynostosis surgery is considered high-risk surgery, because of possible sudden and extensive blood loss, and is usually performed in cardiopulmonary healthy children. Children with congenital heart disease undergoing noncardiac surgery have an increased risk of perioperative morbidity and cardiac arrest. Patients with hypoplastic left heart syndrome are a high-risk population when undergoing noncardiac surgery, in all stages of palliation. This infant would be undergoing a partial cavo-pulmonary connection (PCPC) within a few months. With a PCPC, drainage of cranial vessels is dependent on passive flow via the superior caval vein directly into the pulmonary artery. Consequently, this could lead to an increased blood loss during craniosynostosis surgery. Therefore, it was decided to perform the craniosynostosis surgery first, before establishing a PCPC. When a child with CHD presents for high-risk noncardiac surgery, future cardiac procedures and physiology also have to be taken into account. A multidisciplinary approach, involving pediatric cardiologists and pediatric anesthesiologists, is essential in making this decision.
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Affiliation(s)
- Bas Bergmans
- Department of Anesthesiology, Erasmus MC- Sophia Children's Hospital, Rotterdam, the Netherlands
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21
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de Heer AMR, Merchant SN, Kammeraad JAE, Cruysberg JRM, Huygen PLM, Cremers CWRJ. Clinical follow-up and histopathology of the temporal bones in Nathalie syndrome. Audiol Neurootol 2012; 17:219-27. [PMID: 22487897 DOI: 10.1159/000336212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 12/15/2011] [Indexed: 11/19/2022] Open
Abstract
The Nathalie syndrome (OMIM 255990) comprises a combination of features that do not resemble any other known syndrome and is as such an independent, rare entity. It is characterized by sensorineural hearing impairment, juvenile cataract, spinal muscular atrophy, skeletal abnormalities, retardation of growth, underdeveloped secondary gender characteristics and cardiomyopathy. Worldwide, only one family with this syndrome is known. An update of the clinical follow-up in this family and the results of autopsy are given. Audiometry showed a downsloping configuration that corresponded to the findings at histopathological examination of the cochlea: a diffuse atrophy of the organ of Corti, severe and diffuse atrophy of the stria vascularis and moderate loss of cochlear neurons in all turns. Another new striking feature is that individuals with the Nathalie syndrome have a shortened life expectancy with a risk of sudden death or death from heart failure resulting from (dilated) cardiomyopathy.
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Affiliation(s)
- Anne-Martine R de Heer
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Kammeraad JAE, Rosenthal E, Bostock J, Rogers J, Sreeram N. Endocardial Pacemaker Implantation in Infants Weighing <= 10 Kilograms. Pacing and Clinical Electrophysiology 2004; 27:1466-74. [PMID: 15546300 DOI: 10.1111/j.1540-8159.2004.00663.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Epicardial pacemaker implantation is the most common approach for small children requiring pacemaker implantation, though it is not free from complications. This article reviews the experience with endocardial pacemaker implantation, as an alternative approach, in children < or =10 kg at two centers. Thirty-nine children, median age 3.8 months (2 days-35 months), weight 4.6 kg (2.3-10 kg) underwent endocardial permanent pacing (VVI/R in 38, DDDR in 1). Indications for pacing were complete heart block (CHB) in 34 (congenital in 21, postsurgical in 12, congenitally corrected transposition of the great arteries 1), long QT syndrome in 3, and sinus bradycardia in 2 children. Two children with postsurgical CHB died 7 days and 3 weeks after implantation, respectively, due to heart failure and septicemia, despite appropriate pacemaker therapy. Over a median follow-up of 4.3 years (9 months-15.3 years), 12 patients underwent 18 generator replacements. Five patients were upgraded to physiological pacing. Ten patients underwent 12 ventricular lead advancements. Ventricular lead extraction was attempted 11 times in nine patients and succeeded 10 times. Two patients were converted to epicardial dual chamber systems. Two prepectorally placed generators required resiting due to threatened skin necrosis. Infective endocarditis on the lead, 9 months postimplant required removal of the system in one patient. The subclavian vein was found to be asymptomatically thrombosed in four patients. Endocardial permanent pacing is feasible and effective in children < or = 10 kg and an acceptable alternative to epicardial pacing.
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Kammeraad JAE, van Deurzen CHM, Sreeram N, Bink-Boelkens MTE, Ottenkamp J, Helbing WA, Lam J, Sobotka-Plojhar MA, Daniels O, Balaji S. Predictors of sudden cardiac death after Mustard or Senning repair for transposition of the great arteries. J Am Coll Cardiol 2004; 44:1095-102. [PMID: 15337224 DOI: 10.1016/j.jacc.2004.05.073] [Citation(s) in RCA: 229] [Impact Index Per Article: 11.5] [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: 12/22/2003] [Revised: 04/28/2004] [Accepted: 05/18/2004] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The goal of this research was to identify predictors for sudden death (SD) in patients with transposition of the great arteries (TGA) who have undergone atrial inflow repair. BACKGROUND Sudden death is the most common cause of late death after atrial inflow repair of TGA. Little is known about the predictors of SD. METHODS This was a retrospective, multicenter, case-controlled study. We identified 47 patients after Mustard's or Senning's operation who experienced an SD event (34 SD, 13 near-miss SD). Each patient was matched with two controls with the same operation, but without an SD event. Information on numerous variables before the event was obtained and compared with controls at the same time frame. RESULTS Presence of symptoms of arrhythmia or heart failure at most recent follow-up and history of documented arrhythmia (atrial flutter [AFL]/atrial fibrillation [AF]) were found to increase the risk of SD. Electrocardiogram (ECG), chest X-ray, and Holter ECG findings were not predictive of SD. Neither medication nor pacing was found to be protective. Most SD events (81%) occurred during exercise. Ventricular tachycardia/ventricular fibrillation were the recorded rhythm during SD in 21 of 47 patients. CONCLUSIONS Presence of symptoms and documented AFL/AF are the best predictors of SD in TGA patients. Patients with these findings should be further evaluated for risk of SD.
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Affiliation(s)
- Janneke A E Kammeraad
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
We determined the clinical value of routine transthoracic echocardiography performed after catheter ablation of supraventricular tachyarrhythmias in children. Between April 1996 and December 2003, 253 children, of whom 135 male, with the overall group having a median age of 9, ranging from 0.1 to 19 years, underwent 280 uncomplicated radiofrequency catheter ablation procedures for supraventricular tachyarrhythmias at three institutions. In every child, transthoracic Doppler echocardiography was performed before and after the procedure. The pre-ablation transthoracic echocardiograms were normal in all, and this was one of the criterions for inclusion. The post-ablation echocardiogram showed a disorder in four asymptomatic patients. In one patient, with focal atrial tachycardia, ablated via a retrograde aortic approach, there was mild aortic valvar insufficiency. This had resolved 6 months later. Pericardial effusions developed in 3 other children. In 2 the effusions resolved spontaneously but 1 patient required pericardial drainage. This same patient also developed clinically asymptomatic mild aortic insufficiency, which resolved spontaneously within 6 months. Routine echocardiography after uncomplicated catheter ablation procedures is of clinical value, and is especially indicated when a retrograde aortic approach has been used.
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26
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Kammeraad JAE, Balaji S, Oliver RP, Chugh SS, Halperin BD, Kron J, McAnulty JH. Nonautomatic focal atrial tachycardia: characterization and ablation of a poorly understood arrhythmia in 38 patients. Pacing Clin Electrophysiol 2003; 26:736-42. [PMID: 12698675 DOI: 10.1046/j.1460-9592.2003.00125.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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] [Indexed: 11/20/2022]
Abstract
Nonautomatic focal atrial tachycardia (NAFAT) is a rare and poorly understood arrhythmia either due to microreentry or triggered mechanism. NAFAT was defined as a focal atrial tachycardia which was inducible with pacing maneuvers in the electrophysiology lab. We reviewed the charts and EP study reports of all 38 patients with NAFAT, who underwent an EP study at our center between April 1994 and September 2000. Patients' were predominantly female (n = 31, 82%), aged 11-78 years (median 46). The mean age at presentation was 31 years (range 7-71 years). None of the patients had structural heart disease or had undergone prior heart surgery. Electroanatomic mapping (EAM) was performed in 22 patients and showed no scars in the atrium. A total of 45 foci were identified (range 1-3 foci/patient). Anatomically NAFAT foci were predominantly right atrial (n = 35) rather than left (n = 10). The NAFAT cycle length ranged from 270 to 490 (mean +/- SD; 380 +/- 69 ms) and was significantly lower in patients younger than 24 years of age. Ablation, attempted for 42 foci was successful in 33 (79%). The success rate in the EAM group was 20/25 foci (80%) compared to 13/18 (72%) in the non-EAM group. In conclusion, NAFAT is a rare arrhythmia which predominantly affects women with no other associated cardiac disease. It mainly occurs in the right atrium, affects all ages and is amenable to catheter ablation.
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Affiliation(s)
- Janneke A E Kammeraad
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, 707 SW Gaines Road, Portland, OR 97201, USA
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