Acute outcomes of three-dimensional mapping for fluoroscopy reduction in paediatric catheter ablation for supraventricular tachycardia.

Background: Catheter ablation is a safe and effective therapy for the treatment of supraventricular tachycardia in children. Current improvements in technology have allowed progressive reduction in radiation exposure associated with the procedure. To assess the impact of three-dimensional mapping, we compared acute procedural results collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to published results from the Prospective Assessment after Pediatric Cardiac Ablation study.

Bubble bilevel ventilation facilitates gas exchange in anesthetized rabbits.

Background: Bubble continuous positive airway pressure is an established therapy for infants in respiratory distress. In resource-limited settings, few treatment options exist for infants requiring further respiratory support. A bubble bilevel device has been developed to provide nonelectric, time-cycled, pressure-limited respiratory support.

Frequency of CIED remote monitoring: A quality improvement follow-up study.

Background: Based on the findings of a prior study of CIED (Cardiac Implantable Electrical Device) remote monitoring (RM) frequency at the same center, the University of Michigan Congenital Heart Center (UMCHC) instituted a quality improvement (QI) change to reduce the frequency of routine CIED RM from every 2 months to every 3 months. The objective of this study is to determine the impact of this QI initiative to reduce workload without compromising patient care.

Methods: This is a single-center, retrospective cohort study of all UMCHC patients with CIEDs followed via Medtronic CareLink CIED remote monitoring system from July 2015 to June 2017, after the QI change in 2014.

Variation in Pediatric Post-Ablation Care: A Survey of the Pediatric and Congenital Electrophysiology Society (PACES).

Although catheter ablation is a standard treatment for pediatric arrhythmias, there are no consensus guidelines for follow-up care. This study describes the variation in post-ablation practices identified through a survey of the pediatric and congenital electrophysiology society (PACES). Pediatric and congenital electrophysiology society members were invited to participate in an online survey of post-ablation practices in September 2014.

Follow-Up of a Prospective Surgical Strategy to Prevent Intra-Atrial Reentrant Tachycardia After the Fontan Operation.

Background: Intra-atrial reentrant tachycardia (IART) after the Fontan operation had an early reported incidence of 10% to 35% during early and intermediate follow-up and posed substantial management challenges.

Methods And Results: To reduce the incidence of IART after the Fontan procedure, we performed a randomized, double-blind study to evaluate the impact of an incision in the right atrium joining the lateral tunnel suture line and the tricuspid valve annulus. Between March 1998 and September 2003, 134 subjects (median age: 1.

Transseptal access in pediatric and congenital electrophysiology procedures: defining risk.

Purpose: Transseptal puncture (TSP) is commonly used to access the left heart for catheter ablation procedures. The specific complication risk of this procedure has not been determined. This study assesses the risk of TSP using a single standard technique during electrophysiology study (EPS) in pediatrics and congenital heart disease (CHD).

Antitachycardia pacemakers in congenital heart disease.

Background: Many patients with congenital heart disease (CHD) acquire rhythm abnormalities related to their repair, most commonly intraatrial reentrant tachycardia (IART). Treatment of IART in CHD is often multifaceted, and may include medication, ablation, and pacing. Evidence regarding the use of antitachycardia pacing therapies is limited.

Cardiac implantable electronic device remote monitoring surveillance in pediatric and congenital heart disease: Utility relative to frequency.

Background: Heart Rhythm Society expert consensus provides recommendations for surveillance monitoring of cardiac implantable electronic devices (CIEDs), but limited data are available for the pediatric and congenital heart disease population.

Objective: The purpose of this study was to determine the rate of actionable events during CIED surveillance in this population, assess the utility of routine CIED remote monitoring, and assess the potential benefit from more frequent monitoring.

Methods: This was a retrospective cohort study of all CIED patients followed at a pediatric and congenital heart center and enrolled in the Medtronic Carelink system with either (1) a chronic (implanted for >6 months) CIED followed between July 1, 2010, and July 1, 2012, on a bimonthly schedule; or (2) a new CIED (implanted <6 months) between July 1, 2008, and July 1, 2012, followed on a monthly schedule.

Patient and Procedural Correlates of Fluoroscopy Use During Catheter Ablation in the Pediatric and Congenital Electrophysiology Lab.

Objective: To identify factors associated with fluoroscopy use in pediatric and congenital heart disease (CHD) patients.

Design: Retrospective cohort.

Setting: Pediatric electrophysiology lab in a single tertiary-care children's hospital.

Research accomplishments in pediatric electrophysiology: a historical review.

Arrhythmia management in young patients plays a small but important role within the broader discipline of cardiac electrophysiology (EP). By virtue of its sharp focus on developmental cardiology, congenital heart defects, and hereditary channelopathies, pediatric EP has contributed in significant ways to improved understanding of rhythm disorders in patients of all ages. Scientific progress in the field was recently reviewed at the 2012 meeting of the Heart Rhythm Society, where historical details of pioneering investigations in pediatric EP were highlighted.

Arrhythmogenic channelopathy syndromes presenting as refractory epilepsy.

Background: Children and young adults with potentially lethal cardiac channelopathies often present to medical care with a history of syncope or seizures due to episodic ventricular arrhythmias and associated cerebral hypoperfusion.

Methods: Two important types of genetic arrhythmia syndromes-long QT syndrome and catecholaminergic polymorphic ventricular tachycardia-are discussed using relevant case examples. The pathophysiology and distinguishing clinical features of these conditions are reviewed.

Verapamil in infants: an exaggerated fear?

The use of intravenous verapamil for tachyarrhythmia in infants is widely considered contraindicated due to the perceived risk of hemodynamic collapse after administration. This article reviews the relatively limited evidence that led to this well-known contraindication and highlights the interesting process by which medical practice may evolve in the absence of persuasive science.

Utility of intrathoracic impedance monitoring in pediatric and congenital heart disease.

Background: The utility of cardiac device-based intrathoracic monitoring (OptiVol, Medtronic Inc., Minneapolis, MN, USA) for congestive heart failure (CHF) exacerbation has not been evaluated in pediatric or congenital heart disease patients.

Methods: This was a retrospective study of all patients at a single center with an endocardial OptiVol capable device.

Implanted defibrillators in young hypertrophic cardiomyopathy patients: a multicenter study.

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, with an annual risk of sudden cardiac death (SCD) estimated at 1 %. Limited data are available regarding both the risk of SCD in the young HCM population and the use of implantable cardioverter-defibrillators (ICDs). This retrospective study included all patients with HCM who underwent ICD implantation for primary or secondary prevention of SCD before the age of 30 years at five institutions between 1995 and 2009.

Pattern of recovery for transient complete heart block after open heart surgery for congenital heart disease: duration alone predicts risk of late complete heart block.

Transient complete heart block (TCHB) is defined as complete interruption of atrioventricular conduction (AVC) after cardiac surgery followed by return of conduction. This study aimed to assess the risk for the development of late complete heart block (LCHB) after recovery of TCHB and to examine the electrocardiographic and electrophysiologic properties of the AVC system after TCHB. Of the 44 patients in this study who experienced TCHB, 37 recovered completely.

Novel ryanodine receptor 2 mutation associated with a severe phenotype of catecholaminergic polymorphic ventricular tachycardia.

An adolescent girl with a history of anxiety associated seizure-like episodes was ultimately diagnosed with catecholaminergic polymorphic ventricular tachycardia. She tested positive for a novel mutation of the ryanodine receptor. The report underscores how genetic arrhythmia syndromes may be mistaken for neurologic disorders.

Iatrogenic atrioventricular reentrant tachycardia following Bjork/Fontan palliation of tricuspid atresia: Electro-anatomic mapping, ablation, review and possible mechanism.

This case report describes the successful ablation of an iatrogenic accessory pathway in a Fontan patient. A 15-year-old girl with tricuspid atresia was palliated with a Bjork modification Fontan procedure; six years later she developed supraventricular tachycardia. Electro-anatomic mapping during electrophysiology study localized a concealed iatrogenic atrioventricular accessory pathway and facilitated successful ablation using radiofrequency energy.

Cryoablation therapy for atrioventricular nodal reentrant tachycardia in children: a multicenter experience of efficacy.

Atrioventricular nodal reentrant tachycardia (AVNRT), a common tachycardia in children, is routinely treated by catheter ablation using radiofrequency or cryothermal energy. Acute success rates of 95-97 % are reported for cryoablation, similar to those achieved with radiofrequency ablation (RFA). However, early studies reported higher recurrence rates after cryoablation for treatment of AVNRT than those reported for RFA.

Multicenter study of the effectiveness of implantable cardioverter defibrillators in children and young adults with heart disease.

Implantable cardioverter defibrillators (ICDs) are being used with increasing frequency in children and young adults. Our aim was to examine the appropriateness and frequency of ICD discharges in children and young adults, to compare the effectiveness of ICDs when placed for primary or secondary prevention, and to provide time-dependent analysis of ICD discharges. Data were collected from seven institutions on 210 patients <30 years of age who underwent ICD implantation from October 1992 to January 2007.

Experience with CartoSound for arrhythmia ablation in pediatric and congenital heart disease patients.

Purpose: Electro-anatomic mapping (EAM) has been used for more than a decade to assist in defining arrhythmia propagation for transcatheter ablation. Intra-cardiac echocardiography (ICE) has also gained acceptance as an adjunct to further define intracardiac anatomy. The integration of these two technologies (CartoSound, Biosense-Webster, Diamond Bar, CA, USA) is a recent development.

Inappropriate ICD discharges in single-chamber versus dual-chamber devices in the pediatric and young adult population.

Background: Implantable cardioverter defibrillator (ICD) use is increasing in young patients and is frequently complicated by inappropriate device discharges (IDs), leading to discomfort, anxiety and, potentially, proarrhythmia. Dual-chamber (DC) ICDs may decrease IDs by improving rhythm discrimination, but are associated with increased size, expense, and implant complications. We examined whether the frequency of IDs was the same in dual- and single-chamber (SC) ICDs in young patients.

Sensitivity and specificity of an automated external defibrillator algorithm designed for pediatric patients.

Objective: Electrocardiographic (ECG) rhythm analysis algorithms for cardiac rhythm analysis in automated external defibrillators (AEDs) have been tested against pediatric patient rhythms (patients < or = 8 years old) using adult ECG algorithm criteria. However these adult algorithms may fail to detect non-shockable pediatric tachycardias because they do not account for the difference in the rates of normal sinus rhythm and typical tachyarrhythmias in childhood.

Methods: This study was designed to define shockable and non-shockable rhythm detection criteria specific to pediatric patients to create a pediatric rhythm database of annotated rhythms, to develop a pediatric-based AED rhythm analysis algorithm, and to test the algorithm's accuracy.