Cardiovascular Collapse with Intravenous Amiodarone in Children: A Multi-Center Retrospective Cohort Study.

Objective: To determine the incidence of cardiovascular collapse in children receiving intravenous (IV) amiodarone and to identify the population at risk.

Design: A multicenter study of patients ≤ 18 years of age who received intravenous amiodarone between January 2005 and December 2015. A retrospective analysis was performed to identify patients who developed cardiovascular collapse (bradycardia and/or hypotension).

Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network.

Objectives: The study objective was to determine the predictors of new-onset arrhythmia among infants with single-ventricle anomalies during the post-Norwood hospitalization and the association of those arrhythmias with postoperative outcomes (ventilator time and length of stay) and interstage mortality.

Methods: After excluding patients with preoperative arrhythmias, we used data from the Pediatric Heart Network Single Ventricle Reconstruction Trial to identify risk factors for tachyarrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, junctional ectopic tachycardia, and ventricular tachycardia) and atrioventricular block (second or third degree) among 544 eligible patients. We then determined the association of arrhythmia with outcomes during the post-Norwood hospitalization and interstage period, adjusting for identified risk factors and previously published factors.

Hemodynamic effects of sustained postoperative cardiac resynchronization therapy in infants after repair of congenital heart disease: Results of a randomized clinical trial.

Background: It is unknown whether continuous cardiac resynchronization therapy (CRT) can lead to sustained improvement in hemodynamics after surgery for congenital heart disease (CHD).

Objective: We investigated whether CRT improves cardiac index (CI) and blood pressure in infants after biventricular repair of CHD.

Methods: We randomized infants younger than 4 months after biventricular CHD surgery to standard care or standard care plus CRT for 48 hours or until extubation if sooner.

Cox-Maze IV in Total Anomalous Pulmonary Venous Drainage After Sutureless Repair.

Modifications of conventional ablation strategies can make arrhythmia surgery more efficient after primary sutureless repair of total anomalous pulmonary venous drainage. We present a surgical technique performed in a 3-year-old patient who experienced ongoing atrial arrhythmia after sutureless repair. A new modified Cox-Maze IV procedure was performed, which respects the special characteristics of patients after sutureless repairs, showing good short-term results.

Associations Between Day of Admission and Day of Surgery on Outcome and Resource Utilization in Infants With Hypoplastic Left Heart Syndrome Who Underwent Stage I Palliation (from the Single Ventricle Reconstruction Trial).

Newborns with hypoplastic left heart syndrome and other single right ventricular variants require substantial health care resources. Weekend acute care has been associated with worse outcomes and increased resource use in other populations but has not been studied in patients with single ventricle. Subjects of the Single Ventricle Reconstruction trial were classified by whether they had a weekend admission and by day of the week of Norwood procedure.

Optimizing outcomes of catheter ablation in infants and toddlers.

Since the introduction of transcatheter ablation in the late 1980s, there has been significant technical development. With a very high success rate and low complication rate, ablation has now become the standard of care in children and adults. However, long-term data remain insufficient and the application of ablation therapy in small children is debatable.

Cryotherapy ablation of parahisian accessory pathways in children.

Background: Because of its safety profile, cryoablation has become an alternative therapy for septal arrhythmias, including parahisian accessory pathways (APs). Data regarding its efficacy, safety, and late outcome for parahisian APs in children are limited.

Objective: The purpose of this study was to evaluate the safety and efficacy of cryoablation of parahisian APs in children.

Sudden cardiac death in children and adolescents between 1 and 19 years of age.

Background: Understanding pediatric sudden cardiac death (SCD) may inform age-specific prevention strategies.

Objective: To characterize potential underlying causes of SCD in children and adolescents

Methods: We performed a retrospective population-based study in Ontario, Canada, of all SCD cases in a 5-year period (2005-2009) involving persons aged 1-19 years identified from the comprehensive database of the Office of the Chief Coroner. Of 1204 coroner's cases, 351 potential SCD cases were reviewed.

Scope and nature of sudden cardiac death before age 40 in Ontario: a report from the cardiac death advisory committee of the office of the chief coroner.

Background: Understanding sudden cardiac death in the young may inform prevention strategies.

Objective: To determine the scope and nature of sudden death in a geographically defined population.

Methods: We performed a retrospective population-based cohort study in Ontario, Canada, of all sudden cardiac death cases involving persons aged 2-40 years identified from the 2008 comprehensive Coroner database.

Arrhythmia associated with tetracaine in an extremely low birth weight premature infant.

Infants in NICUs undergo a variety of painful procedures. The management of pain has become an integral part of newborn infant care with the use of both systemic and topical agents to provide analgesia and anesthesia for procedural pain. Tetracaine and prilocaine-lidocaine are the 2 topical anesthetics most frequently used.

Triphasic mitral and tricuspid flows: a sign of diastolic dysfunction in a young patient with severely dilated atria and giant pulmonary veins.

This report presents a case with severe dilation of both atria and giant pulmonary veins manifested with atrial fibrillation. The following cardiac magnetic resonance findings are highly suggestive of restrictive physiology: E/A ratio greater than two, prominent A wave across the pulmonary veins and inferior vena cava, and more interestingly, a triphasic flow across the mitral and tricuspid valves.

Cause, timing, and location of death in the Single Ventricle Reconstruction trial.

Objectives: The Single Ventricle Reconstruction trial randomized 555 subjects with a single right ventricle undergoing the Norwood procedure at 15 North American centers to receive either a modified Blalock-Taussig shunt or right ventricle-to-pulmonary artery shunt. Results demonstrated a rate of death or cardiac transplantation by 12 months postrandomization of 36% for the modified Blalock-Taussig shunt and 26% for the right ventricle-to-pulmonary artery shunt, consistent with other publications. Despite this high mortality rate, little is known about the circumstances surrounding these deaths.

Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial.

Objectives: We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial.

Methods: Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay.

The effect of NavX on fluoroscopy times in pediatric catheter ablation.

Purpose: Catheter ablation is the established curative therapy for pediatric tachyarrhythmias. However, exposure to ionizing radiation from fluoroscopy during the procedure is of concern to both patients and caregivers. We sought to assess the impact of an impedance-based three-dimensional navigation system (NavX(TM), Endocardial Solutions, Inc.

Recommendations for the use of genetic testing in the clinical evaluation of inherited cardiac arrhythmias associated with sudden cardiac death: Canadian Cardiovascular Society/Canadian Heart Rhythm Society joint position paper.

The era of gene discovery and molecular medicine has had a significant impact on clinical practice. Knowledge of specific genetic findings causative for or associated with human disease may enhance diagnostic accuracy and influence treatment decisions. In cardiovascular disease, gene discovery for inherited arrhythmia syndromes has advanced most rapidly.

"What I wish you knew": Social barriers toward physical activity in youth with congenital heart disease (CHD).

Despite the benefits of physical activity for youth with congenital heart disease (CHD), most patients are inactive. Although literature has addressed medical and psychological barriers to participation, little is known about the social barriers that youth encounter. This qualitative study explored sociocultural barriers to physical activity from the perspective of 17 youth with CHD.

The perceptions of caregivers toward physical activity and health in youth with congenital heart disease.

Medical advances have reduced mortality in youth with congenital heart disease (CHD). Although physical activity is associated with enhanced quality of life, most patients are inactive. By addressing medical and psychological barriers, previous literature has reproduced discourses of individualism which position cardiac youth as personally responsible for physical inactivity.

Diagnosis-specific characteristics of ventricular tachycardia in children with structurally normal hearts.

Background: Improved mechanistic insights and clinical tools provide increasing diagnostic refinement for ventricular tachycardia in young patients with structurally normal hearts, yielding potentially important prognostic and management implications.

Objective: The purpose of this study was to survey the clinical characteristics and outcomes of otherwise healthy children with ventricular tachycardia (VT) who were classified according to contemporary diagnostic criteria.

Methods: A single-center retrospective review of patients younger than 18 years of age with VT diagnosed between January 1980 and December 2005 was undertaken.

Prenatal diagnosis and risk factors for preoperative death in neonates with single right ventricle and systemic outflow obstruction: screening data from the Pediatric Heart Network Single Ventricle Reconstruction Trial(∗).

Objectives: The purpose of this analysis was to assess preoperative risk factors before the first-stage Norwood procedure in infants with hypoplastic left heart syndrome and related single-ventricle lesions and to evaluate practice patterns in prenatal diagnosis, as well as the role of prenatal diagnosis in outcome.

Methods: Data from all live births with morphologic single right ventricle and systemic outflow obstruction screened for the Pediatric Heart Network's Single Ventricle Reconstruction Trial were used to investigate prenatal diagnosis and preoperative risk factors. Demographics, gestational age, prenatal diagnosis status, presence of major extracardiac congenital abnormalities, and preoperative mortality rates were recorded.