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Krumerman A, Di Biase L, Gerstenfeld E, Dickfeld T, Verma N, Liberman L, Amara R, Kacorri A, Crosson L, Wilk A, Ferrick KJ. Premature Ventricular Complexes: Assessing Burden Density in a Large National Cohort to Better Define Optimal ECG Monitoring Duration. Heart Rhythm 2024:S1547-5271(24)02393-2. [PMID: 38641221 DOI: 10.1016/j.hrthm.2024.04.066] [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: 01/07/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Premature ventricular contractions (PVCs) burden is a risk factor for heart failure and cardiovascular death in patients with structural heart disease. Long-term ECG monitoring can have a significant impact on PVC burden evaluation by further defining PVC distribution patterns. OBJECTIVE This study aimed to ascertain the optimal duration of ECG monitoring to characterize PVC burden and understand clinical characteristics associated with frequent PVCs and NSVT in a large US cohort. METHODS Commercial data (iRhythm's Zio patch) from June 2011 to April 2022 were analyzed. Inclusion criteria were age >18 years, PVC burden ≥5%, and wear period ≥13 days. PVC burden cutoffs were determined based on AHA/ACC/HRS guidelines for very frequent PVCs (10,000-20,000 over 24 hours). Patients were categorized by PVC densities : Low (<10%), Moderate (10% to <20%) and High (≥20%). Mean measured error was assessed at baseline and daily until wear period's end for overall PVC Burden and different PVC densities. RESULTS Analysis of 106,705 patch monitors revealed a study population with mean age of 70.6±14.6 years; 33.6% female. PVC burden was higher in males and those >65 years of age. PVC burden mean error decreased from 2.9% at 24 hours to 1.3% at 7 days, and 0.7% at 10 days. Number of VT episodes per patient increased with increasing PVC burden (p<0.0001). CONCLUSION Extending ambulatory monitoring beyond 24 hours to 7 days or more, improves accuracy of assessing PVC burden. VT frequency and duration vary based on initial PVC density, highlighting the need for prolonged cardiac monitoring.
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Affiliation(s)
| | | | | | - Timm Dickfeld
- University of Maryland Medical Center, Baltimore, MD
| | | | | | - Richard Amara
- University of Maryland Medical Center, Baltimore, MD
| | | | | | - Alan Wilk
- iRhythm Technologies, San Francisco, CA
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Butensky AM, Patten WF, Silver ES, Liberman L. Oral Albuterol Treatment in Three Pediatric Patients with Bradycardia: A Novel Therapy. Pediatr Cardiol 2024; 45:441-445. [PMID: 38145427 DOI: 10.1007/s00246-023-03379-4] [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: 10/16/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
Clinically significant bradycardia is an uncommon problem in children, but one that can cause significant morbidity and sometimes necessitates implantation of a pacemaker. The most common causes of bradycardia are complete heart block (CHB), which can be congenital or acquired, and sinus node dysfunction, which is rare in children with structurally normal hearts. Pacemaker is indicated as therapy for the majority of children with CHB, and while early mortality is lower in postnatally diagnosed CHB than in fetal CHB, it is still up to 16%. In young children, less invasive transvenous pacemaker systems can be technically challenging to place and carry a high risk of complications, often necessitating surgical epicardial pacemaker placement, which usually entails a median sternotomy. We report three cases of pediatric patients referred for pacemaker implantation for different types of bradycardia, treated at our institution with oral albuterol with therapeutic results that avoided the need for surgical pacemaker implantation at that time.
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Affiliation(s)
- Adam M Butensky
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
| | - William F Patten
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Eric S Silver
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Leonardo Liberman
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
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Kailas M, Layton AM, Pesce M, Liberman L, Starc TJ, Fremed MA, Garofano R, Rosenzweig EB, Krishnan US. Exercise-Induced Electrocardiography Changes in Pulmonary Arterial Hypertension. Am J Cardiol 2023; 208:60-64. [PMID: 37820548 DOI: 10.1016/j.amjcard.2023.09.014] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023]
Abstract
Cardiopulmonary exercise testing (CPET) is an important tool in assessing the functional status of patients with pulmonary arterial hypertension (PAH). During CPET, continuous electrocardiography (ECG) is used as a marker of exercise-induced ischemia or arrhythmia. We hypothesize that ECG changes with exercise may be an early indicator of clinical worsening in PAH and could predict adverse outcomes. Clinical, hemodynamic, and CPET data of 155 children and young adult patients with PAH who underwent CPET between 2012 and 2019 in our pulmonary hypertension (PH) center were included in this retrospective analysis. ECGs were analyzed for ST depressions and T-wave inversions, along with coincident hemodynamic data. These data were correlated with adverse outcomes divided into 2 categories: severe worsening (death or receiving lung transplant) and mild to moderate worsening (PAH medication escalation, hospitalization, shunt creation, or listing for lung transplant). The median age was 19 years (range 7 to 40 years), 69% were female, and the average follow-up time was 5 years (range 1 to 8 years). A total of 63 patients (41%) had at least 1 adverse outcome. A total of 39 patients (25%) demonstrated significant ST-T-wave changes with exercise. Patients with ST-T-wave changes were 20% more likely to die or need lung transplant than those without. The multiple linear regression found that ST-T-wave changes were a predictor of elevated mean pulmonary arterial pressure (mPAP) found on catheterization (R = 0.489, p = 0.003), although not of pulmonary vascular resistance index (R = -0.112, p = 0.484). An mPAP of 55 mm Hg was the most sensitive and specific point in identifying when ST-T-wave changes with exercise begin to appear. In conclusion, ST-T-wave changes on exercise ECG are significantly associated with adverse outcomes in PH in a medium-term follow-up study, and the presence of ST-T-wave changes correlates with higher mPAP. These ECG changes with exercise may be used as early indicators of clinical worsening in PH and predictors of adverse outcomes.
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Affiliation(s)
- Maya Kailas
- Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, New York, New York.
| | - Aimee M Layton
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Meredith Pesce
- Department of Pediatric Cardiology, Yale New Haven Hospital, New Haven, Connecticut
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Thomas J Starc
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Michael A Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Robert Garofano
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Usha S Krishnan
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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Smerling JL, Goldstone AB, Bacha EA, Liberman L. Long-term outcomes of tricuspid valve intervention during stage 2 palliation in patients with a single right ventricle. J Thorac Cardiovasc Surg 2023; 166:1200-1209.e3. [PMID: 37225082 DOI: 10.1016/j.jtcvs.2023.05.014] [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: 01/18/2023] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES In patients with single ventricle physiology and a systemic right ventricle, tricuspid valve regurgitation increases the risk of adverse outcomes, and tricuspid valve intervention at the time of staged palliation further increases that risk in the postoperative period. However, long-term outcomes of valve intervention in patients with significant regurgitation during stage 2 palliation have not been established. The purpose of this study is to evaluate the long-term outcomes after tricuspid valve intervention during stage 2 palliation in patients with right ventricular dominant circulation in a multicenter study. METHODS The study was performed using the Single Ventricle Reconstruction Trial and Single Ventricle Reconstruction Follow-up 2 Trial datasets. Survival analysis was performed to describe the association among valve regurgitation, intervention, and long-term survival. Cox proportional hazards modeling was used to estimate the longitudinal association of tricuspid intervention and transplant-free survival. RESULTS Patients with tricuspid regurgitation at stage 1 or 2 had worse transplant-free survival (hazard ratio, 1.61; 95% confidence interval, 1.12-2.32; hazard ratio, 2.3; 95% confidence interval 1.39-3.82). Those with regurgitation who underwent concomitant valve intervention at stage 2 were significantly more likely to die or undergo heart transplantation compared with those with regurgitation who did not (hazard ratio, 2.93; confidence interval, 2.16-3.99). Patients with tricuspid regurgitation at the time of the Fontan had favorable outcomes regardless of valve intervention. CONCLUSIONS The risks associated with tricuspid regurgitation in patients with single ventricle physiology do not appear to be mitigated by valve intervention at the time of stage 2 palliation. Patients who underwent valve intervention for tricuspid regurgitation at stage 2 had significantly worse survival compared with patients with tricuspid regurgitation who did not.
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Affiliation(s)
- Jennifer L Smerling
- Division of Pediatric Cardiology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.
| | - Andrew B Goldstone
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Emile A Bacha
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Leonardo Liberman
- Division of Pediatric Cardiology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
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Epstein R, Liberman L, Silver ES. Long-Term Follow-Up of Second-Degree Heart Block in Children. Pediatr Cardiol 2023; 44:1529-1535. [PMID: 37658175 DOI: 10.1007/s00246-023-03195-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/20/2023] [Indexed: 09/03/2023]
Abstract
Little is known about the outcomes of children with second-degree heart block. We aimed to determine whether children with structurally normal hearts and Mobitz 1, 2:1 block or Mobitz 2 are at increased risk for progressing to complete heart block (CHB) or requiring a pacemaker (PM) at long-term follow-up. We searched our institutional electrophysiology database for children with potentially concerning second-degree block on ambulatory rhythm monitoring between 2009 and 2021, defined as frequent episodes of Mobitz 1 or 2:1 block, episodes of Mobitz 1 or 2:1 block with additional evidence of conduction disease (i.e. first-degree heart block, bundle branch block), or episodes of Mobitz 2. Ambulatory rhythm monitor, ECG, and demographic data were reviewed. The primary composite outcome was CHB on follow-up rhythm monitor or PM placement. 20 patients were in the final analysis. Six (30%) patients either developed CHB but do not have a PM (4 = 20%) or have a PM (2 = 10%). Median follow-up was 5.8 years (IQR 4.4-7.0). Patients with CHB or PM were more likely to have second-degree block at maximum sinus rate (67% vs. 0%, p = 0.003), a below normal average heart rate (67% vs. 14%, p = 0.04), and 2:1 block on initial ECG (50% vs. 0%, p = 0.02). In this study of children with potentially concerning second-degree block, 30% of patients progressed to CHB or required a PM. Second-degree block at maximum sinus rate, a low average heart, and 2:1 block on initial ECG were associated with increased risk of disease progression.
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Affiliation(s)
- Rebecca Epstein
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, 3959 Broadway, New York, NY, 10032, USA.
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, 3959 Broadway, New York, NY, 10032, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, 3959 Broadway, New York, NY, 10032, USA
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Marshall M, Malik A, Shah M, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P, Law IH, Kantoch MJ, Kertesz NJ, Strieper M, Erickson CC, Moore JP, Nakano SJ, Singh HR, Chang P, Cohen M, Fournier A, Ilina MV, Zimmermann F, Horndasch M, Li W, Batra AS, Liberman L, Hamilton R, Janson CM, Sanatani S, Zeltser I, McDaniel G, Blaufox AD, Garnreiter JM, Balaji S. Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 2023:10.1007/s00246-023-03252-4. [PMID: 37684488 DOI: 10.1007/s00246-023-03252-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/25/2023] [Indexed: 09/10/2023]
Abstract
Hypertrophic cardiomyopathy (HCM), a common cardiomyopathy in children, is an important cause of morbidity and mortality. Early recognition and appropriate management are important. An electrocardiogram (ECG) is often used as a screening tool in children to detect heart disease. The ECG patterns in children with HCM are not well described.ECGs collected from an international cohort of children, and adolescents (≤ 21 years) with HCM were reviewed. 482 ECGs met inclusion criteria. Age ranged from 1 day to 21 years, median 13 years. Of the 482 ECGs, 57 (12%) were normal. The most common abnormalities noted were left ventricular hypertrophy (LVH) in 108/482 (22%) and biventricular hypertrophy (BVH) in 116/482 (24%) Of the patients with LVH/BVH (n = 224), 135 (60%) also had a strain pattern (LVH in 83, BVH in 52). Isolated strain pattern (in the absence of criteria for hypertrophy) was seen in 43/482 (9%). Isolated pathologic Q waves were seen in 71/482 (15%). Pediatric HCM, 88% have an abnormal ECG. The most common ECG abnormalities were LVH or BVH with or without strain. Strain pattern without hypertrophy and a pathologic Q wave were present in a significant proportion (24%) of patients. Thus, a significant number of children with HCM have ECG abnormalities that are not typical for "hypertrophy". The presence of the ECG abnormalities described above in a child should prompt further examination with an echocardiogram to rule out HCM.
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Affiliation(s)
- Mayme Marshall
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Aneeq Malik
- University of Los Angeles Olive View, Los Angeles, CA, USA
| | - Maully Shah
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Peter F Aziz
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | | | | | - Andreas Pflaumer
- Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | | | | | - Ian H Law
- University of Iowa, Iowa City, IA, USA
| | | | | | - Margaret Strieper
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | | | | | | | - Harinder R Singh
- Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, USA
| | | | - Mitchell Cohen
- Inova LJ Murphy Children's Hospital, Falls Church, VA, USA
| | | | | | | | | | - Walter Li
- University of California, San Francisco, CA, USA
| | | | | | | | | | | | | | | | - Andrew D Blaufox
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Seshadri Balaji
- Oregon Health and Science University, 707 SW Gaines Street, Portland, OR, 97239, USA.
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Apfel G, Choi NH, Silver ES, Liberman L. Assessing the utility of atrial fibrillation induction to risk stratify children with Wolff-Parkinson-White syndrome. Cardiol Young 2023:1-5. [PMID: 37309199 DOI: 10.1017/s1047951123001415] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Wolff-Parkinson-White syndrome is associated with sudden cardiac death from rapid conduction through the accessory pathway in atrial fibrillation. Adult patients are at higher risk for sudden cardiac death if the shortest-pre-excited-RR-interval in atrial fibrillation (SPERRI) is ≤250 milliseconds (msec) during electrophysiologic study. Exclusive conduction through the atrioventricular node in atrial fibrillation is presumed to convey lower risk. The shortest-pre-excited-paced-cycle-length with atrial pacing has also served as a marker for risk stratification. OBJECTIVE To determine accessory pathway characteristic of patients undergoing induction of atrial fibrillation during electrophysiologic study. METHODS We reviewed 321 pediatric patients that underwent electrophysiologic study between 2010 and 2019. Induction of atrial fibrillation was attempted on patients while on isoproterenol and SPERRI was measured if atrial fibrillation was induced. Shortest-pre-excited-paced-cycle-length (SPPCL) was determined while on isoproterenol. RESULTS Atrial fibrillation was induced in 233 (73%) patients. Of those, 104 (45%) patients conducted exclusively through the atrioventricular node during atrial fibrillation (Group A). The remaining 129 (55%) patients had some conduction through the accessory pathway (Group B). In Group A, SPPCL was 260 msec with 48 (46%) conducting through the accessory pathway at ≤250 msec. In Group B, SPPCL was 240 msec with 92 patients (71%) conducting at ≤250 msec (p < 0.05). In Group B, SPERRI was 250 msec and had a positive correlation with SPPCL (p < 0.001, R2 = 0.28). Almost half (46%) of those with exclusive conduction through the atrioventricular node in atrial fibrillation had rapid accessory pathway conduction with atrial pacing. CONCLUSION Conduction in atrial fibrillation during electrophysiologic study on isoproterenol via the atrioventricular node may not exclude high-risk accessory pathways in pediatric patients.
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Affiliation(s)
- Gabriel Apfel
- New York-Presbyterian, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Nak Hyun Choi
- New York-Presbyterian, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Eric S Silver
- New York-Presbyterian, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Leonardo Liberman
- New York-Presbyterian, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA
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Miyake CY, Lay EJ, Soler-Alfonso C, Glinton KE, Houck KM, Tosur M, Moran NE, Stephens SB, Scaglia F, Howard TS, Kim JJ, Pham TD, Valdes SO, Li N, Murali CN, Zhang L, Kava M, Yim D, Beach C, Webster G, Liberman L, Janson CM, Kannankeril PJ, Baxter S, Singer-Berk M, Wood J, Mackenzie SJ, Sacher M, Ghaloul-Gonzalez L, Pedroza C, Morris SA, Ehsan SA, Azamian MS, Lalani SR. Natural history of TANGO2 deficiency disorder: Baseline assessment of 73 patients. Genet Med 2023; 25:100352. [PMID: 36473599 PMCID: PMC10306319 DOI: 10.1016/j.gim.2022.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 07/15/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE TANGO2 deficiency disorder (TDD), an autosomal recessive disease first reported in 2016, is characterized by neurodevelopmental delay, seizures, intermittent ataxia, hypothyroidism, and life-threatening metabolic and cardiac crises. The purpose of this study was to define the natural history of TDD. METHODS Data were collected from an ongoing natural history study of patients with TDD enrolled between February 2019 and May 2022. Data were obtained through phone or video based parent interviews and medical record review. RESULTS Data were collected from 73 patients (59% male) from 57 unrelated families living in 16 different countries. The median age of participants at the time of data collection was 9.0 years (interquartile range = 5.3-15.9 years, range = fetal to 31.8 years). A total of 24 different TANGO2 alleles were observed. Patients showed normal development in early infancy, with progressive delay in developmental milestones thereafter. Symptoms included ataxia, dystonia, and speech difficulties, typically starting between the ages of 1 to 3 years. A total of 46/71 (65%) patients suffered metabolic crises, and of those, 30 (65%) developed cardiac crises. Metabolic crises were significantly decreased after the initiation of B-complex or multivitamin supplementation. CONCLUSION We provide the most comprehensive review of natural history of TDD and important observational data suggesting that B-complex or multivitamins may prevent metabolic crises.
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Affiliation(s)
- Christina Y Miyake
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston TX.
| | - Erica J Lay
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | | | - Kevin E Glinton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Kimberly M Houck
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Mustafa Tosur
- Division of Diabetes and Endocrinology, Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Nancy E Moran
- USDA/ARS Children's Nutrition Research Center, Division of Nutrition, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Sara B Stephens
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Fernando Scaglia
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX; BCM-CUHK Center of Medical Genetics, Prince of Wales Hospital, Hong Kong, Special Administrative Region
| | - Taylor S Howard
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Jeffrey J Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Tam Dam Pham
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Santiago O Valdes
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Na Li
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
| | - Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Lilei Zhang
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston TX; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Maina Kava
- Department of Neurology, Perth Children's Hospital, Perth, Western Australia, Australia; Departments of Metabolic Medicine and Rheumatology, Perth Children's Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Deane Yim
- Department of Cardiology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Cheyenne Beach
- Division of Cardiology, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, CT
| | - Gregory Webster
- Division of Cardiology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Nortwestern University Feinberg School of Medicine, Chicago, IL
| | - Leonardo Liberman
- Division of Cardiology, Department of Pediatrics, New York Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Christopher M Janson
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Prince J Kannankeril
- Center for Pediatric Precision Medicine, Department of Pediatrics, Vanderbilt University Medical Center and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | | | | | - Jordan Wood
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Samuel J Mackenzie
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Michael Sacher
- Department of Biology, Concordia University, Montreal, Quebec, Canada; Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
| | - Lina Ghaloul-Gonzalez
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School, University of Texas Health Center at Houston, Houston, TX
| | - Shaine A Morris
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | | | - Mahshid S Azamian
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
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Girvin ZP, Silver ES, Liberman L. Comparison of AliveCor KardiaMobile Six-Lead ECG with Standard ECG in Pediatric Patients. Pediatr Cardiol 2023; 44:689-694. [PMID: 36056945 DOI: 10.1007/s00246-022-02998-7] [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: 05/06/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
The AliveCor KardiaMobile (ACKM) is a remote electrocardiogram (ECG) monitoring device. Little research has been conducted on its accuracy with pediatric patients. This prospective study aims to compare the ACKM six-lead device with a standard fifteen-lead ECG in measuring the QTc, QRS, and axis in pediatric patients. Pediatric patients ages 5 to 21 years were enrolled prospectively to have their ECG recorded using an ACKM six-lead device following a recording with the standard 15-lead ECG. A pediatric electrophysiologist measured the QTc, QRS interval, and QRS axis for both ECGs. Bland-Altman analysis was performed to assess agreement among measurements. The study included 141 patients. The mean age was 12.3 ± 4.4 years. Average heart rate was 79 ± 16 bpm. The mean difference in the QTc measurements for a paired standard ECG and ACKM was - 0.6 ms [95% confidence interval - 48 to 47 ms]. Of the ACKM QTc measurements, 117 (83%) were within 30 ms of the standard ECG. The mean difference in paired QRS measurements was - 1.3 ms [95% confidence interval - 23 to 21 ms]. Of the ACKM QRS measurements, 134 (95%) were within 20 ms of the standard ECG. The measured axis was the same for 84% of ACKM and standard ECGs. Over 80% of the ACKM six-lead ECGs produced QTc, QRS, and axis deviation measurements within a clinically useful range of the standard ECG. However, it is not accurate enough to be used consistently in place of a standard ECG for QTc and QRS measurement for pediatric patients.
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Affiliation(s)
- Zachary P Girvin
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Eric S Silver
- Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway Ave - 2 North, New York, NY, 10032, USA
| | - Leonardo Liberman
- Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway Ave - 2 North, New York, NY, 10032, USA.
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Fremed MA, Healy EW, Choi NH, Cheung EW, Choudhury TA, Jiang P, Liberman L, Zucker J, Lytrivi ID, Starc TJ. Elevated cardiac biomarkers and outcomes in children and adolescents with acute COVID-19. Cardiol Young 2023; 33:183-189. [PMID: 35086607 PMCID: PMC8861549 DOI: 10.1017/s1047951122000397] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/14/2022] [Accepted: 01/23/2022] [Indexed: 12/15/2022]
Abstract
Cardiac involvement associated with multi-system inflammatory syndrome in children has been extensively reported, but the prevalence of cardiac involvement in children with SARS-CoV-2 infection in the absence of inflammatory syndrome has not been well described. In this retrospective, single centre, cohort study, we describe the cardiac involvement found in this population and report on outcomes of patients with and without elevated cardiac biomarkers. Those with multi-system inflammatory syndrome in children, cardiomyopathy, or complex CHD were excluded. Inclusion criteriaz were met by 80 patients during the initial peak of the pandemic at our institution. High-sensitivity troponin T and/or N-terminal pro-brain type natriuretic peptide were measured in 27/80 (34%) patients and abnormalities were present in 5/27 (19%), all of whom had underlying comorbidities. Advanced respiratory support was required in all patients with elevated cardiac biomarkers. Electrocardiographic abnormalities were identified in 14/38 (37%) studies. Echocardiograms were performed on 7/80 patients, and none demonstrated left ventricular dysfunction. Larger studies to determine the true extent of cardiac involvement in children with COVID-19 would be useful to guide recommendations for standard workup and management.
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Affiliation(s)
- Michael A. Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Emma W. Healy
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Nak Hyun Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Eva W. Cheung
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
- Division of Pediatric Critical Care & Hospital Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tarif A. Choudhury
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
- Division of Pediatric Critical Care & Hospital Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Pengfei Jiang
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Jason Zucker
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Irene D. Lytrivi
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Thomas J. Starc
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
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11
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Miyake CY, Lay EJ, Beach CM, Ceresnak SR, Delauz CM, Howard TS, Janson CM, Jardine K, Kannankeril PJ, Kava M, Kim JJ, Liberman L, Macicek SL, Pham TD, Robertson T, Valdes SO, Webster G, Stephens SB, Milewicz DM, Azamian M, Ehsan SA, Houck KM, Soler-Alfonso C, Glinton KE, Tosur M, Li N, Xu W, Lalani SR, Zhang L. Cardiac crises: Cardiac arrhythmias and cardiomyopathy during TANGO2 deficiency related metabolic crises. Heart Rhythm 2022; 19:1673-1681. [PMID: 35568137 PMCID: PMC10642301 DOI: 10.1016/j.hrthm.2022.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 03/26/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND TANGO2 deficiency disorder (TDD) is an autosomal recessive disease associated with metabolic crisis, lethal cardiac arrhythmias, and cardiomyopathy. Data regarding treatment, management, and outcomes of cardiac manifestations of TDD are lacking. OBJECTIVE The purpose of this study was to describe TDD-related cardiac crises. METHODS Retrospective multicenter chart review was made of TDD patients admitted with cardiac crises, defined as development of ventricular tachycardia (VT), cardiomyopathy, or cardiac arrest during metabolic crises. RESULTS Twenty-seven children were admitted for 43 cardiac crises (median age 6.4 years; interquartile range [IQR] 2.4-9.8 years) at 14 centers. During crisis, QTc prolongation occurred in all (median 547 ms; IQR 504-600 ms) and a type I Brugada pattern in 8 (26%). Arrhythmias included VT in 21 (78%), supraventricular tachycardia in 3 (11%), and heart block in 1 (4%). Nineteen patients (70%) developed cardiomyopathy, and 20 (74%) experienced a cardiac arrest. There were 10 deaths (37%), 6 related to arrhythmias. In 5 patients, recalcitrant VT occurred despite use of antiarrhythmic drugs. In 6 patients, arrhythmias were controlled after extracorporeal membrane oxygenation (ECMO) support; 5 of these patients survived. Among 10 patients who survived VT without ECMO, successful treatment included intravenous magnesium, isoproterenol, and atrial pacing in multiple cases and verapamil in 1 patient. Initiation of feeds seemed to decrease VT events. CONCLUSION TDD-related cardiac crises are associated with a high risk of arrhythmias, cardiomyopathy, cardiac arrest, and death. Although further studies are needed, early recognition and appropriate treatment are critical. Acutely, intravenous magnesium, isoproterenol, atrial pacing, and ECMO as a last resort seem to be the best current treatment options, and early initiation of feeds may prevent VT events.
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Affiliation(s)
- Christina Y Miyake
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston Texas.
| | - Erica J Lay
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | | | - Scott R Ceresnak
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | | | - Taylor S Howard
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Kate Jardine
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | | | - Maina Kava
- Department of Neurology and Metabolic Medicine, Perth Children's Hospital, Perth, Western Australia
| | - Jeffrey J Kim
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Leonardo Liberman
- New York Presbyterian, Morgan Stanley Children's Hospital, New York, New York
| | | | - Tam Dam Pham
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Santiago O Valdes
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Sara B Stephens
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Diana M Milewicz
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Center at Houston, Houston, Texas
| | - Mahshid Azamian
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Saad A Ehsan
- Baylor College School of Medicine, Houston, Texas
| | - Kimberly M Houck
- Department of Pediatrics, Division of Neurology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Claudia Soler-Alfonso
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Kevin E Glinton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Mustafa Tosur
- Department of Pediatrics, Division of Endocrinology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Na Li
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Center at Houston, Houston, Texas
| | - Weiyi Xu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Lilei Zhang
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston Texas; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
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12
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Tortigue M, Nield LE, Karakachoff M, McLeod CJ, Belli E, Babu-Narayan SV, Prigent S, Boet A, Conway M, Elder RW, Ladouceur M, Khairy P, Kowalik E, Kalfa DM, Barron DJ, Mussa S, Hiippala A, Temple J, Abadir S, Le Gloan L, Lachaud M, Sanatani S, Thambo JB, Gronier CG, Amedro P, Vaksmann G, Charbonneau A, Koutbi L, Ovaert C, Houeijeh A, Combes N, Maury P, Duthoit G, Hiel B, Erickson CC, Bonnet C, Van Hare GF, Dina C, Karsenty C, Fournier E, Le Bloa M, Pass RH, Liberman L, Happonen JM, Perry JC, Romefort B, Benbrik N, Hauet Q, Fraisse A, Gatzoulis MA, Abrams DJ, Dubin AM, Ho SY, Redon R, Bacha EA, Schott JJ, Baruteau AE. Familial Recurrence Patterns in Congenitally Corrected Transposition of the Great Arteries: An International Study. Circ Genom Precis Med 2022; 15:e003464. [PMID: 35549293 DOI: 10.1161/circgen.121.003464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenitally corrected transposition of the great arteries (ccTGA) is a rare disease of unknown cause. We aimed to better understand familial recurrence patterns. METHODS An international, multicentre, retrospective cohort study was conducted in 29 tertiary hospitals in 6 countries between 1990 and 2018, entailing investigation of 1043 unrelated ccTGA probands. RESULTS Laterality defects and atrioventricular block at diagnosis were observed in 29.9% and 9.3%, respectively. ccTGA was associated with primary ciliary dyskinesia in 11 patients. Parental consanguinity was noted in 3.4% cases. A congenital heart defect was diagnosed in 81 relatives from 69 families, 58% of them being first-degree relatives, including 28 siblings. The most prevalent defects in relatives were dextro-transposition of the great arteries (28.4%), laterality defects (13.6%), and ccTGA (11.1%); 36 new familial clusters were described, including 8 pedigrees with concordant familial aggregation of ccTGA, 19 pedigrees with familial co-segregation of ccTGA and dextro-transposition of the great arteries, and 9 familial co-segregation of ccTGA and laterality defects. In one family co-segregation of ccTGA, dextro-transposition of the great arteries and heterotaxy syndrome in 3 distinct relatives was found. In another family, twins both displayed ccTGA and primary ciliary dyskinesia. CONCLUSIONS ccTGA is not always a sporadic congenital heart defect. Familial clusters as well as evidence of an association between ccTGA, dextro-transposition of the great arteries, laterality defects and in some cases primary ciliary dyskinesia, strongly suggest a common pathogenetic pathway involving laterality genes in the pathophysiology of ccTGA.
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Affiliation(s)
- Marine Tortigue
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Lynne E Nield
- Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Canada (L.E.N., D.J.B.)
| | | | | | - Emre Belli
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Sonya V Babu-Narayan
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Solène Prigent
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Angèle Boet
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Miriam Conway
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Robert W Elder
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT (R.W.E.)
| | - Magalie Ladouceur
- Department of Adult Congenital Heart Diseases, M3C Hôpital Européen Georges Pompidou, Paris, France (M.L.)
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Quebec, Canada (P.K., S.A.)
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland (E.K.)
| | - David M Kalfa
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - David J Barron
- Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Canada (L.E.N., D.J.B.)
| | - Shafi Mussa
- Department of Congenital Cardiac Surgery, University Hospitals Bristol NHS Foundation Trust, United Kingdom (S.M.)
| | - Anita Hiippala
- Department of Pediatric Cardiology, New Children's Hospital, Helsinki University Hospital, Finland (A.H., J.-M.H.)
| | - Joel Temple
- Department of Pediatrics, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE (J.T.)
| | - Sylvia Abadir
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Quebec, Canada (P.K., S.A.)
- Division of Cardiology, CHU Mère-Enfant Sainte-Justine, University of Montreal, Quebec, Canada (S.A.)
| | - Laurianne Le Gloan
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Department of Cardiology, CHU Nantes, Nantes, France (L.L.G.)
| | | | - Shubhayan Sanatani
- Division of Cardiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada (S.S.)
| | | | - Céline Grunenwald Gronier
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Pascal Amedro
- Department of Cardiology, CHU Bordeaux, France (J.-B.T., P.A.)
- PhyMedExp, CNRS, INSERM, University of Montpellier, France (P.A.)
| | - Guy Vaksmann
- Department of Pediatric Cardiology, Hôpital Privé de La Louvière, Lille, France (G.V.)
| | - Anne Charbonneau
- Department of Pediatric and Congenital Cardiology, American Memorial Hospital, CHU Reims, France (A.C.)
| | - Linda Koutbi
- Department of Cardiology (L.K.), La Timone Hospital, CHU Marseille, France
| | - Caroline Ovaert
- Department of Pediatric Cardiology (C.O.), La Timone Hospital, CHU Marseille, France
- Marseille Medical Genetics, Inserm UMR 1251, Aix-Marseille University, France (C.O.)
| | - Ali Houeijeh
- Department of Pediatric Cardiology, CHRU Lille, France (A.H.)
| | - Nicolas Combes
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
- Department of Cardiology, Pasteur Clinic, Toulouse, France (N.C.)
| | | | - Guillaume Duthoit
- Department of Cardiology, Groupe Hospitalier Pitié Salpétrière, Sorbonne Université, Paris, France (G.D.)
| | - Bérengère Hiel
- Department of Pediatric Cardiology, CHU Amiens, France (B.H.)
| | - Christopher C Erickson
- UDivision of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE (C.C.E.)
| | | | - George F Van Hare
- Division of Pediatric Cardiology, St Louis Children's Hospital, Washington University School of Medicine (G.F.V.H.)
| | - Christian Dina
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
| | - Clément Karsenty
- Department of Pediatric and Congenital Cardiology, Children's Hospital (C.K.), CHU Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR 1048, Université de Toulouse, France (C.K.)
| | - Emmanuelle Fournier
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Mathieu Le Bloa
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Switzerland (M.L.B.)
| | - Robert H Pass
- Department of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, NY (R.H.P.)
| | - Leonardo Liberman
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - Juha-Matti Happonen
- Department of Pediatric Cardiology, New Children's Hospital, Helsinki University Hospital, Finland (A.H., J.-M.H.)
| | - James C Perry
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego (J.C.P.)
| | - Bénédicte Romefort
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Nadir Benbrik
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Quentin Hauet
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Alain Fraisse
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Michael A Gatzoulis
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (D.J.A.)
| | - Anne M Dubin
- Division of Pediatric Cardiology, Stanford University, Palo Alto, CA (A.M.D.)
| | - Siew Yen Ho
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Richard Redon
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
| | - Emile A Bacha
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - Jean-Jacques Schott
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
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13
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Püttgen KB, Hansen LM, Lauren C, Stefanko N, Mathes E, Olsen GM, Tollefson MM, Adams D, Baselga E, Chamlin S, Corey K, Frascari FF, Frieden IJ, Galligan ER, Gupta D, Haggstrom A, Horii K, Hornik CP, Klajn J, Liberman L, Mancini A, Mannschreck D, McGinness A, McCuaig C, Newell B, Nguyen H, Nopper A, Oyesanya T, Powell J, Reynolds M, Rios M, Siegel DH, Ward K, Garzon MC, Frommelt P, Drolet BA. Limited utility of repeated vital sign monitoring during initiation of oral propranolol for complicated infantile hemangioma. J Am Acad Dermatol 2021; 85:345-352. [PMID: 32289387 DOI: 10.1016/j.jaad.2020.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/11/2019] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Initial propranolol recommendations for infantile hemangioma published in 2013 were intended as provisional best practices to be updated as evidence-based data emerged. METHODS A retrospective multicenter study was performed to evaluate utility of prolonged monitoring after first propranolol dose and escalation(s). Inclusion criteria included diagnosis of hemangioma requiring propranolol of greater than or equal to 0.3 mg/kg per dose, younger than 2 years, and heart rate monitoring for greater than or equal to 1 hour. Data collected included demographics, dose, vital signs, and adverse events. RESULTS A total of 783 subjects met inclusion criteria; median age at initiation was 112 days. None of the 1148 episodes of prolonged monitoring warranted immediate intervention or drug discontinuation. No symptomatic bradycardia or hypotension occurred during monitoring. Mean heart rate change from baseline to 1 hour was -8.19/min (±15.54/min) and baseline to 2 hours was -9.24/min (±15.84/min). Three preterm subjects had dose adjustments because of prescriber concerns about asymptomatic vital sign changes. No significant difference existed in pretreatment heart rate or in heart rate change between individuals with later adverse events during treatment and those without. CONCLUSION Prolonged monitoring for initiation and escalation of oral propranolol rarely changed management and did not predict future adverse events. Few serious adverse events occurred during therapy; none were cardiovascular.
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Affiliation(s)
| | | | | | | | - Erin Mathes
- University of California-San Francisco, San Francisco, California
| | | | | | | | | | - Sarah Chamlin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Flora F Frascari
- University of California-San Francisco, San Francisco, California
| | - Ilona J Frieden
- University of California-San Francisco, San Francisco, California
| | | | - Deepti Gupta
- Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | | | | | | | - Justyna Klajn
- University of California-San Francisco, San Francisco, California
| | | | - Anthony Mancini
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Anelah McGinness
- University of California-San Francisco, San Francisco, California
| | | | | | | | - Amy Nopper
- University of Missouri, Kansas City, Missouri
| | - Tola Oyesanya
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Powell
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Megan Reynolds
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Monica Rios
- Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Kendra Ward
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Beth A Drolet
- School of Medicine and Public Health, University of Wisconsin, Milwaukee, Wisconsin.
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14
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Richardson C, Silver ES, Liberman L. Conduction Properties and Ablation of Adenosine Sensitive Accessory Pathways in Children. Pediatr Cardiol 2021; 42:1350-1355. [PMID: 33893526 DOI: 10.1007/s00246-021-02618-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
Block in accessory pathway (AP) conduction with adenosine has been previously described. However, conduction characteristics of these APs has not been well defined to date. All patients with APs </ = 21 years old who underwent an EP study from 2014 to 2017 were included in our study. Patients with adenosine sensitive APs were identified (group 1). Demographic and AP conduction characteristics were compared between group 1 and the entire cohort of patients. Local atrioventricular (AV) or ventriculoatrial (VA) time, cycle length and need for isoproterenol were compared to a control group matched by age and AP location (group 2). Student's t test, Wilcoxon rank sum, χ2 and Fisher's exact were used for analysis. Fourteen (7%) out of 207 patients had an adenosine sensitive AP. The median age of patients with adenosine sensitive APs was 11.8 (IQR 8.5-13.5) years vs. 14 (IQR 10.6-16.7) for the rest of the cohort (p = 0.04). Three of the 134 patients with preexcitation had adenosine sensitive APs (2%) vs. 11 of the 73 patients with concealed APs (15%) (p = 0.001). The median local AV/VA time at the site of successful ablation was longer in group 1 vs group 2 [78 ms, IQR 62-116 vs. 31 ms, IQR 30-38; p < 0.001]. Antegrade AP effective refractory period and total procedure time were longer in patients with adenosine sensitive APs (p = 0.03 & p = 0.04, respectively). Adenosine sensitive APs which occur in children are more often concealed. These APs have a longer conduction time at the site of successful ablation.
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Affiliation(s)
- Chalese Richardson
- Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, 3959 Broadway, 2 North, New York, NY, 10032, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, 3959 Broadway, 2 North, New York, NY, 10032, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, 3959 Broadway, 2 North, New York, NY, 10032, USA.
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15
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Malik A, Marshall ME, Shah MJ, Fish FA, Etheridge SP, Aziz PF, Russell M, Tisma-Dupanovic S, Pflaumer A, Sreeram N, Kubuš P, Law IH, Kantoch M, Kertesz NJ, Strieper MJ, Erickson CC, Moore JP, Nakano S, Singh HR, Chang PM, Cohen MI, Fournier A, Ilina MV, Smith RT, Zimmermann F, Horndasch M, Li WL, Batra AS, Liberman L, Hamilton RM, Janson CM, Sanatani S, Zeltser I, McDaniel GM, Blaufox AD, Garnreiter JM, Balaji S. B-PO02-197 PATTERNS OF ELECTROCARDIOGRAPH ABNORMALITIES IN CHILDREN WITH HYPERTROPHIC CARDIOMYOPATHY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Boscamp NS, Liberman L, Silver ES. Anodal stimulation in pediatric patients with permanent epicardial ventricular pacemakers. Pacing Clin Electrophysiol 2021; 44:1593-1598. [PMID: 34287953 DOI: 10.1111/pace.14323] [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] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/08/2021] [Accepted: 07/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to measure the frequency and factors associated with anodal stimulation in a pediatric population with epicardial pacing leads. BACKGROUND In bipolar pacemakers, capture of the myocardium typically occurs at the cathode. However, AS with capture at the anode has been described. This has not been described in epicardial pacemakers. METHODS Retrospective data were collected from patients ≤ 21 years of age with permanent bipolar epicardial ventricular pacemakers from 1/2017 to 1/2018. AS was defined as a clear change on surface ECG in at least one of the 12 leads assessed by two blinded pediatric electrophysiologists. RESULTS Twenty-four bipolar leads in 23 patients were included in the study. One patient had both biventricular leads tested. Median age was 7.1 years (IQR 5.0-10.9), weight was 20.9 kg (IQR 16.5-33.5), and 65% were male. Testing was performed at a median of 2.8 years (IQR 1.6-6.1) after implant. Congenital heart disease was present in 57%. Complete heart block was the pacemaker indication in 78%. AS was identified in 16/24 (67%) of leads tested. Identification of AS was associated with presence of congenital heart disease (p = 0.004) and 3DD between electrodes (p = 0.04). CONCLUSIONS AS is common in pediatric patients and was associated with a history of congenital heart disease and greater estimated 3DD between electrodes. The prevalent nature of AS may allow clinicians to utilize existing pacemakers as multisite pacing systems.
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Affiliation(s)
- Nicholas S Boscamp
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Irving Medical Center, New York, New York, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Irving Medical Center, New York, New York, USA
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17
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Liberman L, Liberman N, Silver ES. Cardiac monitoring: is longer better? Kardiol Pol 2021; 79:110-111. [PMID: 33635029 DOI: 10.33963/kp.15825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Choi NH, Fremed M, Starc T, Weller R, Cheung E, Ferris A, Silver ES, Liberman L. MIS-C and Cardiac Conduction Abnormalities. Pediatrics 2020; 146:peds.2020-009738. [PMID: 33184170 DOI: 10.1542/peds.2020-009738] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Multisystem inflammatory syndrome in children (MIS-C) has spread through the pediatric population during the coronavirus disease 2019 pandemic. Our objective for the study was to report the prevalence of conduction anomalies in MIS-C and identify predictive factors for the conduction abnormalities. METHODS We performed a single-center retrospective cohort study of pediatric patients <21 years of age presenting with MIS-C over a 1-month period. We collected clinical outcomes, laboratory findings, and diagnostic studies, including serial electrocardiograms, in all patients with MIS-C to identify those with first-degree atrioventricular block (AVB) during the acute phase and assess for predictive factors. RESULTS Thirty-two patients met inclusion criteria. Median age at admission was 9 years. Six of 32 patients (19%) were found to have first-degree AVB, with a median longest PR interval of 225 milliseconds (interquartile range 200-302), compared with 140 milliseconds (interquartile range 80-178) in patients without first-degree AVB. The onset of AVB occurred at a median of 8 days after the initial symptoms and returned to normal 3 days thereafter. No patients developed advanced AVB, although 1 patient developed a PR interval >300 milliseconds. Another patient developed new-onset right bundle branch block, which resolved during hospitalization. Cardiac enzymes, inflammatory markers, and cardiac function were not associated with AVB development. CONCLUSIONS In our population, there is a 19% prevalence of first-degree AVB in patients with MIS-C. All patients with a prolonged PR interval recovered without progression to high-degree AVB. Patients admitted with MIS-C require close electrocardiogram monitoring during the acute phase.
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Affiliation(s)
- Nak Hyun Choi
- Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Michael Fremed
- Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Thomas Starc
- Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Rachel Weller
- Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Eva Cheung
- Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Anne Ferris
- Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Eric S Silver
- Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Leonardo Liberman
- Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
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19
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Abstract
A diagnosis of Brugada pattern in paediatric or adolescent patients is rare. COVID-19 is characterised by fevers and a pro-inflammatory state, which may serve as inciting factors for Brugada pattern. Recently described in two adult patients, we report the first case of Brugada pattern in an adolescent with COVID-19.
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Affiliation(s)
- Nak Hyun Choi
- Division of Paediatric Cardiology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Eric S. Silver
- Division of Paediatric Cardiology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Michael Fremed
- Division of Paediatric Cardiology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Leonardo Liberman
- Division of Paediatric Cardiology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York, USA
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20
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Fremed MA, Lytrivi ID, Liberman L, Anderson BR, Barry OM, Choudhury TA, Chrisomalis-Dring S, Ferris A, Glickstein JS, Krishnan U, Levasseur S, Rosenzweig EB, Shah A, Silver ES, Suh S, Turner ME, Weller R, Woo J, Starc TJ. Cardiac workup and monitoring in hospitalised children with COVID- 19. Cardiol Young 2020; 30:907-910. [PMID: 32611457 PMCID: PMC8717675 DOI: 10.1017/s1047951120001778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
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Affiliation(s)
- Michael A Fremed
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Irene D Lytrivi
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Brett R Anderson
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Oliver M Barry
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Tarif A Choudhury
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Anne Ferris
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie S Glickstein
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Usha Krishnan
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Stéphanie Levasseur
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Amee Shah
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sanghee Suh
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mariel E Turner
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Weller
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joyce Woo
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Thomas J Starc
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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21
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Satzer MB, Flyer JN, Zuckerman WA, Liberman L, Richmond ME, Anderson BR, Addonizio LJ, Silver ES. Impact of dipyridamole on adenosine dosing in pediatric and young adult patients after heart transplantation. Pediatr Transplant 2020; 24:e13689. [PMID: 32157785 PMCID: PMC9610548 DOI: 10.1111/petr.13689] [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: 09/08/2019] [Revised: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Relative contraindications to adenosine use have included heart transplant and dipyridamole. We previously demonstrated the safety and efficacy of adenosine-induced atrioventricular (AV) block in healthy young heart transplant recipients while suspending dipyridamole therapy (dual antiplatelet agent). This prospective follow-up study evaluated the safety and efficacy of adenosine use in the same cohort of heart transplant recipients while on dipyridamole. METHODS Adenosine was incrementally dosed until AV block occurred (maximum 200 mcg/kg up to 12 mg). The primary outcome was clinically significant asystole (≥12 seconds). Secondary outcomes included maximal adenosine dose, AV block duration, dysrhythmias, and clinical symptoms. Outcomes were compared to the parent study. RESULTS Thirty of 39 eligible patients (5-24 years) were tested. No patient (0%, CI 0%-8%) experienced clinically significant asystole. AV block occurred in 29/30 patients (97%, CI 86%-100%). The median dose causing AV block was 50mcg/kg (vs 100 mcg/kg off dipyridamole; P = .011). Seventeen patients (57%, CI 39%-72%) required less adenosine to achieve AV block on dipyridamole; six (20%) required more. AV block occurred at doses ≥25 mcg/kg in all patients. In pairwise comparison to prior testing off dipyridamole, no significant change occurred in AV block duration, frequency of cardiac ectopy, or incidence of reported symptoms. No atrial fibrillation/flutter occurred. CONCLUSIONS AV block often occurs at twofold lower adenosine doses in healthy young heart transplant recipients taking oral dipyridamole, compared with previous testing of this cohort off dipyridamole. Results suggest that initial dosing of 25 mcg/kg (maximum 0.8 mg) with stepwise escalation poses low risk of prolonged asystole on dipyridamole.
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Affiliation(s)
- Michael B. Satzer
- Division of Pediatric Cardiology Columbia University Irving Medical Center New York NY USA
| | - Jonathan N. Flyer
- Division of Pediatric Cardiology Columbia University Irving Medical Center New York NY USA
- Department of Pediatrics Division of Pediatric Cardiology The Robert Larner, M.D. College of Medicine at The University of Vermont Burlington VT USA
| | - Warren A. Zuckerman
- Division of Pediatric Cardiology Columbia University Irving Medical Center New York NY USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology Columbia University Irving Medical Center New York NY USA
| | - Marc E. Richmond
- Division of Pediatric Cardiology Columbia University Irving Medical Center New York NY USA
| | - Brett R. Anderson
- Division of Pediatric Cardiology Columbia University Irving Medical Center New York NY USA
| | - Linda J. Addonizio
- Division of Pediatric Cardiology Columbia University Irving Medical Center New York NY USA
| | - Eric S. Silver
- Division of Pediatric Cardiology Columbia University Irving Medical Center New York NY USA
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22
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Melki L, Grubb CS, Weber R, Nauleau P, Garan H, Wan E, Silver ES, Liberman L, Konofagou EE. 3D-rendered Electromechanical Wave Imaging for Localization of Accessory Pathways in Wolff-Parkinson-White Minors .. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:6192-6195. [PMID: 31947257 DOI: 10.1109/embc.2019.8857876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Arrhythmia localization prior to catheter ablation is critical for clinical decision making and treatment planning. The current standard lies in 12-lead electrocardiogram (ECG) interpretation, but this method is non-specific and anatomically limited. Accurate localization requires intracardiac catheter mapping prior to ablation. Electromechanical Wave Imaging (EWI) is a high frame-rate ultrasound modality capable of non-invasively mapping the electromechanical activation in all cardiac chambers in vivo. In this study, we evaluate 3D-rendered EWI as a technique for consistently localizing the accessory pathway (AP) in Wolff-Parkinson-White (WPW) pediatric patients. A 2000 Hz EWI diverging sequence was used to transthoracically image 13 patients with evidence of ECG pre-excitation, immediately prior to catheter ablation and after successful ablation whenever possible. 3D-rendered activation maps were generated by co-registering and interpolating the 4 resulting multi-2D isochrones. A blinded electrophysiologist predicted the AP location on 12-lead ECG prior to ablation. Double-blinded EWI isochrones and clinician assessments were compared to the successful ablation site as confirmed by intracardiac mapping using a segmented template of the heart with 19 ventricular regions. 3D-rendered EWI was shown capable of consistently localizing AP in all the WPW cases. Clinical ECG interpretation correctly predicted the origin with an accuracy of 53.8%, respectively 84.6% when considering predictions in immediately adjacent segments correct. Our method was also capable of assessing the difference in activation pattern from before to after successful ablation on the same patient. These findings indicate that EWI could inform current diagnosis and expedite treatment planning of WPW ablation procedures.
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23
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Balaji S, DiLorenzo MP, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P, Law IH, Kantoch MJ, Kertesz NJ, Strieper M, Erickson CC, Moore JP, Nakano SJ, Singh HR, Chang P, Cohen M, Fournier A, Ilina MV, Smith RT, Zimmerman F, Horndasch M, Li W, Batra A, Liberman L, Hamilton R, Janson CM, Sanatani S, Zeltser I, McDaniel G, Blaufox AD, Garnreiter JM, Katcoff H, Shah M. Risk factors for lethal arrhythmic events in children and adolescents with hypertrophic cardiomyopathy and an implantable defibrillator: An international multicenter study. Heart Rhythm 2019; 16:1462-1467. [DOI: 10.1016/j.hrthm.2019.04.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 11/16/2022]
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24
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Baruteau AE, Kyndt F, Behr E, Vink A, Lachaud M, Joong A, Schott JJ, Horie M, Denjoy I, Crotti L, Shimizu W, Bos J, Stephenson E, Wong L, Abrams D, Davis A, Winbo A, Dubin A, Sanatani S, Liberman L, Kaski JP, Rudic B, Kwok SY, Rieubland C, Tfelt-Hansen J, Van Hare G, Guyomarc’h-Delasalle B, Blom N, Wijeyeratne Y, Gourraud JB, Le Marec H, Ozawa J, Fressart V, Lupoglazoff JM, Dagradi F, Spazzolini C, Aiba T, Tester D, Zahavich L, Beauséjour-Ladouceur V, Jadhav M, Skinner J, Franciosi S, Krahn A, Abdelsayed M, Ruben P, Yung TC, Ackerman M, Wilde A, Schwartz P, Probst V. SCN5A mutations in 442 neonates and children: Genotype-phenotype correlation and identification of higher-risk subgroups. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Balaji S, DiLorenzo MP, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P, Law IH, Kantoch MJ, Kertesz NJ, Strieper M, Erickson CC, Moore JP, Nakano SJ, Singh HR, Chang P, Cohen M, Fournier A, Ilina MV, Smith RT, Zimmerman F, Horndasch M, Li W, Batra A, Liberman L, Hamilton R, Janson CM, Sanatani S, Zeltser I, McDaniel G, Blaufox AD, Garnreiter JM, Katcoff H, Shah M. Impact of Obesity on Left Ventricular Thickness in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 2019; 40:1253-1257. [PMID: 31263917 DOI: 10.1007/s00246-019-02145-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/01/2019] [Accepted: 06/19/2019] [Indexed: 01/23/2023]
Abstract
Obesity is associated with additional left ventricular hypertrophy (LVH) in adults with hypertrophic cardiomyopathy (HCM). It is not known whether obesity can lead to further LVH in children with HCM. Echocardiographic LV dimensions were determined in 504 children with HCM. Measurements of interventricular septal thickness (IVST) and posterior wall thickness (PWT), and patients' weight and height were recorded. Obesity was defined as a body mass index (BMI) ≥ 99th percentile for age and sex. IVST data was available for 498 and PWT data for 484 patients. Patient age ranged from 2 to 20 years (mean ± SD, 12.5 ± 3.9) and 340 (68%) were males. Overall, patient BMI ranged from 7 to 50 (22.7 ± 6.1). Obesity (BMI 18-50, mean 29.1) was present in 140 children aged 2-19.6 (11.3 ± 4.1). The overall mean IVST was 20.5 ± 9.6 mm and the overall mean PWT was 11.0 ± 8.4 mm. The mean IVST in the obese patients was 21.6 ± 10.0 mm and mean PWT was 13.3 ± 14.7 mm. The mean IVST in the non-obese patients was 20.1 ± 9.5 mm and mean PWT was 10.4 ± 4.3 mm. Obesity was not significantly associated with IVST (p = 0.12), but was associated with increased PWT (0.0011). Obesity is associated with increased PWT but not IVST in children with HCM. Whether obesity and its impact on LVH influences clinical outcomes in children with HCM needs to be studied.
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Affiliation(s)
- Seshadri Balaji
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, 707, SW Gaines Street, Mailcode: CDRC-P, Portland, OR, 97239, USA.
| | | | | | | | | | | | | | | | | | | | - Ian H Law
- University of Iowa, Iowa City, IA, USA
| | | | | | | | | | | | | | - Harinder R Singh
- Children's Hospital of Michigan, Detroit, MI, USA
- Children's Hospital of San Antonio, San Antonio, TX, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hannah Katcoff
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maully Shah
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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26
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Abstract
BACKGROUND The clinical course of children with advanced heart block secondary to Lyme disease has not been well characterized. OBJECTIVE To review the presentation, management, and time to resolution of heart block due to Lyme disease in previously healthy children. METHODS An IRB approved single-center retrospective study was conducted of all patients < 21 years old with confirmed Lyme disease and advanced second or third degree heart block between 2007 and 2017. RESULTS Twelve patients (100% male) with a mean age of 15.9 years (range 13.2-18.1) were identified. Six patients (50%) had mild to moderate atrioventricular valve regurgitation and all had normal biventricular function. Five patients had advanced second degree heart block and 7 had complete heart block with an escape rate of 20-57 bpm. Isoproterenol was used in 4 patients for 3-4 days and one patient required transvenous pacing for 2 days. Patients were treated with 21 days (n = 6, 50%) or 28 days (n = 6, 50%) of antibiotics. Three patients received steroids for 3-4 days. Advanced heart block resolved in all patients within 2-5 days, and all had a normal PR interval within 3 days to 16 months from hospital discharge. CONCLUSION Symptomatic children who present with new high-grade heart block from an endemic area should be tested for Lyme disease. Antibiotic therapy provides quick and complete resolution of advanced heart block within 5 days, while steroids did not appear to shorten the time course in this case series. Importantly, no patients required a permanent pacemaker.
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Affiliation(s)
- Meena Bolourchi
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, 2-North, New York, NY, USA
| | - Eric S Silver
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, 2-North, New York, NY, USA
| | - Leonardo Liberman
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, 2-North, New York, NY, USA.
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27
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Melki L, Grubb CS, Weber R, Nauleau P, Garan H, Wan E, Silver ES, Liberman L, Konofagou EE. Localization of Accessory Pathways in Pediatric Patients With Wolff-Parkinson-White Syndrome Using 3D-Rendered Electromechanical Wave Imaging. JACC Clin Electrophysiol 2019; 5:427-437. [PMID: 31000096 DOI: 10.1016/j.jacep.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/15/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study sought to demonstrate the feasibility of electromechanical wave imaging (EWI) for localization of accessory pathways (AP) prior to catheter ablation in a pediatric population. BACKGROUND Prediction of AP locations in patients with Wolff-Parkinson-White syndrome is currently based on analysis of 12-lead electrocardiography (ECG). In the pediatric population, specific algorithms have been developed to aid in localization, but these can be unreliable. EWI is a noninvasive imaging modality relying on a high frame rate ultrasound sequence capable of visualizing cardiac electromechanical activation. METHODS Pediatric patients with ventricular pre-excitation presenting for catheter ablation were imaged with EWI immediately prior to the start of the procedure. Two clinical pediatric electrophysiologists predicted the location of the AP based on ECG. Both EWI and ECG predictions were blinded to the results of catheter ablation. EWI and ECG localizations were subsequently compared with the site of successful ablation. RESULTS Fifteen patients were imaged with EWI. One patient was excluded for poor echocardiographic windows and the inability to image the entire ventricular myocardium. EWI correctly predicted the location of the AP in all 14 patients. ECG analysis correctly predicted 11 of 14 (78.6%) of the AP locations. CONCLUSIONS EWI was shown to be capable of consistently localizing accessory pathways. EWI predicted the site of successful ablation more frequently than analysis of 12-lead ECG. EWI isochrones also provide anatomical visualization of ventricular pre-excitation. These findings suggest that EWI can predict AP locations, and EWI may have the potential to better inform clinical electrophysiologists prior to catheter ablation procedures.
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Affiliation(s)
- Lea Melki
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Christopher S Grubb
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Rachel Weber
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Pierre Nauleau
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Elaine Wan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Eric S Silver
- Pediatric Electrophysiology, Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Leonardo Liberman
- Pediatric Electrophysiology, Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Elisa E Konofagou
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York; Department of Radiology, Columbia University Medical Center, New York, New York.
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Oh SL, Liberman L, Mishler O. Faculty calibration and students' self-assessments using an instructional rubric in preparation for a practical examination. Eur J Dent Educ 2018; 22:e400-e407. [PMID: 29266593 DOI: 10.1111/eje.12318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to investigate the effect of faculty calibration and students' self-assessments on students' performances in a periodontal practical examination. METHODS Before a new instructional rubric was implemented in the second-year periodontics course, faculty calibration was conducted with a pilot group of 32 third-year dental students. Afterwards, the new rubric was implemented in the second-year periodontics course. Second-year students used the rubric for their self-assessments before the practical examination. An intraclass correlation coefficient was used to test the reliability of the faculty members. A paired t test was used to compare scores between self-assessments of the pilot group (third-year students) and faculty evaluation. A two-way analysis of variance was performed to compare scores between self-assessments of second-year students and faculty evaluations. Chi-square tests were used to compare overall failure rates amongst four different classes. RESULTS The reliability amongst the faculty members was strong (the ICC = 0.75 at the first and 0.97 at the second calibration). The mean self-assessment score from the pilot group was significantly higher than the faculty evaluation. However, the mean self-assessment score of second-year students was significantly lower than the faculty evaluation. The class that practiced self-assessments with the validated instructional rubric exhibited the lowest overall failure rate compared to three past classes. CONCLUSIONS Using an instructional rubric and conducting faculty calibration improved the process of the periodontal practical examination. Improving the examination process and practicing self-assessments with feedback from faculty may have a positive impact on students' performances in the examination.
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Affiliation(s)
- S-L Oh
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - L Liberman
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - O Mishler
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
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Baruteau AE, Kyndt F, Behr ER, Vink AS, Lachaud M, Joong A, Schott JJ, Horie M, Denjoy I, Crotti L, Shimizu W, Bos JM, Stephenson EA, Wong L, Abrams DJ, Davis AM, Winbo A, Dubin AM, Sanatani S, Liberman L, Kaski JP, Rudic B, Kwok SY, Rieubland C, Tfelt-Hansen J, Van Hare GF, Guyomarc’h-Delasalle B, Blom NA, Wijeyeratne YD, Gourraud JB, Le Marec H, Ozawa J, Fressart V, Lupoglazoff JM, Dagradi F, Spazzolini C, Aiba T, Tester DJ, Zahavich LA, Beauséjour-Ladouceur V, Jadhav M, Skinner JR, Franciosi S, Krahn AD, Abdelsayed M, Ruben PC, Yung TC, Ackerman MJ, Wilde AA, Schwartz PJ, Probst V. SCN5A mutations in 442 neonates and children: genotype–phenotype correlation and identification of higher-risk subgroups. Eur Heart J 2018; 39:2879-2887. [DOI: 10.1093/eurheartj/ehy412] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 07/01/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Alban-Elouen Baruteau
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
- Department of Congenital Cardiology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- M3C CHU de Nantes, Fédération des Cardiopathies Congénitales, Nantes, F-44000, France
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Florence Kyndt
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Arja S Vink
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, The Netherlands
| | - Matthias Lachaud
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Anna Joong
- Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | | | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Sciences, Otsu, Japan
| | - Isabelle Denjoy
- AP-HP, Hôpital Bichat, Service de Cardiologie, Université Denis Diderot, Paris, France
| | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Johan M Bos
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Stephenson
- The Hospital for Sick Children, Labbatt Family, Heart Centre, University of Toronto, Toronto, Canada
| | - Leonie Wong
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew M Davis
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute and University of Melbourne, Melbourne, Australia
| | - Annika Winbo
- Greenlane Paediatric and Congenital Cardiac Services, Starship Childrens Hospital, Auckland, New Zealand
- Department of Congenital Cardiology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Anne M Dubin
- Division of Pediatric Electrophysiology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA
| | - Shubhayan Sanatani
- Divisions of Cardiology, Department of Pediatrics and Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Juan Pablo Kaski
- Department of Cardiology, Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Boris Rudic
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany
- DZHK (German Centre for Cardiovascular Research), Mannheim, Germany
| | - Sit Yee Kwok
- Department of Paediatric Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Claudine Rieubland
- Division of Human Genetics, Department of Pediatrics, Inselspital, University of Bern, Switzerland
| | - Jacob Tfelt-Hansen
- Faculty of Health and Medical Science, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
| | - George F Van Hare
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Nico A Blom
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Yanushi D Wijeyeratne
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | | | - Hervé Le Marec
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Junichi Ozawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Sciences, Otsu, Japan
| | - Véronique Fressart
- AP-HP, Hôpital Pitié Salpétrière, Service de Biologie Moléculaire, Paris, France
| | | | - Federica Dagradi
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Carla Spazzolini
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - David J Tester
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Laura A Zahavich
- The Hospital for Sick Children, Labbatt Family, Heart Centre, University of Toronto, Toronto, Canada
| | | | - Mangesh Jadhav
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
| | - Jonathan R Skinner
- Greenlane Paediatric and Congenital Cardiac Services, Starship Childrens Hospital, Auckland, New Zealand
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Sonia Franciosi
- Divisions of Cardiology, Department of Pediatrics and Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D Krahn
- Divisions of Cardiology, Department of Pediatrics and Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Mena Abdelsayed
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Peter C Ruben
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Tak-Cheung Yung
- Department of Paediatric Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Michael J Ackerman
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, The Netherlands
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Vincent Probst
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
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Liberman L, Starc TJ, Silver ES. Usefulness of High-Dose Oral Flecainide for Termination of Recent-Onset Atrial Fibrillation in Children. Am J Cardiol 2018; 121:1530-1533. [PMID: 29661475 DOI: 10.1016/j.amjcard.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/08/2018] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Abstract
A high dose of oral flecainide has been used for acute termination of atrial fibrillation (AF) and atrial flutter or intra-atrial re-entry tachycardia (AFL-IART) in adults. The use of flecainide for these conditions in children has not been well described. We describe our institutional experience on acute termination of AF or AFL-IART in children with a single high dose of oral flecainide in a hospital setting. All patients who received a single high dose of oral flecainide from 2009 to 2016 who were <21 years of age were included. Patients were treated only if AF or AFL-IART was less than 24 hours of duration. The dose was 300 mg for patients >70 kg, 200 mg for patients 40 to 70 kg, and 5 mg/kg for patients <40 kg. Charts were reviewed to determine demographic information, flecainide dose, termination of arrhythmia, and time to termination. There were 22 patients identified. The median age was 16 years (range 4.6 to 20.3) with a median weight of 75 kg (range 19 to 112). There were 13 patients with AF (11 with a normal heart, 85%) and 9 patients with AFL-IART (1 with a normal heart, 11%) (p <0.05). The median dose of flecainide given was 3.6 mg/kg (range 2.7 to 6.1) or 136 mg/m2 (range 90 to 171). AF in all patients (13/13, 100%) and AFL-IART in 5 of 9 patients (55%) terminated acutely (p <0.05). All patients with normal heart (12/12, 100%) and 6 of the 10 patients (60%) with heart disease have their arrhythmia terminated acutely (p <0.05). The only patients whose tachycardia did not terminate were 4 patients with IART and heart disease. The arrhythmia terminated in a median time of 60 minutes (range 30 to 120). There were no adverse events or proarrhythmia encountered. In conclusion, a single high dose of oral flecainide successfully terminated AF of less than 24 hours' duration in all pediatric patients without side effects. This approach is less effective for AFL-IART in patients with heart disease.
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Affiliation(s)
- Leonardo Liberman
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York.
| | - Thomas J Starc
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | - Eric S Silver
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
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Grubb C, Melki L, Liberman L, Silver E, Sorbera C, Wang DY, Iyer V, Shah R, Waase M, Garan H, Konofagou E, Wan E. NOVEL 3D NONINVASIVE ULTRASOUND IMAGING LOCALIZES ACCESSORY PATHWAYS IN ADULTS AND ADOLESCENTS WITH WOLFF-PARKINSON-WHITE SYNDROME. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pass RH, Liberman L, Silver ES, Janson CM, Blaufox AD, Nappo L, Ceresnak SR. The "hidden" concealed left-sided accessory pathway: An uncommon cause of SVT in young people. Pacing Clin Electrophysiol 2018; 41:368-371. [PMID: 29327439 DOI: 10.1111/pace.13279] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 12/03/2017] [Accepted: 12/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Concealed left-sided accessory pathways (CLAP) are a cause of supraventricular tachycardia (SVT) in the young. Most are mapped with right ventricular (RV) apical/outflow pacing. Rarely, alternative means of mapping are required. We review our experience from three pediatric electrophysiology (EP) centers with a rare form of "hidden" CLAP. METHODS All patients <21 years undergoing EP study from 2008 to 2014 with a "hidden" CLAP (defined as an accessory pathway [AP] for which RV pacing at cycle lengths [CL] stable for mapping did not demonstrate eccentric retrograde conduction) were included. EXCLUSION CRITERIA preexcitation. Demographic, procedural, and follow-up data were collected. RESULTS A total of 23 patients met the criteria (median age, 14.3 years [range 7-21], weight, 51 kg [31-99]). 21 (96%) had SVT and one AFIB (4%). APs were adenosine sensitive in 7/20 patients (35%) and VA conduction was decremental in six (26%). CLAP conduction was demonstrable with orthodromic reentrant tachycardia in all patients, with RV extrastimulus testing in seven (30%) and with rapid RV pacing (<CL 300) in three (13%). Left ventricular (LV) pacing demonstrated CLAP conduction in 17/17 (100%) patients in whom it was used. All 23 CLAPs were successfully ablated (100%) via transseptal approach with radiofrequency energy. Specific ablation techniques included: 16 (70%) during LV paced rhythm, four (17%) during orthodromic reciprocating tachycardia (ORT; 3/4 ventricular entrained), and three (13%) with brief rapid RV pacing. There were no complications. At 18 months (range 3-96), there was one recurrence (4%). CONCLUSIONS Some CLAPs are only demonstrable with LV pacing, entrained ORT, or rapid RV pacing. LV pacing facilitated preferential AP conduction, allowing for mapping while maintaining stable hemodynamics.
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Affiliation(s)
- Robert H Pass
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Leonardo Liberman
- New York Presbyterian Hospital, Children's Hospital of NY, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Eric S Silver
- New York Presbyterian Hospital, Children's Hospital of NY, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Christopher M Janson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Andrew D Blaufox
- Cohen's Children's Hospital, Hofstra-Northwell School of Medicine, New Hyde Park, NY, USA
| | - Lynn Nappo
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Scott R Ceresnak
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
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Flyer JN, Zuckerman WA, Richmond ME, Anderson BR, Mendelsberg TG, McAllister JM, Liberman L, Addonizio LJ, Silver ES. Prospective Study of Adenosine on Atrioventricular Nodal Conduction in Pediatric and Young Adult Patients After Heart Transplantation. Circulation 2017; 135:2485-2493. [PMID: 28450351 DOI: 10.1161/circulationaha.117.028087] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 04/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Supraventricular tachycardia is common after heart transplantation. Adenosine, the standard therapy for treating supraventricular tachycardia in children and adults without transplantation, is relatively contraindicated after transplantation because of a presumed risk of prolonged atrioventricular block in denervated hearts. This study tested whether adenosine caused prolonged asystole after transplantation and if it was effective in blocking atrioventricular nodal conduction in these patients. METHODS This was a single-center prospective clinical study including healthy heart transplant recipients 6 months to 25 years of age presenting for routine cardiac catheterization during 2015 to 2016. After catheterization, a transvenous pacing catheter was placed and adenosine was given following a dose-escalation protocol until atrioventricular block was achieved. The incidence of clinically significant asystole (≥12 seconds after adenosine) was quantified. The effects of patient characteristics on adenosine dose required to produce atrioventricular block and duration of effect were also measured. RESULTS Eighty patients completed adenosine testing. No patient (0%; 95% confidence interval, 0-3) required rescue ventricular pacing. Atrioventricular block was observed in 77 patients (96%; 95% confidence interval, 89-99). The median longest atrioventricular block was 1.9 seconds (interquartile range, 1.4-3.2 seconds), with a mean duration of adenosine effect of 4.3±2.0 seconds. No patient characteristic significantly predicted the adenosine dose to produce atrioventricular block or duration of effect. Results were similar across patient weight categories. CONCLUSIONS Adenosine induces atrioventricular block in healthy pediatric and young adult heart transplant recipients with minimal risk when low initial doses are used (25 μg/kg; 1.5 mg if ≥60 kg) and therapy is gradually escalated. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02462941.
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Affiliation(s)
- Jonathan N Flyer
- From Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY
| | - Warren A Zuckerman
- From Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY
| | - Marc E Richmond
- From Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY
| | - Brett R Anderson
- From Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY
| | - Tamar G Mendelsberg
- From Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY
| | - Jennie M McAllister
- From Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY
| | - Leonardo Liberman
- From Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY
| | - Linda J Addonizio
- From Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY
| | - Eric S Silver
- From Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY.
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Liberman L, Silver ES, Chai PJ, Anderson BR. Incidence and characteristics of heart block after heart surgery in pediatric patients: A multicenter study. J Thorac Cardiovasc Surg 2016; 152:197-202. [PMID: 27167020 DOI: 10.1016/j.jtcvs.2016.03.081] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 10/27/2015] [Revised: 02/12/2016] [Accepted: 03/26/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Advanced second- or third-degree heart block has been reported with variable incidence after surgery for congenital heart disease in children. We report the incidence of heart block requiring a pacemaker and describe the risk factors for this complication in a large multicenter study. METHODS We performed a retrospective cohort study, using the Pediatric Health Information System database from 45 hospitals in the United States, for all children aged 18 years, discharged between January 1, 2004, and December 31, 2013, who underwent open surgery for congenital heart disease. Patients who had heart block and placement of a pacemaker during the same hospitalization were identified. Demographic characteristics, procedure and diagnostic codes, length of stay, and mortality were analyzed. Univariable and multivariable analyses were performed. RESULTS There were 101,006 surgeries performed. The median age of patients was 0.5 years (interquartile range, 26 days to 3.2 years), and 1% of patients (n = 990) had heart block and placement of a pacemaker. Surgeries associated with the highest incidences of heart block and placement of a pacemaker included the double switch operation (15.6%), tricuspid valve (7.8%) and mitral valve (7.4%) replacement, atrial switch with ventricular septal defect repair (6.4%), and Rastelli operation (4.8%). On multivariable analysis, after controlling for surgical complexity, other comorbidities, age at surgery, admission year, and clustering by institution, patients with heart block and placement of a pacemaker had higher odds of mortality (odds ratio, 1.67; 95% confidence interval, 1.24-2.26; P < .001). CONCLUSIONS The incidence of postoperative heart block requiring permanent pacemaker placement immediately after congenital heart surgery is low (1%). However, these patients have higher mortality even after adjusting for heart surgery complexity.
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Affiliation(s)
- Leonardo Liberman
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
| | - Eric S Silver
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
| | - Paul J Chai
- Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
| | - Brett R Anderson
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
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Baruteau AE, Pass RH, Thambo JB, Behaghel A, Le Pennec S, Perdreau E, Combes N, Liberman L, McLeod CJ. Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management. Eur J Pediatr 2016; 175:1235-1248. [PMID: 27351174 PMCID: PMC5005411 DOI: 10.1007/s00431-016-2748-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 01/28/2016] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED Atrioventricular block is classified as congenital if diagnosed in utero, at birth, or within the first month of life. The pathophysiological process is believed to be due to immune-mediated injury of the conduction system, which occurs as a result of transplacental passage of maternal anti-SSA/Ro-SSB/La antibodies. Childhood atrioventricular block is therefore diagnosed between the first month and the 18th year of life. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited progressive cardiac conduction disorders. Indications and techniques of cardiac pacing have also evolved to allow safe permanent cardiac pacing in almost all patients, including those with structural heart abnormalities. CONCLUSION Early diagnosis and appropriate management are critical in many cases in order to prevent sudden death, and this review critically assesses our current understanding of the pathogenetic mechanisms, clinical course, and optimal management of congenital and childhood AV block. WHAT IS KNOWN • Prevalence of congenital heart block of 1 per 15,000 to 20,000 live births. AV block is defined as congenital if diagnosed in utero, at birth, or within the first month of life, whereas childhood AV block is diagnosed between the first month and the 18th year of life. As a result of several different etiologies, congenital and childhood atrioventricular block may occur in an entirely structurally normal heart or in association with concomitant congenital heart disease. Cardiac pacing is indicated in symptomatic patients and has several prophylactic indications in asymptomatic patients to prevent sudden death. • Autoimmune, congenital AV block is associated with a high neonatal mortality rate and development of dilated cardiomyopathy in 5 to 30 % cases. What is New: • Several genes including SCN5A have been implicated in autosomal dominant forms of familial progressive cardiac conduction disorders. • Leadless pacemaker technology and gene therapy for biological pacing are promising research fields. In utero percutaneous pacing appears to be at high risk and needs further development before it can be adopted into routine clinical practice. Cardiac resynchronization therapy is of proven value in case of pacing-induced cardiomyopathy.
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Affiliation(s)
- Alban-Elouen Baruteau
- Cardiovascular and Cell Sciences Research Center, St George's University of London, London, UK. .,LIRYC Institute, CHU Bordeaux, Department of Pediatric Cardiology, Bordeaux-II University, Bordeaux, France. .,Service de Cardiologie Pédiatrique, Hôpital du Haut Lévèque, Institut Hospitalo-Universitaire LIRYC (Electrophysiology and Heart Modeling Institute), 5 avenue de Magellan, 33600, Pessac, France.
| | - Robert H. Pass
- Division of Pediatric Electrophysiology, Albert Einstein College of Medicine, Montefiore Children’s Hospital, Bronx, NY USA
| | - Jean-Benoit Thambo
- LIRYC Institute, CHU Bordeaux, Department of Pediatric Cardiology, Bordeaux-II University, Bordeaux, France
| | - Albin Behaghel
- CHU Rennes, Department of Cardiology, LTSI, INSERM 1099, Rennes-1 University, Rennes, France
| | - Solène Le Pennec
- CHU Rennes, Department of Cardiology, LTSI, INSERM 1099, Rennes-1 University, Rennes, France
| | - Elodie Perdreau
- LIRYC Institute, CHU Bordeaux, Department of Pediatric Cardiology, Bordeaux-II University, Bordeaux, France
| | - Nicolas Combes
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Leonardo Liberman
- Morgan Stanley Children’s Hospital, Division of Pediatric Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY USA
| | - Christopher J. McLeod
- Mayo Clinic, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN USA
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Ferdman DJ, Liberman L, Silver ES. A Smartphone Application to Diagnose the Mechanism of Pediatric Supraventricular Tachycardia. Pediatr Cardiol 2015; 36:1452-7. [PMID: 25958154 DOI: 10.1007/s00246-015-1185-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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] [Received: 01/04/2015] [Accepted: 04/30/2015] [Indexed: 11/25/2022]
Abstract
Smartphone applications that record a single-lead ECG are increasingly available. We sought to determine the utility of a smartphone application (AliveCor) to record supraventricular tachycardia (SVT) and to distinguish atrioventricular reentrant tachycardia (AVRT) from atrioventricular nodal reentrant tachycardia (AVNRT) in pediatric patients. A prior study demonstrated that interpretation of standard event and Holter monitors accurately identifies the tachycardia mechanism in only 45 % of recordings. We performed an IRB-approved prospective study in pediatric patients undergoing an ablation for SVT. Tracings were obtained by placing the smartphone in three different positions on the chest (PI-horizontal, PII-rotated 60° clockwise, and PIII-rotated 120° clockwise). Two blinded pediatric electrophysiologists jointly analyzed a pair of sinus and tachycardia tracings in each position. Tracings with visible retrograde P waves were classified as AVRT. The three positions were compared by Chi-square test. Thirty-seven patients (age 13.7 ± 2.8 years) were enrolled in the study. Twenty-four had AVRT, and 13 had AVNRT. One hundred and eight pairs of tracings were obtained. The correct diagnosis was made in 27/37 (73 %) with position PI, 28/37 (76 %) with PII, and 20/34 (59 %) with PIII (p = 0.04 for PII vs. PIII and p = NS for other comparisons). A single-lead ECG obtained with a smartphone monitor can successfully record SVT in pediatric patients and can predict the SVT mechanism at least as well as previously published reports of Holter monitors, along with the added convenience of not requiring patients to carry a dedicated monitor.
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Affiliation(s)
- Dina J Ferdman
- Division of Pediatric Cardiology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University Medical Center, 3959 Broadway, 2-North, New York, NY, 10032, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University Medical Center, 3959 Broadway, 2-North, New York, NY, 10032, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University Medical Center, 3959 Broadway, 2-North, New York, NY, 10032, USA.
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Monaco MA, Liberman L, Starc TJ, Silver ES. Defining the electrocardiogram in the neonate with hypoplastic left heart syndrome. Pediatr Cardiol 2015; 36:1014-8. [PMID: 25605039 DOI: 10.1007/s00246-015-1112-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Received: 09/26/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
Hypoplastic left heart syndrome (HLHS) is a severe form of congenital heart disease characterized by underdevelopment of the left heart. There has been no previously defined "classic" ECG pattern in a large homogenous population of patients with HLHS. We performed a retrospective review of ECGs from neonates with HLHS from 2001 to 2011 with electrocardiograms available prior to surgical intervention. Eighty-nine neonates met the inclusion criteria and were compared to a control population. HLHS patients had a longer PR interval 108 ± 18 versus 98 ± 11 ms (p < 0.05), a wider QRS complex 84 ± 17 versus 54 ± 5 ms (p < 0.05), lower voltage S waves in V1 2.0 ± 3.3 versus 5.8 ± 4.6 mm (p < 0.001) or absent S waves in V1 52 versus 4 % (p < 0.001) and lower voltage R waves in V6 7.8 ± 4.8 versus 9.3 ± 4.2 mm (p < 0.05). Patients with HLHS were more likely to have absent Q waves in the lateral precordial leads 78 versus 0 % (p < 0.001) and inferior leads 20 versus 1 % (p < 0.001) and an abnormal frontal plane QRS axis 26 versus 11 % (p < 0.05). HLHS patients were more likely to have a preexcited appearance 11 versus 0 % (p = 0.001). Despite these findings, 20 % of patients with HLHS had a normal ECG. Compared to age-matched controls, patients with HLHS were more likely to exhibit a longer PR interval, a wider QRS complex, decreased left-sided forces, an absence of septal Q waves in the inferior and lateral leads, an abnormal frontal plane QRS axis and a preexcited appearance.
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Affiliation(s)
- Michael A Monaco
- Division of Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, 3959 Broadway, CH-2 North, New York, NY, 10032-3784, USA
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Heching HJ, Bacha EA, Liberman L. Post-pericardiotomy syndrome in pediatric patients following surgical closure of secundum atrial septal defects: incidence and risk factors. Pediatr Cardiol 2015; 36:498-502. [PMID: 25293428 DOI: 10.1007/s00246-014-1039-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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] [Received: 06/23/2014] [Accepted: 09/27/2014] [Indexed: 12/14/2022]
Abstract
Surgical repair for atrial septal defects (ASD) generally occurs during childhood. Post-pericardiotomy syndrome (PPS) after cardiac surgery has a reported incidence of 1-40 %. We focused exclusively on secundum ASD repair to evaluate the incidence of PPS. The purpose of this study is to determine the incidence of PPS after surgical repair of secundum ASD and investigate what risk factors may be predictive of its development. A retrospective study was performed, and 97 patients who underwent surgical closure of a secundum ASD were identified. 27 (28 %) were diagnosed with PPS within the first postoperative year. Diagnosis was made if they had evidence of new or worsening pericardial effusion and the presence of ≥2 of the following criteria: fever >72 h postoperatively, irritability, pleuritic chest pain, or pericardial friction rub. Closure of secundum ASDs was performed at a median age of 3.8 years (Interquartile Range (IQR): 2.2-6.0 years) and a median weight of 14.3 kilograms (IQR: 10.9-19.3 kilograms). The median time for development of PPS was 8 days post-op (IQR: 5-14). Significantly, 19 (27 %) of 70 patients in the non-PPS group had a small pericardial effusion on their discharge echocardiogram, while of the 27 patients who developed PPS, 17 (63 %) had a small pericardial effusion on their discharge echocardiogram (p = 0.001). PPS is relatively common following surgical closure of secundum ASDs. A small pericardial effusion on discharge echocardiogram is predictive of development of PPS postoperatively. In patients who develop PPS, there is a good response to therapy with a benign course.
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Affiliation(s)
- Howard J Heching
- Department of Pediatric Cardiology, Morgan Stanley Children's Hospital, 3959 Broadway, 2 North, New York, NY, 10032, USA,
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Liberman L, Spar DS, Nash MC, Silver ES. Cryoablation of anteroseptal accessory pathways with a his bundle electrogram on the ablation catheter. Indian Pacing Electrophysiol J 2014; 14:284-90. [PMID: 25609896 PMCID: PMC4286952 DOI: 10.1016/s0972-6292(16)30816-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Radiofrequency catheter ablations of anteroseptal (AS) accessory pathways (AP) in pediatric patients have higher incidence of atrioventricular (AV) block than other AP locations. We report our experience using cryoablation in pediatric patients where a His bundle electrogram was noted on the ablation catheter at the site of the successful ablation. Methods and Results We retrospectively reviewed all patients ≤21 years that underwent cryoablation for an AS AP from 2005 to 2012 at our institution (n=70). Patients with a His bundle electrogram noted on the cryoablation catheter at the location of the successful lesion were identified (n=6, 8.5%). All six patients had ventricular preexcitation. Median age of 15.9 years (7.2 - 18.2). AV nodal function was monitored during the cryoablation with intermittent rapid atrial pacing conducted through the AV node (n=2), with atrial extra-stimulus testing (n=2), or during orthodromic reentrant tachycardia (n=2). Acute success occurred in all patients. Two patients had early recurrence of AP conduction. Both patients underwent a second successful cryoablation, again with a His bundle electrogram on the cryoablation catheter. At a median follow-up of 13 months (3 to 37 months) there was no recurrence of accessory pathway conduction and AVN function was normal. Conclusion In a small number of pediatric patients with AS AP with a His bundle electrogram seen on the ablation catheter, the use of cryotherapy was safe and effective for elimination of AP conduction without impairment of AV nodal conduction.
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Affiliation(s)
- Leonardo Liberman
- Pediatric Arrhythmia Service, Department of Pediatrics, Morgan Stanley Children Hospital, Columbia University, New York, New York
| | - David S Spar
- Pediatric Arrhythmia Service, Department of Pediatrics, Morgan Stanley Children Hospital, Columbia University, New York, New York
| | - Mary C Nash
- Pediatric Arrhythmia Service, Department of Pediatrics, Morgan Stanley Children Hospital, Columbia University, New York, New York
| | - Eric S Silver
- Pediatric Arrhythmia Service, Department of Pediatrics, Morgan Stanley Children Hospital, Columbia University, New York, New York
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Anderson BR, Silver ES, Richmond ME, Liberman L. Usefulness of arrhythmias as predictors of death and resource utilization in children with myocarditis. Am J Cardiol 2014; 114:1400-5. [PMID: 25200339 DOI: 10.1016/j.amjcard.2014.07.074] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 02/03/2023]
Abstract
Myocarditis in children can result in significant morbidity and mortality, yet limited prognostic data exist. The aim of this study was to test the hypothesis that pediatric patients with arrhythmias during hospitalization for acute myocarditis have worse outcomes and increased resource utilization. A retrospective study using the Pediatric Health Information System database was performed to examine the effects of clinically significant arrhythmias on in-hospital mortality, length of stay, and costs per day. Data were obtained for children ≤18 years of age, discharged from January 1, 2004 to March 31, 2013, with a diagnosis of myocarditis. Clinically significant tachyarrhythmia was defined as supraventricular tachycardia, atrial fibrillation or flutter, or ventricular tachycardia or fibrillation in patients receiving antiarrhythmic medications or cardioversion. Clinically significant bradyarrhythmia was defined as second-degree, complete, or other heart block for which a pacemaker was placed. Multivariable analyses were performed. A total of 2,041 subjects with myocarditis were identified. Tachyarrhythmias were reported in 234 (11.5%) and bradyarrhythmias in 22 (1.1%). Overall mortality was 8.7%. In multivariable analyses, after considering the effects of gender, age at admission, geographic region, year and month of admission, presence of congenital heart disease or an identified virus, and use of steroids, nonsteroidal anti-inflammatories, or inotropes, and after controlling for clustering by institution, tachyarrhythmias were associated with a 2.3 times increase in the odds of mortality (95% confidence interval 1.6 to 3.3, p < 0.001), a 58% increase in length of stay (95% confidence interval 38% to 82%, p < 0.001), and a 28% increase in costs per day (95% confidence interval 15% to 43%, p < 0.001). Bradyarrhythmia was not associated with mortality, length of stay, or costs per day. In conclusion, tachyarrhythmias are associated with significant increases in mortality and resource utilization in children with myocarditis.
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Liberman L, Anderson B, Silver ES, Singh R, Richmond ME. INCIDENCE AND CHARACTERISTICS OF ARRHYTHMIAS IN PEDIATRIC PATIENTS WITH MYOCARDITIS: A MULTICENTER STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60483-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Granit RZ, Gabai Y, Hadar T, Karamansha Y, Liberman L, Waldhorn I, Gat-Viks I, Regev A, Maly B, Darash-Yahana M, Peretz T, Ben-Porath I. EZH2 promotes a bi-lineage identity in basal-like breast cancer cells. Oncogene 2013; 32:3886-95. [PMID: 22986524 DOI: 10.1038/onc.2012.390] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The mechanisms regulating breast cancer differentiation state are poorly understood. Of particular interest are molecular regulators controlling the highly aggressive and poorly differentiated traits of basal-like breast carcinomas. Here we show that the Polycomb factor EZH2 maintains the differentiation state of basal-like breast cancer cells, and promotes the expression of progenitor associated and basal-lineage genes. Specifically, EZH2 regulates the composition of basal-like breast cancer cell populations by promoting a ‘bi-lineage’ differentiation state, in which cells co-express basal- and luminal-lineage markers. We show that human basal-like breast cancers contain a subpopulation of bi-lineage cells, and that EZH2-deficient cells give rise to tumors with a decreased proportion of such cells. Bi-lineage cells express genes that are active in normal luminal progenitors, and possess increased colony-formation capacity, consistent with a primitive differentiation state. We found that GATA3, a driver of luminal differentiation, performs a function opposite to EZH2, acting to suppress bi-lineage identity and luminal-progenitor gene expression. GATA3 levels increase upon EZH2 silencing, mediating a decrease in bi-lineage cell numbers. Our findings reveal a novel role for EZH2 in controlling basal-like breast cancer differentiation state and intra-tumoral cell composition.
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Affiliation(s)
- R Z Granit
- Department of Developmental Biology and Cancer Research, Institute for Medical Research – Israel-Canada, Hadassah School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Ceresnak SR, Liberman L, Silver ES, Fishberger SB, Gates GJ, Nappo L, Mahgerefteh J, Pass RH. Lone atrial fibrillation in the young - perhaps not so "lone"? J Pediatr 2013; 162:827-31. [PMID: 23092527 DOI: 10.1016/j.jpeds.2012.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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] [Received: 05/21/2012] [Revised: 07/18/2012] [Accepted: 09/07/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if pediatric patients with a history of lone atrial fibrillation (AF) have other forms of supraventricular tachycardia (SVT) that may potentially trigger AF. STUDY DESIGN A multicenter review of patients with lone AF who underwent electrophysiology (EP) study from 2006-2011 was performed. INCLUSION CRITERIA age ≤21 years, normal ventricular function, structurally normal heart, history of AF, and EP study and/or ablation performed. EXCLUSION CRITERIA congenital heart disease or cardiomyopathy. Patient demographics, findings at EP study and follow-up data were recorded. RESULTS Eighteen patients met inclusion criteria. The mean age was 17.9 ± 2.2 years, weight was 82 ± 21 kg, body mass index was 27 ± 6, and 15 (83%) were males. Eleven (61%) were overweight or obese. Seven (39%) had inducible SVT during EP study: 5 atrioventricular nodal re-entry tachycardia (71%) and 2 concealed accessory pathways with inducible atrioventricular re-entry tachycardia (29%). All 7 patients with inducible SVT underwent radiofrequency ablation. There were no complications during EP study and/or ablation for all 18 patients. The mean follow-up was 1.7 ± 1.5 years and there were no recurrences in the 7 patients who underwent ablation. There were 2 recurrences of AF in patients with no other form of SVT during EP study. CONCLUSIONS Inducible SVT was found in 39% of pediatric patients undergoing EP study for lone AF. EP study should be considered for pediatric patients presenting with lone AF.
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Affiliation(s)
- Scott R Ceresnak
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10467-2490, USA.
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Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE, Chun RH, Garzon MC, Holland KE, Liberman L, MacLellan-Tobert S, Mancini AJ, Metry D, Puttgen KB, Seefeldt M, Sidbury R, Ward KM, Blei F, Baselga E, Cassidy L, Darrow DH, Joachim S, Kwon EKM, Martin K, Perkins J, Siegel DH, Boucek RJ, Frieden IJ. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics 2013; 131:128-40. [PMID: 23266923 PMCID: PMC3529954 DOI: 10.1542/peds.2012-1691] [Citation(s) in RCA: 325] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Infantile hemangiomas (IHs) are common neoplasms composed of proliferating endothelial-like cells. Despite the relative frequency of IH and the potential severity of complications, there are currently no uniform guidelines for treatment. Although propranolol has rapidly been adopted, there is significant uncertainty and divergence of opinion regarding safety monitoring, dose escalation, and its use in PHACE syndrome (PHACE = posterior fossa, hemangioma, arterial lesions, cardiac abnormalities, eye abnormalities; a cutaneous neurovascular syndrome characterized by large, segmental hemangiomas of the head and neck along with congenital anomalies of the brain, heart, eyes and/or chest wall). A consensus conference was held on December 9, 2011. The multidisciplinary team reviewed existing data on the pharmacologic properties of propranolol and all published reports pertaining to the use of propranolol in pediatric patients. Workgroups were assigned specific topics to propose protocols on the following subjects: contraindications, special populations, pretreatment evaluation, dose escalation, and monitoring. Consensus protocols were recorded during the meeting and refined after the meeting. When appropriate, protocol clarifications and revision were made and agreed upon by the group via teleconference. Because of the absence of high-quality clinical research data, evidence-based recommendations are not possible at present. However, the team agreed on a number of recommendations that arose from a review of existing evidence, including when to treat complicated IH; contraindications and pretreatment evaluation protocols; propranolol use in PHACE syndrome; formulation, target dose, and frequency of propranolol; initiation of propranolol in infants; cardiovascular monitoring; ongoing monitoring; and prevention of hypoglycemia. Where there was considerable controversy, the more conservative approach was selected. We acknowledge that the recommendations are conservative in nature and anticipate that they will be revised as more data are made available.
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Affiliation(s)
| | | | - Sarah L. Chamlin
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Anita Haggstrom
- Departments of Dermatology and Pediatrics, Indiana University, Indianapolis, Indiana
| | - Nancy M. Bauman
- Department of Otolaryngology, Children’s National Medical Center, Washington, District of Columbia
| | | | | | | | | | | | | | - Anthony J. Mancini
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | | | - Marcia Seefeldt
- Department of Dermatology, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Robert Sidbury
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Kendra M. Ward
- Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Francine Blei
- Departments of Hematology & Oncology, Vascular Birthmark Institute of New York, New York, New York
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Laura Cassidy
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David H. Darrow
- Departments of Otolaryngology and Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia; and
| | | | | | | | | | | | - Robert J. Boucek
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Ilona J. Frieden
- Departments of Dermatology & Pediatrics, University of California San Francisco, San Francisco, California
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Behr GG, Liberman L, Compton J, Garzon MC, Morel KD, Lauren CT, Starc TJ, Kovacs SJ, Beltroni V, Landres R, Anyane-Yeboa K, Meyers PM, Bacha E, Kandel JJ. CM-AVM syndrome in a neonate: case report and treatment with a novel flow reduction strategy. Vasc Cell 2012; 4:19. [PMID: 23164092 PMCID: PMC3517480 DOI: 10.1186/2045-824x-4-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 11/08/2012] [Indexed: 12/28/2022] Open
Abstract
Mutations in the RASA-1 gene underlie several related disorders of vasculogenesis. Capillary malformation-arteriovenous malformation (CM-AVM) is one such entity and was recently encountered in a neonate who demonstrated its clinical and radiologic features. A single mutation in the RASA-1 gene was detected.A novel flow reduction strategy was employed to a large AVM affecting the patient's upper limb. The imaging findings, surgical procedure and patient's improved post-operative state are described.
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Affiliation(s)
- Gerald G Behr
- Department of Radiology, Division of Pediatric Radiology Columbia University, New York, NY, USA
| | - Leonardo Liberman
- Department of Pediatrics, Division of Cardiology Columbia University, New York, NY, USA
| | - Jocelyn Compton
- Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Maria C Garzon
- Department of Dermatology and Pediatrics, Columbia University, New York, NY, USA
| | - Kimberly D Morel
- Department of Dermatology and Pediatrics, Columbia University, New York, NY, USA
| | - Christine T Lauren
- Department of Dermatology and Pediatrics, Columbia University, New York, NY, USA
| | - Thomas J Starc
- Department of Pediatrics, Division of Cardiology Columbia University, New York, NY, USA
| | - Stephen J Kovacs
- Division of Neonatology, Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Vincent Beltroni
- Division of Neonatology, Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Rachel Landres
- Division of Neonatology, Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Kwame Anyane-Yeboa
- Department of Pediatrics, Division of Clinical Genetics, Columbia University, New York, NY, USA
| | - Philip M Meyers
- Department of Radiology, Division of Interventional Neuroradiology, Columbia University, New York, NY, USA
| | - Emile Bacha
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Jessica J Kandel
- Department of Surgery, Division of Pediatric Surgery, Columbia University, New York, NY, USA
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Granit R, Hadar T, Karamansha Y, Waldhorn I, Gat-Viks I, Liberman L, Maly B, Peretz T, Regev A, Ben-Porath I. 191 EZH2 and GATA3 Play Opposing Roles in Controlling the Differentiation State of Basal-like Breast Cancer Cells. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spar DS, Silver ES, Hordof AJ, Liberman L. Relation of the utility of exercise testing for risk assessment in pediatric patients with ventricular preexcitation to pathway location. Am J Cardiol 2012; 109:1011-4. [PMID: 22221954 DOI: 10.1016/j.amjcard.2011.11.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 11/11/2011] [Accepted: 11/11/2011] [Indexed: 10/14/2022]
Abstract
The gradual loss of ventricular preexcitation during exercise stress testing (EST) has an unclear risk of an association with life-threatening arrhythmia and could be related to the accessory pathway (AP) location. We compared the loss of preexcitation during EST with the risk assessment during invasive electrophysiology testing and determined whether the loss of preexcitation correlates with the AP location. We retrospectively reviewed patients aged ≤21 years with ventricular preexcitation who had undergone both EST and an electrophysiology study. The patients were divided into 3 groups: sudden loss (SL), gradual loss (GL), or no loss (NL) of preexcitation during EST. A total of 76 patients were included, with 11 (14%) in the SL group, 18 (24%) in the GL group, and 47 (62%) in the NL group. The SL group demonstrated a longer cycle length with 1-to-1 conduction by way of the AP during incremental atrial pacing compared with the NL group (375 ± 135 ms vs 296 ± 52 ms, p = 0.002), with no difference between the GL and NL groups (325 ± 96 vs 296 ± 52 ms, p = NS). Of the patients with 1-to-1 AP conduction of <270 ms, none (0 of 11) were in the SL group compared to 18 of 47 in the NL group (p = 0.0017), with no significant difference in the GL group (5 of 18) compared to the NL group (p = NS). The patients in the GL group were more likely to have a left-sided AP (14 of 18) than the NL group (17 of 47, p = 0.002) and the SL group (3 of 11, p = 0.002). In conclusion, a sudden loss of preexcitation during an EST predicted a long cycle length with 1-to-1 conduction by way of the AP. Also, the AP conduction characteristics in patients with GL compared to those with NL did not differ, and the GL of preexcitation was more frequently seen in patients with a left-sided AP.
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Shetty I, Silver ES, Hordof AJ, Goldberg PH, Liberman L. Ablation of supraventricular tachycardia allows more liberal therapy in some children with attention-deficit-hyperactivity disorder. Pediatr Int 2011; 53:715-717. [PMID: 21261787 DOI: 10.1111/j.1442-200x.2011.03326.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/28/2022]
Abstract
BACKGROUND First-line therapy for children with attention-deficit-hyperactivity disorder (ADHD) is stimulant medication, which may have potential cardiovascular side-effects. In patients with supraventricular tachycardia or Wolf-Parkinson-White syndrome (WPW), therapy for ADHD could become challenging. The purpose of the present study was to review the authors' experience of performing electrophysiologic study (EPS) with or without ablation to determine how it affected ADHD therapy. METHODS Retrospective chart review of patients who underwent EPS between 2002 and 2009 was carried out. All patients under 21 years of age who had prior diagnosis of ADHD were included. RESULTS Twenty patients met the inclusion criteria. The mean age was 12.1 ± 2.7 years (range: 5.6-16.8 years). The patients were diagnosed with ADHD on average 3.9 ± 2.7 years (range: 6 months-9 years) prior to the EPS. All patients had a structurally normal heart. Sixteen patients had cardiac symptoms. Seventeen patients underwent ablation of the arrhythmia substrate (16/17, 94% successful). Three patients with asymptomatic WPW were at low risk for life-threatening arrhythmias and did not have ablation. After the EPS, two patients had increased doses of their ADHD medications, and two patients whose health-care providers stopped the stimulant medication prior to EPS because of recurrent tachycardia were restarted on medications. All other patients on ADHD medications continued therapy. CONCLUSIONS EPS for risk stratification and ablation of arrhythmia substrate is safe and effective, allowing more liberal therapy in patients with ADHD and supraventricular tachycardia or WPW.
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Affiliation(s)
- Ira Shetty
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Eric S Silver
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Allan J Hordof
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Pablo H Goldberg
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Leonardo Liberman
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
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Liberman L, Boehe D. Worldwide willingness to delegate and country labor quality. The International Journal of Human Resource Management 2011. [DOI: 10.1080/09585192.2011.610943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Panageas KS, Sima CS, Liberman L, Schrag D. Use of high technology imaging for surveillance of early stage breast cancer. Breast Cancer Res Treat 2011; 131:663-70. [PMID: 21947679 DOI: 10.1007/s10549-011-1773-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 09/05/2011] [Indexed: 11/29/2022]
Abstract
Guidelines do not support utilization of high technology radiologic imaging (HTRI) for surveillance after curative treatment for early stage breast cancer. Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data were used to identify 25,555 women diagnosed with stage I-II breast cancer between 1998 and 2003 who survived ≥ 48 months from diagnosis without evidence of second primary or recurrent cancer in this interval. HTRI utilization (computerized tomography scanning (CT), bone scan (BS), breast magnetic resonance imaging, and positron emission tomography scans) was measured in months 13-48 post-diagnosis. Cases were individually matched to 75,669 female Medicare enrollees without cancer. Factors associated with HTRI utilization were evaluated. Forty percent of women with stage I-II breast cancer and 25% of controls had ≥ 1 HTRI during the surveillance interval (P < 0.001). High utilization rates were observed for CT (30%) and BSs (19%). The proportion of women who had a CT during the surveillance period increased in both cancer survivors and controls. Among breast cancer cases age <80, higher comorbidity index, stage II disease, and more recent diagnosis were independently associated with receipt of HTRI. Paralleling patterns observed in controls, HTRI utilization for surveillance following diagnosis of early stage breast cancer has steadily increased among Medicare beneficiaries. Strategies to foster judicious utilization of HTRI should be a priority.
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Affiliation(s)
- K S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, 3rd Floor, New York, NY 10021, USA.
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