Incidence and Outcomes of Iatrogenic Complete Atrioventricular Block After Congenital Heart Surgery.

Background: Iatrogenic complete atrioventricular block (ICAVB) has long been noted as a major complication after congenital heart surgery (CHS), and it contributes to complex postoperative care and potentially affects patients' outcomes.

Methods: This study is a retrospective review of the Pediatric Health Information System database from January 1, 2004 to September 30, 2023. All patients who underwent The Society of Thoracic Surgeons benchmark procedures were included.

Impact of electrophysiologists at daily multidisciplinary report in a paediatric cardiac care unit.

Background: Paediatric cardiac electrophysiologists are essential in CHD inpatient care, but their involvement is typically limited to consultation with individual patients. In our integrated heart centre, an electrophysiologist reviews all cardiac inpatient telemetry over the preceding 24 hours and participates in daily multidisciplinary morning report. This study investigates the impact of the strategy of consistent, formalised electrophysiologist presence at multidisciplinary morning report.

Pacemaker Management and In-Hospital Outcomes in Neonatal Congenital Atrioventricular Block.

Background: Neonatal congenital atrioventricular block (nCAVB) is rare, causes bradycardia, confers high mortality, and frequently requires pacing. In-hospital outcomes and pacemaker management in nCAVB are limited.

Objectives: The purpose of this study was to analyze pacing and outcomes of nCAVB with and without congenital heart disease (CHD) using a multicenter database.

Long QT and Hearing Loss in High-Risk Infants Prospective Study Registry.

The objective of this study is to determine the prevalence of an abnormal electrocardiogram showing a prolonged QTc greater than 450 ms in infants with unilateral or bilateral sensorineural hearing loss. We conducted a prospective study of healthy term infants (≥37 weeks gestational age) who failed their newborn auditory brainstem response hearing screen, were seen by an audiologist and diagnosed as having sensorineural hearing loss during follow-up to 1 year of age. In infants with a diagnosis of hearing loss, we collected a detailed family history and performed an ECG between 2 and 6 months of age.

Arrhythmias Requiring ECMO in Infants Without Structural Congenital Heart Disease.

Arrhythmias account for 55 per 100,000 patient evaluations in pediatric emergency departments. Most arrhythmias in children are amenable to medical management or cardioversion. Rarely, arrhythmias lead to significant hemodynamic instability requiring extracorporeal membrane oxygenation (ECMO) support.

Lessons learned from preparticipation cardiovascular screening in a state funded program.

In 2007, the Texas legislature appropriated money for a pilot study to evaluate cardiovascular screening of student athletes to identify those who might be at risk of sudden death using a questionnaire, physical examination, electrocardiography, and limited echocardiography. We sought to determine (1) the feasibility of a state-wide cardiovascular screening program, (2) the ability to reliably identify at-risk subjects, and (3) problems in implementing screening state wide. The data were analyzed using established pediatric electrocardiographic and echocardiographic criteria.

Radiofrequency ablation of nonautomatic focal atrial tachycardia in children with structurally normal hearts.

Introduction: The majority of children presenting with paroxysmal supraventricular tachycardia (SVT) have either accessory-pathway-mediated tachycardia or AV node reentry tachycardia. The purpose of this study is to report an unusual mechanism of SVT found in children with structurally normal hearts.

Methods And Results: Records of all patients undergoing an electrophysiology study (EPS) at our institution between 2000 and 2004 were reviewed to identify those with nonautomatic focal atrial tachycardia (NAFAT).

Transcatheter closure of patent ductus arteriosus and aorto-pulmonary vessels using non-ferromagnetic Inconel MReye embolization coils.

Objectives: We report the use of non-ferromagnetic embolization coils for transcatheter PDA closure.

Background: Transcatheter patent ductus arteriosus (PDA) closure has been performed for 40 years. A number of devices have been used with varying degrees of success.

Can pediatric electrophysiologists safely perform electrophysiology studies on adults with congenital heart disease?

Introduction: Adults with congenital heart disease (ACHD) are known to have arrhythmias. The purpose of this study was to review the safety and efficacy of a pediatric electrophysiologist performing electrophysiology studies (EPS) on ACHD.

Methods: All ACHD >18 years of age who underwent an EPS performed by a pediatric electrophysiologist between 1995 and 2004 were included.

Ventricular function and long-term pacing in children with congenital complete atrioventricular block.

Objective: To determine the sequela of right ventricular pacing in children with congenital complete atrioventricular block.

Background: Pacing is a well-accepted therapy for patients with congenital complete atrioventricular block. The long-term sequela of right ventricular pacing in this population has not been well described.

Atrial flutter in infants.

Objectives: We sought to characterize the clinical nature of atrial flutter (AFL) in a large cohort of infants.

Background: There are no large studies describing the natural history of AFL in infants. Previous studies vary in the therapy used and expected prognosis.

Innovative techniques for placement of implantable cardioverter-defibrillator leads in patients with limited venous access to the heart.

Background: Because of venous occlusion, intracardiac shunting, previous surgery, or small size placement of implantable cardioverter-defibrillator (ICD) leads may not be possible using traditional methods. The purpose of this study was to evaluate and describe innovative methods of placing ICD leads.

Methods: The records of all patients undergoing ICD implantation at our institution were reviewed to identify patients with nontraditional lead placement.

Can pediatric residents interpret electrocardiograms?

The purpose of this study was to assess the electrocardiogram (ECG) interpretation skills of pediatric residents in a controlled environment and determine if the level of residency training (intern vs senior) improves accuracy. A list of ECG diagnoses was provided to four pediatric residency educators with instructions to categorize each diagnosis as follows: I, all residents; II, the majority of residents, including all senior residents; III, less than the majority of residents; and IV, few residents should be able to interpret correctly. Only those categories that the entire panel believed all residents (category I) or all senior residents (category II) should be able to interpret correctly were included.

Salvaging the failing Fontan: lateral tunnel versus extracardiac conduit.

Background: Since Fontan revision has been demonstrated to provide hemodynamic and symptomatic improvement in select patients with failing Fontan circulations, we now believe it is important to determine if one type of revision (lateral tunnel [LT] or extracardiac conduit [ECC]) provides superior outcomes.

Methods: Thirty-five Fontan revisions were performed (Jun 1997 to Dec 2004): 19 ECC (54%) and 16 LT. Preoperative variables were similar: New York Heart Association (NYHA) IV (LT = 4 vs ECC = 2, p = not significant [NS]), preoperative arrhythmias (LT = 13 vs ECC = 16, p = NS) and systemic right ventricle (LT = 4 vs ECC = 2, p = NS).

Atrial flutter following placement of an umbilical venous catheter.

Atrial flutter is a rare complication of the insertion of an umbilical venous catheter. We report a neonate who had an umbilical venous catheter placed within the first 24 hours of life and developed a hemodynamically stable tachyarrhythmia. The arrhythmia was successfully managed with synchronized cardioversion, with no further complications.

Atrioventricular junction ablation and pacemaker therapy in patients with drug-resistant atrial tachyarrhythmias after the Fontan operation.

Introduction: Drug-resistant intraatrial reentrant tachycardia (IART) occurs frequently after the Fontan operation and is a major cause of morbidity and rarely mortality. We describe our experience with AV junction ablation after pacemaker implantation in postoperative Fontan patients with drug-resistant IART.

Methods And Results: We performed retrospective analysis of Fontan patients with IART and attempted radiofrequency ablation (RFA) of the AV junction.

Improved early results with the Fontan operation in adults with functional single ventricle.

Background: A growing number of adults with functional single ventricles are presenting as candidates for first-time and redo-Fontan operations. This study describes the clinical presentation and early operative results of adults who have undergone Fontan modifications.

Methods: Between July 1995 and April 2003, 23 patients (>18 years old) had Fontan operations.

Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children < 3 or > or =3 years of age.

Objectives: We assessed the clinical presentation, natural history, and treatment response of atrial ectopic tachycardia (AET) in children <3 years of age (group 1) compared with those > or =3 years of age (group 2).

Background: Atrial ectopic tachycardia is a common cause of chronic supraventricular tachycardia in children and can be resistant to pharmacologic therapy. Radiofrequency ablation (RFA) can eliminate AET arising from a single focus.

Late pacemaker requirement after pediatric orthotopic heart transplantation may predict the presence of transplant coronary artery disease.

Background: Few data are available regarding pacemaker implantation after pediatric orthotopic heart transplantation. The purpose of this study was to assess the incidence, indications and associations with regard to pacemaker placement in children who have undergone orthotopic heart transplantation.

Methods: We performed a retrospective study of all patients undergoing orthotopic heart transplantation at our institution from October 1984 to March 2001.

The use of implantable cardioverter-defibrillators in pediatric patients awaiting heart transplantation.

Background: This multicenter study evaluated experience with implantable cardioverter defibrillators (ICD) as a bridge to orthotopic heart transplantation (OHT) in children.

Methods: The application of ICD therapy continues to expand in pediatric populations, due in part to improved technology and new indications, including the prevention of sudden death while awaiting OHT.

Methods: We performed a retrospective review of ICD databases at 9 pediatric transplant centers.

Frequency of recurrence among infants with supraventricular tachycardia and comparison of recurrence rates among those with and without preexcitation and among those with and without response to digoxin and/or propranolol therapy.

Approximately 60% of children with supraventricular tachycardia (SVT) develop their initial episode by 1 year of age. Despite resolution in most of these patients by 1 year, approximately 30% of the SVT will recur. We performed a retrospective review of all patients <1 year of age with SVT between January 1984 and December 2000.

Long-term follow-up of arrhythmias in pediatric orthotopic heart transplant recipients: incidence and correlation with rejection.

Background: Arrhythmias in adult orthotopic heart transplant (OHT) recipients are common and have been used as predictors of rejection. Because of the paucity of information in pediatric OHT recipients, the purpose of this study was to determine the incidence and correlation of arrhythmias with rejection or with coronary artery disease (CAD) in children.

Methods: We retrospectively reviewed the records, electrocardiograms (ECGs), and 24-hour ambulatory ECGs of patients who underwent OHT from January 1984 to December 1999.

Amiodarone-induced 2 to 1 atrioventricular block in association with prolongation of the QT interval.

The potential for development of 2 to 1 atrioventricular conduction in children with prolongation of the QT interval has been previously reported secondary to electrolytic disturbances. We report here a child who developed 2 to 1 atrioventricular conduction with prolongation of the QT interval following treatment with amiodarone for refractory supraventricular tachycardia. We highlight the importance of electrocardiographic monitoring to assess for those at risk of amiodarone toxicity, which may be manifested by prolongation of the QT interval and the simultaneous loss of atrioventricular conduction, and of equal importance the need for prompt conversion to an alternative anti-arrhythmic agent.