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Lamba A, Roston TM, Peltenburg PJ, Kallas D, Franciosi S, Lieve KVV, Kannankeril PJ, Horie M, Ohno S, Brugada R, Aiba T, Fischbach P, Knight L, Till J, Kwok SY, Probst V, Backhoff D, LaPage MJ, Batra AS, Drago F, Haugaa K, Krahn AD, Robyns T, Swan H, Tavacova T, Atallah J, Borggrefe M, Rudic B, Sarquella-Brugada G, Chorin E, Hill A, Kammeraad J, Kamp A, Law I, Perry J, Roberts JD, Tisma-Dupanovic S, Semsarian C, Skinner JR, Tfelt-Hansen J, Denjoy I, Leenhardt A, Schwartz PJ, Ackerman MJ, Wilde AAM, van der Werf C, Sanatani S. An international multicenter cohort study on implantable cardioverter-defibrillators for the treatment of symptomatic children with catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm 2024:S1547-5271(24)02323-3. [PMID: 38588993 DOI: 10.1016/j.hrthm.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Catecholaminergic polymorphic ventricular tachycardia (CPVT) may cause sudden cardiac death (SCD) despite medical therapy. Therefore, implantable cardioverter-defibrillators (ICDs) are commonly advised. However, there are limited data on the outcomes of ICD use in children. OBJECTIVE The purpose of this study was to compare the risk of arrhythmic events in pediatric patients with CPVT with and without ICD. METHODS We compared the risk of SCD in patients with RYR2 (ryanodine receptor 2) variants and phenotype-positive symptomatic patients with CPVT with and without ICD who were younger than 19 years and had no history of sudden cardiac arrest at phenotype diagnosis. The primary outcome was SCD; secondary outcomes were composite end points of SCD, sudden cardiac arrest, or appropriate ICD shocks with or without arrhythmic syncope. RESULTS The study included 235 patients, 73 with ICD (31.1%) and 162 without ICD (68.9%). Over a median follow-up of 8.0 years (interquartile range 4.3-13.4 years), SCD occurred in 7 patients (3.0%), of whom 4 (57.1%) were noncompliant with medications and none had an ICD. Patients with ICD had a higher risk of both secondary composite outcomes (without syncope: hazard ratio 5.85; 95% confidence interval 3.40-10.09; P < .0001; with syncope: hazard ratio 2.55; 95% confidence interval 1.50-4.34; P = .0005). Thirty-one patients with ICD (42.5%) experienced appropriate shocks, 18 (24.7%) inappropriate shocks, and 21 (28.8%) device-related complications. CONCLUSION SCD events occurred only in the no ICD group and in those not on optimal medical therapy. Patients with ICD had a high risk of appropriate and inappropriate shocks, which may be reduced with appropriate device programming. Severe ICD complications were common, and risks vs benefits of ICDs need to be considered.
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Affiliation(s)
- Avani Lamba
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas M Roston
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada; Center for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Puck J Peltenburg
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Dania Kallas
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia Franciosi
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Krystien V V Lieve
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Prince J Kannankeril
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Centre, Nashville, Tennessee
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Seiko Ohno
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan; Department of Bioscience and Genetics, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain, Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), University of Girona, Girona, Spain, Medical Science Department, School of Medicine, University of Girona, Girona, Spain, Cardiology Service, Hospital Josep Trueta, Girona, Spain
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Peter Fischbach
- Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Linda Knight
- Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jan Till
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Sit-Yee Kwok
- Hong Kong Children's Hospital, Hong Kong, SAR, China
| | - Vincent Probst
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | | | | | - Anjan S Batra
- Division of Cardiology, Department of Pediatrics, Irvine and Children's Hospital of Orange County, University of California, Orange, California
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Palidoro-Rome, Italy
| | - Kristina Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway, Department of Cardiology, Karolinska University Hospital, Solna, Sweden, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tomas Robyns
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Heikki Swan
- Heart and Lung Centre, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Terezia Tavacova
- Department of Pediatric Cardiology, Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague; Motol University Hospital, Prague, Czech Republic
| | - Joseph Atallah
- Cardiology, Faculty of Medicine & Dentistry - Pediatrics Department, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Martin Borggrefe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany, German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Boris Rudic
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain, Medical Science Department, School of Medicine, Universitat de Girona, Girona, Spain
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain, Medical Science Department, School of Medicine, Universitat de Girona, Girona, Spain
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Allison Hill
- Children's Hospital Los Angeles, Los Angeles, California
| | - Janneke Kammeraad
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Department of Pediatric Cardiology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Anna Kamp
- Nationwide Children's Hospital, Columbus, Ohio
| | - Ian Law
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - James Perry
- Rady Children's Hospital, San Diego, California
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada, Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
| | | | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group New Zealand, Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand, Department of Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Isabelle Denjoy
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, APHP, Université de Paris Cité, Paris, France
| | - Antoine Leenhardt
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, APHP, Université de Paris Cité, Paris, France
| | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Division of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Christian van der Werf
- Amsterdam UMC, University of Amsterdam, Heart Centre; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Shubhayan Sanatani
- BC Children's Hospital, Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
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Bergeman AT, Lieve KV, Kallas D, Bos JM, Rosés i Noguer F, Denjoy I, Zorio E, Kammeraad JA, Peltenburg PJ, Tobert K, Aiba T, Atallah J, Drago F, Batra AS, Brugada R, Borggrefe M, Clur SAB, Cox MG, Davis A, Dhillon S, Etheridge SP, Fischbach P, Franciosi S, Haugaa K, Horie M, Johnsrude C, Kane AM, Krause U, Kwok SY, LaPage MJ, Ohno S, Probst V, Roberts JD, Robyns T, Sacher F, Semsarian C, Skinner JR, Swan H, Tavacova T, Tisma-Dupanovic S, Tfelt-Hansen J, Yap SC, Kannankeril PJ, Leenhardt A, Till J, Sanatani S, Tanck MW, Ackerman MJ, Wilde AA, van der Werf C. Flecainide Is Associated With a Lower Incidence of Arrhythmic Events in a Large Cohort of Patients With Catecholaminergic Polymorphic Ventricular Tachycardia. Circulation 2023; 148:2029-2037. [PMID: 37886885 PMCID: PMC10727202 DOI: 10.1161/circulationaha.123.064786] [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: 03/17/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND In severely affected patients with catecholaminergic polymorphic ventricular tachycardia, beta-blockers are often insufficiently protective. The purpose of this study was to evaluate whether flecainide is associated with a lower incidence of arrhythmic events (AEs) when added to beta-blockers in a large cohort of patients with catecholaminergic polymorphic ventricular tachycardia. METHODS From 2 international registries, this multicenter case cross-over study included patients with a clinical or genetic diagnosis of catecholaminergic polymorphic ventricular tachycardia in whom flecainide was added to beta-blocker therapy. The study period was defined as the period in which background therapy (ie, beta-blocker type [beta1-selective or nonselective]), left cardiac sympathetic denervation, and implantable cardioverter defibrillator treatment status, remained unchanged within individual patients and was divided into pre-flecainide and on-flecainide periods. The primary end point was AEs, defined as sudden cardiac death, sudden cardiac arrest, appropriate implantable cardioverter defibrillator shock, and arrhythmic syncope. The association of flecainide with AE rates was assessed using a generalized linear mixed model assuming negative binomial distribution and random effects for patients. RESULTS A total of 247 patients (123 [50%] females; median age at start of flecainide, 18 years [interquartile range, 14-29]; median flecainide dose, 2.2 mg/kg per day [interquartile range, 1.7-3.1]) were included. At baseline, all patients used a beta-blocker, 70 (28%) had an implantable cardioverter defibrillator, and 21 (9%) had a left cardiac sympathetic denervation. During a median pre-flecainide follow-up of 2.1 years (interquartile range, 0.4-7.2), 41 patients (17%) experienced 58 AEs (annual event rate, 5.6%). During a median on-flecainide follow-up of 2.9 years (interquartile range, 1.0-6.0), 23 patients (9%) experienced 38 AEs (annual event rate, 4.0%). There were significantly fewer AEs after initiation of flecainide (incidence rate ratio, 0.55 [95% CI, 0.38-0.83]; P=0.007). Among patients who were symptomatic before diagnosis or during the pre-flecainide period (n=167), flecainide was associated with significantly fewer AEs (incidence rate ratio, 0.49 [95% CI, 0.31-0.77]; P=0.002). Among patients with ≥1 AE on beta-blocker therapy (n=41), adding flecainide was also associated with significantly fewer AEs (incidence rate ratio, 0.25 [95% CI, 0.14-0.45]; P<0.001). CONCLUSIONS For patients with catecholaminergic polymorphic ventricular tachycardia, adding flecainide to beta-blocker therapy was associated with a lower incidence of AEs in the overall cohort, in symptomatic patients, and particularly in patients with breakthrough AEs while on beta-blocker therapy.
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MESH Headings
- Female
- Humans
- Adolescent
- Male
- Flecainide/adverse effects
- Incidence
- Cross-Over Studies
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/drug therapy
- Tachycardia, Ventricular/epidemiology
- Adrenergic beta-Antagonists/adverse effects
- Defibrillators, Implantable
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
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Affiliation(s)
- Auke T. Bergeman
- Heart Centre, Department of Cardiology (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.), Amsterdam UMC Location AMC, University of Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, The Netherlands (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.)
| | - Krystien V.V. Lieve
- Heart Centre, Department of Cardiology (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.), Amsterdam UMC Location AMC, University of Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, The Netherlands (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.)
| | - Dania Kallas
- Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada (D.K., S.F., S.S.)
| | - J. Martijn Bos
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (J.M.B., K.T., M.J.A.)
| | - Ferran Rosés i Noguer
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom (F.R.y.N., J.T.)
- Department of Paediatric Cardiology, Vall d’Hebron University Hospital, Barcelona, Spain (F.R.y.N.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
| | - Isabelle Denjoy
- Service de Cardiologie et CRMR Maladies Cardiaques Héréditaires et Rares, APHP, Hôpital Bichat, Université Paris Cité, France (I.D., A.L.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
| | - Esther Zorio
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain (E.Z.)
- Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad, Instituto de Investigación Sanitaria La Fe, Valencia, Spain (E.Z.)
- Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain (E.Z.)
| | - Janneke A.E. Kammeraad
- Department of Pediatric Cardiology, Erasmus MC–Sophia, Rotterdam, The Netherlands (J.A.E.K.)
| | - Puck J. Peltenburg
- Heart Centre, Department of Cardiology (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.), Amsterdam UMC Location AMC, University of Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, The Netherlands (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.)
| | - Katie Tobert
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (J.M.B., K.T., M.J.A.)
| | - Takeshi Aiba
- Medical Genome Center, National Cerebral and Cardiovascular Center, Suita, Japan (T.A., S.O.)
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, Canada (J.A.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Rome, Italy (F.D.)
| | - Anjan S. Batra
- Department of Pediatrics, University of California, Irvine (A.S.B.)
| | - Ramon Brugada
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica Girona, Hospital Trueta, CIBERCV, University of Girona, Spain (R.B.)
| | - Martin Borggrefe
- Department of Medicine, University Medical Center Mannheim, Germany (M.B.)
| | - Sally-Ann B. Clur
- Department of Pediatric Cardiology, Emma Children’s Hospital (S.-A.B.C.), Amsterdam UMC Location AMC, University of Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
| | - Moniek G.P.J. Cox
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands (M.G.P.J.C.)
| | - Andrew Davis
- The Royal Children’s Hospital, Melbourne, Australia (A.D.)
| | - Santokh Dhillon
- IWK Health Center, Dalhousie University, Halifax, Canada (S.D.)
| | - Susan P. Etheridge
- Division of Pediatric Cardiology, University of Utah, Salt Lake City (S.P.E.)
| | - Peter Fischbach
- Sibley Heart Center, Children’s Healthcare of Atlanta, GA (P.F.)
| | - Sonia Franciosi
- Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada (D.K., S.F., S.S.)
| | - Kristina Haugaa
- ProCardio Center for Innovation, Heart, Vessel and Lung Clinic, Oslo University Hospital, Rikshospitalet, Norway (K.H.)
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan (M.H., S.O.)
| | - Christopher Johnsrude
- Division of Pediatric Cardiology, Department of Pediatrics, Norton Children’s Hospital, University of Louisville School of Medicine, KY (C.J.)
| | | | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Georg-August-University, Germany (U.K.)
| | - Sit-Yee Kwok
- Department of Paediatrics, Hong Kong Children’s Hospital, China (S.-Y.K.)
| | - Martin J. LaPage
- University of Michigan Congenital Heart Center, Ann Arbor (M.J.L.)
| | - Seiko Ohno
- Medical Genome Center, National Cerebral and Cardiovascular Center, Suita, Japan (T.A., S.O.)
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan (M.H., S.O.)
| | - Vincent Probst
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
- Université de Nantes, CHU Nantes, CNRS, INSERM, L’institut du Thorax, France (V.P.)
| | - Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Canada (J.D.R.)
| | - Tomas Robyns
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (T.R.)
| | - Frederic Sacher
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
- LIRYC Institute, Bordeaux University Hospital, Bordeaux University, France (F.S.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S.)
| | - Jonathan R. Skinner
- Cardiac Inherited Disease Group New Zealand, Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland (J.R.S.)
| | - Heikki Swan
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
- Heart and Lung Centre, Helsinki University Hospital and Helsinki University, Finland (H.S.)
| | - Terezia Tavacova
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
- Children’s Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic (T.T.)
| | | | - Jacob Tfelt-Hansen
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (J.T.-H.)
- Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (J.T.-H.)
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands (S.-C.Y.)
| | - Prince J. Kannankeril
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University Medical Centre, Nashville, TN (P.J.K.)
| | - Antoine Leenhardt
- Service de Cardiologie et CRMR Maladies Cardiaques Héréditaires et Rares, APHP, Hôpital Bichat, Université Paris Cité, France (I.D., A.L.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
| | - Janice Till
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom (F.R.y.N., J.T.)
| | - Shubhayan Sanatani
- Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada (D.K., S.F., S.S.)
| | - Michael W.T. Tanck
- Epidemiology and Data Science, Amsterdam Public Health, Methodology (M.W.T.T.), Amsterdam UMC Location AMC, University of Amsterdam, The Netherlands
| | - Michael J. Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (J.M.B., K.T., M.J.A.)
| | - Arthur A.M. Wilde
- Heart Centre, Department of Cardiology (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.), Amsterdam UMC Location AMC, University of Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, The Netherlands (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
| | - Christian van der Werf
- Heart Centre, Department of Cardiology (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.), Amsterdam UMC Location AMC, University of Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, The Netherlands (A.T.B., K.V.V.L., P.J.P., A.A.M.W., C.v.d.W.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart (F.R.y.N., I.D., F.D., S.-A.B.C., V.P., T.R., F.S., H.S., T.T., J.T.-H., A.L., A.A.M.W., C.v.d.W.)
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Brucia RC, Taggart NW, Sagiv E, Kohli U, Tisma-Dupanovic S, Sutton NJ, McDaniel GM, Rossano JW, Dwyer AC, Marshall AC. Applying Practice Analysis to Develop a New Test Content Outline for the Pediatric Cardiology Certification Examination. Pediatr Cardiol 2022; 44:1057-1067. [PMID: 36508019 DOI: 10.1007/s00246-022-03070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
The evolving breadth and complexity of the contemporary pediatric cardiology specialty requires regular, systematic analysis of the practice to ensure that training and certification requirements address the demands of real-world clinical experience. We report the process of the American Board of Pediatrics (ABP) for conducting such a practice analysis and revising the test content outline (TCO) for the pediatric cardiology subspecialty certification exam. A panel of 15 pediatric cardiologists conducted seven 2-h virtual meetings, during which they identified 37 unique tasks that represent the work a pediatric cardiologist may reasonably expect to perform within the first 5 years after training. These tasks were grouped into nine performance domains, similar to the entrustable professional activities (EPA), previously endorsed by the ABP in collaboration with the pediatric cardiology education community, and which represent the critical activities of the profession. The panel then enumerated the knowledge, skills, and abilities necessary to perform each task. These deliberations resulted in two work products: a practice analysis document (PAD) and subspecialty board TCO based on testable knowledge, skills, and abilities. Survey assessments of the panel's work were then distributed to pediatric cardiology fellowship program directors and to practicing pediatric cardiologists for their input, which largely aligned with the panel's recommendations. Survey responses were considered in the final revisions of the PAD and TCO. This approach to practice analysis proved to be an efficient process for describing the work performed by today's pediatric cardiologists and the knowledge, skills, and abilities needed to competently perform that work.
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Affiliation(s)
| | | | - Eyal Sagiv
- Seattle Children's Hospital, Seattle, WA, USA
| | - Utkarsh Kohli
- West Virginia University Medicine Children's Hospital and West Virginia University School of Medicine, Morgantown, WV, USA
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4
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Krivenko GS, Ribeiro ER, Walker S, Mercado-Gonzalez C, Sima S, Ernst E, Tisma-Dupanovic S, Dadlani GH. Feasibility of electrocardiogram screening in the USA prior to high school sport participation. Progress in Pediatric Cardiology 2022. [DOI: 10.1016/j.ppedcard.2022.101522] [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: 11/25/2022]
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5
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Papagiannis J, Yang T, Glazer AM, Tisma-Dupanovic S, Avramidis D, Kannankeril PJ, Viskin S, Walsh EP, Roden DM. Incessant atrial and ventricular tachycardias associated with an SCN5A mutation. HeartRhythm Case Rep 2021; 7:806-811. [PMID: 34987964 PMCID: PMC8695285 DOI: 10.1016/j.hrcr.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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6
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Kallas D, Ghadiry-Tavi R, Roston TM, Franciosi S, Fischbach PS, Knight LM, Kannankeril PJ, Krahn AD, Kwok SY, LaPage MJ, Tisma-Dupanovic S, Atallah J, Kean AC, Etheridge SP, Hill AC, Law IH, Balaji S, Johnsrude CL, Backhoff D, Dhillon SS, Perry JC, Kubuš P, Kovach JR, Fournier A, Kamp AN, Kron J, Lau YR, Brugada GS, Hamilton RM, Sanatani S. B-PO05-167 ATRIAL TACHYARRHYTHMIAS IN CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA: A REPORT FROM THE INTERNATIONAL PEDIATRIC CPVT REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1086] [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: 11/26/2022]
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7
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Tisma-Dupanovic S, Srinivasan C, Malloy-Walton LE, Nelson JA, Baysa SJA, Etheridge SP, Fish FA, Kanter RJ, Niu MC, Papagiannis J, Silver ES, Singh HR, Tan RB, Tsao SS, Thomas PE, Whitehill RD, Balaji S. B-PO05-194 UNEXPLAINED VENTRICULAR FIBRILLATION IN YOUNG. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Lamba A, Roston TM, Franciosi S, Kallas D, Fischbach PS, Knight LM, Atallah J, Hill AC, Kannankeril PJ, Kwok SY, Backhoff D, LaPage MJ, Law IH, Balaji S, Dhillon SS, Krahn AD, Tisma-Dupanovic S, Etheridge SP, Johnsrude CL, Kamp AN, Kovach JR, Kubus P, Perry JC, Fournier A, Kean AC, Lau YR, Sanatani S. B-PO03-182 PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS IN CHILDREN WITH CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA: A PROSPECTIVE STUDY OF THE INTERNATIONAL PEDIATRIC CPVT REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.655] [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: 11/24/2022]
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9
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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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10
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Gupta S, Cho K, Papagiannis J, Tisma-Dupanovic S, Borsa J. A novel technique for extraction of a leadless pacemaker that embolized to the pulmonary artery in a young patient: A case report. HeartRhythm Case Rep 2020; 6:724-728. [PMID: 33101941 PMCID: PMC7573366 DOI: 10.1016/j.hrcr.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Sanjaya Gupta
- Division of Cardiology, Saint Luke’s Mid-America Heart Institute, Kansas City, Missouri
- Address reprint requests and correspondence: Dr Sanjaya Gupta, Saint Luke’s Mid-America Heart Institute, 9th Floor – Cardiovascular Research, 4400 Wornall Rd, Kansas City, MO 64111.
| | - Ken Cho
- Department of Radiology, Saint Luke’s Hospital of Kansas City, Kansas City, Missouri
| | - John Papagiannis
- Division of Cardiology, Saint Luke’s Mid-America Heart Institute, Kansas City, Missouri
- Division of Cardiology, Children’s Mercy Hospital, Kansas City, Missouri
| | - Svjetlana Tisma-Dupanovic
- Division of Cardiology, Saint Luke’s Mid-America Heart Institute, Kansas City, Missouri
- Division of Cardiology, Children’s Mercy Hospital, Kansas City, Missouri
| | - John Borsa
- Department of Radiology, Saint Luke’s Hospital of Kansas City, Kansas City, Missouri
- Department of Radiology, University of Missouri Kansas City, Kansas City, Missouri
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11
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Malloy-Walton L, Tisma-Dupanovic S. The approach to pediatric syncope with exercise. HeartRhythm Case Rep 2019; 5:485-488. [PMID: 33145167 PMCID: PMC7593692 DOI: 10.1016/j.hrcr.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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Papagiannis J, Beissel DJ, Krause U, Cabrera M, Telishevska M, Seslar S, Johnsrude C, Anderson C, Tisma-Dupanovic S, Connelly D, Avramidis D, Carter C, Kornyei L, Law I, Von Bergen N, Janusek J, Silva J, Rosenthal E, Willcox M, Kubus P, Hessling G, Paul T. Atrioventricular Nodal Reentrant Tachycardia in Patients With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004869. [DOI: 10.1161/circep.116.004869] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/22/2016] [Accepted: 06/08/2017] [Indexed: 11/16/2022]
Abstract
Background—
The relationship of atrioventricular nodal reentrant tachycardia to congenital heart disease (CHD) and the outcome of catheter ablation in this population have not been studied adequately.
Methods and Results—
A multicenter retrospective study was performed on patients with CHD who had atrioventricular nodal reentrant tachycardia and were treated with catheter ablation. There were 109 patients (61 women), aged 22.1±13.4 years. The majority, 86 of 109 (79%), had CHD resulting in right heart pressure or volume overload. Patients were divided into 2 groups: group A (n=51) with complex CHD and group B (n=58) with simple CHD. There were no significant differences between groups in patients’ growth parameters, use of 3-dimensional imaging, and type of ablation (radiofrequency versus cryoablation). Procedure times (251±117 versus 174±94 minutes;
P
=0.0006) and fluoroscopy times (median 20.8 versus 16.6 minutes;
P
=0.037) were longer in group A versus group B. There were significant differences between groups in the acute success of ablation (82% versus 97%;
P
=0.04), risk of atrioventricular block (14 versus 0%;
P
=0.004), and need for chronic pacing (10% versus 0%;
P
=0.008). There was no permanent atrioventricular block in patients who underwent cryoablation. After 3.2±2.7 years of follow-up, long-term success was 86% in group A and 100% in group B (
P
=0.004).
Conclusions—
Atrioventricular nodal reentrant tachycardia can complicate the course of patients with CHD. This study demonstrates that the outcome of catheter ablation is favorable in patients with simple CHD. Patients with complex CHD have increased risk of procedural failure and atrioventricular block.
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Affiliation(s)
| | | | - Ulrich Krause
- For the author affiliations, please see the Appendix
| | | | | | | | | | | | | | | | | | | | | | - Ian Law
- For the author affiliations, please see the Appendix
| | | | - Jan Janusek
- For the author affiliations, please see the Appendix
| | | | | | - Mark Willcox
- For the author affiliations, please see the Appendix
| | - Peter Kubus
- For the author affiliations, please see the Appendix
| | | | - Thomas Paul
- For the author affiliations, please see the Appendix
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13
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Afzal MR, Malloy-Walton L, Tisma-Dupanovic S, Miles AL, Shah S, Papagiannis J. External Cardioversion of Supraventricular Tachycardia in Omphalo-Thoracopagus Conjoined Twins. JACC Clin Electrophysiol 2017; 3:310-312. [PMID: 29759526 DOI: 10.1016/j.jacep.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- M Rizwan Afzal
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | | | | | - Andrea L Miles
- Division of Cardiology, Children's Mercy Hospital, Kansas City, Missouri
| | - Sanket Shah
- Division of Cardiology, Children's Mercy Hospital, Kansas City, Missouri
| | - John Papagiannis
- Division of Cardiology, Children's Mercy Hospital, Kansas City, Missouri.
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14
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Papagiannis J, Pillai A, Kaine S, Tisma-Dupanovic S. Acquired right atrial appendage to right ventricle accessory pathway in a lateral tunnel Fontan patient: Successful ablation via transconduit approach. HeartRhythm Case Rep 2015; 1:481-485. [PMID: 28491611 PMCID: PMC5419733 DOI: 10.1016/j.hrcr.2015.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- John Papagiannis
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Anand Pillai
- Division of Cardiology, Department of Internal Medicine, Kansas University Hospital, Kansas City, Kansas
| | - Stephen Kaine
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Svjetlana Tisma-Dupanovic
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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15
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Balaji S, Daga A, Bradley DJ, Etheridge SP, Law IH, Batra AS, Sanatani S, Singh AK, Gajewski KK, Tsao S, Singh HR, Tisma-Dupanovic S, Tateno S, Takamuro M, Nakajima H, Roos-Hesselink JW, Shah M. An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations. J Thorac Cardiovasc Surg 2014; 148:576-81. [DOI: 10.1016/j.jtcvs.2013.08.070] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 11/29/2022]
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16
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Kang KT, Etheridge SP, Kantoch MJ, Tisma-Dupanovic S, Bradley DJ, Balaji S, Hamilton RM, Singh AK, Cannon BC, Schaffer MS, Potts JE, Sanatani S. Current Management of Focal Atrial Tachycardia in Children. Circ Arrhythm Electrophysiol 2014; 7:664-70. [DOI: 10.1161/circep.113.001423] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Focal atrial tachycardia (FAT) is an uncommon cause of supraventricular tachycardia in children. Incessant FAT can lead to tachycardia-induced cardiomyopathy. There is limited information regarding the clinical course and management of FAT. This study characterizes current management strategies for FAT in children including the prevalence of spontaneous resolution and the role of catheter ablation.
Methods and Results—
This is a retrospective chart review of pediatric patients with FAT managed between January 2000 and November 2010 at 10 pediatric centers. There were 249 patients with a median age at diagnosis of 7.2 (95% confidence interval, 5.8–10.4) years. Cardiomyopathy was observed in 28%. Resolution of FAT occurred in 89%, including spontaneous resolution without catheter ablation in 34%. Antiarrhythmic medications were used for initial therapy in 154 patients with control of FAT in 72%. Among first-line medications, β-blockers were the most common (53%) and effective (42%). Catheter ablation was successful in 80% of patients. FAT recurrence was less common with electroanatomic mapping compared with conventional mapping techniques (16% versus 35%;
P
=0.02). Patients were followed for a median of 2.1 (95% confidence interval, 1.8–2.6) years.
Conclusions—
FAT is managed successfully in most children. Current approaches are variable. Many patients have control of FAT with medications; however, catheter ablation is used for most patients. Spontaneous resolution is common for young children, emphasizing the role for delayed ablation in this group. Ablation is successful for all ages. Lower recurrence occurs when electroanatomic mapping techniques are used.
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Affiliation(s)
- Kristopher T. Kang
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Susan P. Etheridge
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Michal J. Kantoch
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Svjetlana Tisma-Dupanovic
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - David J. Bradley
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Seshadri Balaji
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Robert M. Hamilton
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Anoop K. Singh
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Bryan C. Cannon
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Michael S. Schaffer
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - James E. Potts
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Shubhayan Sanatani
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
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Tisma-Dupanovic S, Wagner JB, Shah S, Huang DT, Moss AJ. An adolescent with possible arrhythmogenic right ventricular dysplasia and long QT syndrome: evaluation and management. Ann Noninvasive Electrocardiol 2013; 18:75-8. [PMID: 23347029 DOI: 10.1111/anec.12043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We describe a unique presentation of arrhythmogenic right ventricular dysplasia (ARVD) in a 14-year-old Caucasian male who was additionally diagnosed with long QT syndrome (LQTS). Genetic testing eventually confirmed the diagnosis of both ARVD and LQTS, which combined, to our knowledge, has not been reported in the literature.
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18
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Janoušek J, van Geldorp IE, Krupičková S, Rosenthal E, Nugent K, Tomaske M, Früh A, Elders J, Hiippala A, Kerst G, Gebauer RA, Kubuš P, Frias P, Gabbarini F, Clur SA, Nagel B, Ganame J, Papagiannis J, Marek J, Tisma-Dupanovic S, Tsao S, Nürnberg JH, Wren C, Friedberg M, de Guillebon M, Volaufova J, Prinzen FW, Delhaas T. Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study. Circulation 2012; 127:613-23. [PMID: 23275383 DOI: 10.1161/circulationaha.112.115428] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [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: 12/25/2022]
Abstract
BACKGROUND We evaluated the effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children requiring permanent pacing. METHODS AND RESULTS One hundred seventy-eight children (aged <18 years) from 21 centers with atrioventricular block and a structurally normal heart undergoing permanent pacing were studied cross-sectionally. Median age at evaluation was 11.2 (interquartile range, 6.3-15.0) years. Median pacing duration was 5.4 (interquartile range, 3.1-8.8) years. Pacing sites were the free wall of the right ventricular (RV) outflow tract (n=8), lateral RV (n=44), RV apex (n=61), RV septum (n=29), LV apex (n=12), LV midlateral wall (n=17), and LV base (n=7). LV synchrony, pump function, and contraction efficiency were significantly affected by pacing site and were superior in children paced at the LV apex/LV midlateral wall. LV dyssynchrony correlated inversely with LV ejection fraction (R=0.80, P=0.031). Pacing from the RV outflow tract/lateral RV predicted significantly decreased LV function (LV ejection fraction <45%; odds ratio, 10.72; confidence interval, 2.07-55.60; P=0.005), whereas LV apex/LV midlateral wall pacing was associated with preserved LV function (LV ejection fraction ≥55%; odds ratio, 8.26; confidence interval, 1.46-47.62; P=0.018). Presence of maternal autoantibodies, gender, age at implantation, duration of pacing, DDD mode, and QRS duration had no significant impact on LV ejection fraction. CONCLUSIONS The site of ventricular pacing has a major impact on LV mechanical synchrony, efficiency, and pump function in children who require lifelong pacing. Of the sites studied, LV apex/LV midlateral wall pacing has the greatest potential to prevent pacing-induced reduction of cardiac pump function.
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Affiliation(s)
- Jan Janoušek
- Children's Heart Center, University Hospital Motol, V Úvalu 84, 150 06 Prague 5, Czech Republic.
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19
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Sanatani S, Potts JE, Reed JH, Saul JP, Stephenson EA, Gibbs KA, Anderson CC, Mackie AS, Ro PS, Tisma-Dupanovic S, Kanter RJ, Batra AS, Fournier A, Blaufox AD, Singh HR, Ross BA, Wong KK, Bar-Cohen Y, McCrindle BW, Etheridge SP. The Study of Antiarrhythmic Medications in Infancy (SAMIS). Circ Arrhythm Electrophysiol 2012; 5:984-91. [DOI: 10.1161/circep.112.972620] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Supraventricular tachycardia (SVT) is one of the most common conditions requiring emergent cardiac care in children, yet its management has never been subjected to a randomized controlled clinical trial. The purpose of this study was to compare the efficacy and safety of the 2 most commonly used medications for antiarrhythmic prophylaxis of SVT in infants: digoxin and propranolol.
Methods and Results—
This was a randomized, double-blind, multicenter study of infants <4 months with SVT (atrioventricular reciprocating tachycardia or atrioventricular nodal reentrant tachycardia), excluding Wolff-Parkinson-White, comparing digoxin with propranolol. The primary end point was recurrence of SVT requiring medical intervention. Time to recurrence and adverse events were secondary outcomes. Sixty-one patients completed the study, 27 randomized to digoxin and 34 to propranolol. SVT recurred in 19% of patients on digoxin and 31% of patients on propranolol (
P
=0.25). No first recurrence occurred after 110 days of treatment. The 6-month recurrence-free status was 79% for patients on digoxin and 67% for patients on propranolol (
P
=0.34), and there were no first recurrences in either group between 6 and 12 months. There were no deaths and no serious adverse events related to study medication.
Conclusions—
There was no difference in SVT recurrence in infants treated with digoxin versus propranolol. The current standard practice may be treating infants longer than required and indicates the need for a placebo-controlled trial.
Clinical Trial Registration Information—
http://clinicaltrials.gov
; NCT-00390546.
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Affiliation(s)
- Shubhayan Sanatani
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - James E. Potts
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - John H. Reed
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - J. Philip Saul
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Elizabeth A. Stephenson
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Karen A. Gibbs
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Charles C. Anderson
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Andrew S. Mackie
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Pamela S. Ro
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Svjetlana Tisma-Dupanovic
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Ronald J. Kanter
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Anjan S. Batra
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Anne Fournier
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Andrew D. Blaufox
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Harinder R. Singh
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Bertrand A. Ross
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Kenny K. Wong
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Yaniv Bar-Cohen
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Brian W. McCrindle
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
| | - Susan P. Etheridge
- From the Division of Pediatric Cardiology, British Columbia Children’s Hospital and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (S.S., J.E.P., K.A.G.); Division of Pediatric Cardiology, Medical University of South Carolina Children’s Hospital and Department of Pediatrics, Medical University of South Carolina, Charleston, SC (J.H.R., J.P.S.); Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON,
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20
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Blaufox AD, Tristani-Firouzi M, Seslar S, Sanatani S, Trivedi B, Fischbach P, Paul T, Young ML, Tisma-Dupanovic S, Silva J, Cuneo B, Fournier A, Singh H, Tanel RE, Etheridge SP. Congenital long QT 3 in the pediatric population. Am J Cardiol 2012; 109:1459-65. [PMID: 22360817 DOI: 10.1016/j.amjcard.2012.01.361] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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: 11/11/2011] [Revised: 01/10/2012] [Accepted: 01/10/2012] [Indexed: 11/29/2022]
Abstract
There is insufficient knowledge concerning long-QT (LQT) 3 in the pediatric population to determine whether recommendations for more aggressive therapy in these patients are appropriate. An international multicenter review of 43 children with cardiac sodium channel (SCN5A) mutations and clinical manifestations of LQT syndrome without overlap of other SCN5A syndromes was undertaken to describe the clinical characteristics of LQT3 in children. Patients were aged 7.6 ± 5.9 years at presentation and were followed for 4.7 ± 3.9 years. There was significant intrasubject corrected QT interval (QTc) variability on serial electrocardiography. Forty-two percent presented with severe symptoms or arrhythmia and exhibited longer QTc intervals compared to asymptomatic patients. None of the 14 patients who underwent primary prevention implantable cardioverter-defibrillator (ICD) implantation received appropriate shocks in 41 patient-years of follow-up, while 2 of 6 patients who underwent secondary prevention ICD implantation received appropriate shocks in 30 patient-years of follow-up. Half of patients who underwent ICD implantation experienced inappropriate shocks or ICD-related complications. Mexiletine significantly shortened the QTc interval, and QTc shortening was greater in patients with longer pretreated QTc intervals. Two ICD patients with frequent appropriate ICD shocks showed immediate clinical improvement, with elimination of appropriate ICD shocks after mexiletine loading. In conclusion, severe symptoms are common in children with LQT3 and are associated with longer QTc intervals. ICD implantation is associated with significant morbidity. Mexiletine shortens the QTc interval, and it may be beneficial.
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Affiliation(s)
- Andrew D Blaufox
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, USA.
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21
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Tisma-Dupanovic S, Gowdamarajan R, Goldenberg I, Huang DT, Knilans T, Towbin JA. Prolonged QT in a 13-year-old patient with Down syndrome and complete atrioventricular canal defect. Ann Noninvasive Electrocardiol 2012; 16:403-6. [PMID: 22008496 DOI: 10.1111/j.1542-474x.2011.00471.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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van Geldorp IE, Delhaas T, Gebauer RA, Frias P, Tomaske M, Friedberg MK, Tisma-Dupanovic S, Elders J, Früh A, Gabbarini F, Kubus P, Illikova V, Tsao S, Blank AC, Hiippala A, Sluysmans T, Karpawich P, Clur SA, Ganame X, Collins KK, Dann G, Thambo JB, Trigo C, Nagel B, Papagiannis J, Rackowitz A, Marek J, Nürnberg JH, Vanagt WY, Prinzen FW, Janousek J. Impact of the permanent ventricular pacing site on left ventricular function in children: a retrospective multicentre survey. Heart 2011; 97:2051-5. [PMID: 21917655 DOI: 10.1136/heartjnl-2011-300197] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [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] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic right ventricular (RV) pacing is associated with deleterious effects on cardiac function. OBJECTIVE In an observational multicentre study in children with isolated atrioventricular (AV) block receiving chronic ventricular pacing, the importance of the ventricular pacing site on left ventricular (LV) function was investigated. METHODS Demographics, maternal autoantibody status and echocardiographic measurements on LV end-diastolic and end-systolic dimensions and volumes at age <18 years were retrospectively collected from patients undergoing chronic ventricular pacing (>1 year) for isolated AV block. LV fractional shortening (LVFS) and, if possible LV ejection fraction (LVEF) were calculated. Linear regression analyses were adjusted for patient characteristics. RESULTS From 27 centres, 297 children were included, in whom pacing was applied at the RV epicardium (RVepi, n = 147), RV endocardium (RVendo, n = 113) or LV epicardium (LVepi, n = 37). LVFS was significantly affected by pacing site (p = 0.001), and not by maternal autoantibody status (p = 0.266). LVFS in LVepi (39 ± 5%) was significantly higher than in RVendo (33 ± 7%, p < 0.001) and RVepi (35 ± 8%, p = 0.001; no significant difference between RV-paced groups, p = 0.275). Subnormal LVFS (LVFS < 28%) was seen in 16/113 (14%) RVendo-paced and 21/147 (14%) RVepi-paced children, while LVFS was normal (LVFS ≥ 28%) in all LVepi-paced children (p = 0.049). These results are supported by the findings for LVEF (n = 122): LVEF was <50% in 17/69 (25%) RVendo- and in 10/35 (29%) RVepi-paced patients, while LVEF was ≥ 50% in 17/18 (94%) LVepi-paced patients. CONCLUSION In children with isolated AV block, permanent ventricular pacing site is an important determinant of LV function, with LVFS being significantly higher with LV pacing than with RV pacing.
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Affiliation(s)
- Irene E van Geldorp
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, PO Box 616, Maastricht NL-6200, The Netherlands.
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23
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Budzikowski AS, Tisma-Dupanovic S, Kroening D, Daubert JP. How to perform cryoablation for atrioventricular nodal reentrant tachycardia. Cardiol J 2007; 14:597-604. [PMID: 18651530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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24
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Abstract
Cardiomyocyte injury in pediatric patients has a vast number of causes, which are often distinct from the causes of adult heart failure. However, the management of pediatric heart failure and heart transplantation has generally been inferred from adult studies. New therapies show great promise for the neurohormonal regulation of heart failure and the ability to control immunosuppression after heart transplantation. Large, randomized, multicenter, controlled clinical trials are needed to determine the efficacy of these therapies in this population. This article reviews the current recommendations and evidence-based medicine, where available, for the medical management of myopathic dysfunction and transplantation in pediatric patients.
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Affiliation(s)
- Gul H Dadlani
- Division of Pediatric Cardiology, Golisano Children's Hospital at Strong, University of Rochester School of Medicine and Dentistry, New York 14642, USA
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