Intra-operative arrhythmia predicts post-operative arrhythmia and the need for temporary pacing wires.

Objective: Protocols for the placement of temporary pacing wires vary among institutions. Our current protocol is to selectively place temporary pacing wires in those patients who develop haemodynamically significant intra-operative arrhythmia. We wished to identify how effective our current protocol is at identifying who will develop post-operative arrhythmia and need temporary pacing wires.

Progression to late complete atrioventricular block following amplatzer device closure of atrial septal defect in a child.

Atrial septal defect (ASD) closure by interventional catheterization techniques has been widely accepted and is considered a standard treatment for this congenital heart defect. We report the case of a 6-year-old girl who presented with progression of first-degree atrio-ventricular (AV) block to symptomatic, complete heart block after ASD closure with an Amplatzer septal occluder (ASO). Although she received steroids immediately after the procedure when second-degree AV block was seen, her AV conduction slowly deteriorated over 4 years, requiring permanent pacemaker implantation.

Transthoracic percutaneous access for electroanatomic mapping and catheter ablation of atrial tachycardia in patients with a lateral tunnel Fontan.

Background: The incidence of atrial tachycardia following Fontan surgery is high, but access to the pulmonary venous atrium, a frequent site of arrhythmia origin, is limited.

Objectives: The purpose of this study is to report our results with a novel transthoracic percutaneous technique that provides direct access to the pulmonary venous atrium for electrophysiologic procedures.

Methods: Six transthoracic ablation procedures were performed in five patients (age 1.

Cardiac arrhythmias in the human fetus.

Fetal cardiac arrhythmias have been recognized with increasing frequency during the past several years. Most fetal arrythmias are intermittent extrasystoles, often presenting as irregular pauses of rhythm. These are significant only when they occur with appropriate timing to initiate sustained tachycardia, mediated by anatomic bypass pathways.

Endocardial atrial pacing lead implantation and midterm follow-up in young patients with sinus node dysfunction after the fontan procedure.

The purpose of the study was to investigate the results of endocardial lead implantation, lead performance, and follow-up in young patients after the Fontan procedure. A retrospective study was conducted with patients who had endocardial atrial pacing for SND and intact AVN function after Fontan from two pediatric centers. Patient demographics, pacing, and sensing data of endocardial atrial leads were analyzed at the time of pacemaker implantation and follow-up visits.

Severe obesity associated with cardiovascular deconditioning, high prevalence of cardiovascular risk factors, diabetes mellitus/hyperinsulinemia, and respiratory compromise.

Objective: To determine the extent and severity of obesity-related cardiorespiratory morbidity in children with body mass index (BMI) >or=40 kg/m(2).

Study Design: Cross-sectional analysis of a cohort comprised of 48 boys and girls aged 8 to 17 years with BMI >or=40 kg/m(2). Cardiorespiratory fitness (graded cycle exercise test), left ventricular (LV) mass (echocardiography), blood pressure, fasting lipid profile, fasting insulin, fasting glucose, HbA1c, and pulmonary function (spirometry and sleep studies) were measured.

Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors.

Context: Low cardiorespiratory fitness is an established risk factor for cardiovascular and total mortality; however, mechanisms responsible for these associations are uncertain.

Objective: To test whether low fitness, estimated by short duration on a maximal treadmill test, predicted the development of cardiovascular disease risk factors and whether improving fitness (increase in treadmill test duration between examinations) was associated with risk reduction.

Design, Setting, And Participants: Population-based longitudinal cohort study of men and women 18 to 30 years of age in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Late recovery of surgically-induced atrioventricular block in patients with congenital heart disease.

Objectives: To assess the incidence and establish possible predictors of late recovery of post-surgical heart block, treated with pacemaker implantation, in patients with congenital heart defects.

Background: The American College of Cardiology/American Heart Association Task Force has recommended pacemaker implantation for advanced second or third degree atrioventricular block which persists for 7 to 14 days after surgery. The incidence of late recovery of post-surgical heart block following pacemaker implantation has not been reported.

Ectopic cardiac calcification associated with hyperparathyroidism in a boy with hypophosphatemic rickets.

An adolescent with hypophosphatemic rickets developed cardiac calcifications in the absence of hypercalcemia or elevation of the phosphocalcic product (the product of the total serum calcium and phosphorus concentrations). Cardiac calcifications led to aortic and mitral valve dysfunction, myocardial calcification, and arrhythmia. Hyperparathyroidism probably played a significant role in the development of this complication, which emphasizes the necessity for intermittent assessment of parathyroid status in individuals receiving medical therapy for hypophosphatemic rickets.

Preterm infants with paroxysmal supraventricular tachycardia: presentation, response to therapy, and outcome.

Objectives: We investigated the clinical course of preterm infants with paroxysmal supraventricular tachycardia in comparison to their term counterparts.

Background: Paroxysmal supraventricular tachycardia (PSVT) is the most common arrhythmia in childhood. It is known to cause significant morbidity and rarely mortality, most commonly in infants.

Evaluation and treatment of other arrhythmic causes of syncope in children and adolescents with an apparently normal heart: Wolff-Parkinson-White syndrome and right ventricular cardiomyopathy.

Syncope could be a symptom of tachyarrhythmias related to the Wolff-Parkinson-White syndrome, or the consequence of the ventricular tachycardias seen in patients with Arrhythmogenic Right Ventricular Cardiomyopathy. Syncope should be considered the consequence of atrial fibrillation or flutter, with rapid conduction over the accessory atrioventricular connection in Wolff-Parkinson-White syndrome, and these patients are at risk of presenting with ventricular fibrillation and sudden death. Radiofrequency ablation of the anomalous, accessory connection, which can be performed with high success and low complication rates, should be the first line of treatment for symptomatic children and adolescents with Wolff-Parkinson-White.

Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela.

Objective: We report 16 infants with complete congenital heart block (CHB) who developed late-onset dilated cardiomyopathy despite early institution of cardiac pacing.

Background: Isolated CHB has an excellent prognosis following pacemaker implantation. Most early deaths result from delayed initiation of pacing therapy or hemodynamic abnormalities associated with congenital heart defects.

Recent developments in the etiology, evaluation, and management of the child with palpitations.

The field of arrhythmias in children has recently seen major advances in several aspects, including diagnosis (event monitoring systems) and treatment (very effective acute and long-term medications) and, more importantly, in the definitive cure of supraventricular tachycardia with the use of catheter ablation techniques. These procedures are very successful and can be performed with a low complication rate. The indications for radiofrequency ablation are expanding and the technical aspects improving rapidly, so a larger number of patients will benefit from this curative treatment.

Amiodarone induced pulmonary fibrosis in infancy.

We report a case of pulmonary fibrosis in an infant receiving amiodarone for treatment of intractable atrioventricular reentrant tachycardia secondary to Wolff-Parkinson-White syndrome. At 9 months, a screening chest radiograph showed a diffuse interstitial infiltrate in an asymptomatic, thriving infant. Amiodarone was discontinued and the pulmonary fibrosis resolved gradually over 6 months.

Single coronary artery complicating stent implantation for homograft stenosis in tetralogy of Fallot.

Successful stent implantation for conduit stenosis has been described; however, this procedure may be complicated by compression of adjacent structures during expansion. We report on a rare case of a single right coronary artery system complicating stent implantation for relief of homograft stenosis in tetralogy of Fallot.

Cardiovascular abnormalities in patients with X-linked hypophosphatemia.

Treatment for X-linked hypophosphatemia (XLH; vitamin D metabolites and phosphate salts) may result in hypercalcemia, hypercalciuria, nephrocalcinosis, and hyperparathyroidism. Cardiovascular abnormalities occur in association with these complications, but have not been reported in XLH. We hypothesized that such abnormalities may occur in XLH and evaluated cardiovascular status in 13 patients with this disease.

The role of surgical ligation of patent ductus arteriosus in the era of the Rashkind device.

Background: The role of surgery in managing patent ductus arteriosus (PDA) was studied in the era of the Rashkind double-umbrella device.

Methods: All 354 patients with PDA referred to our center in a 5-year period were included in this report. Of the 354 patients, 236 underwent cardiac catheterization with the intent of transcatheter PDA closure, and 118 had surgical intervention.

[Multiple pathway tachycardias: electrophysiological properties and fulguration of accessory pathways in 2 cases].

We report two patients (male, 35 and female, 28 years old) with recurrent and refractory tachycardias referred for an electrophysiological study. EKG showed left lateral accessory pathway in both, two tachycardias with identical morphology but with different frequency and activation sequence were detected. One was orthodromic with anterograde conduction by the His-Purkinje budle and retrograde by the accessory pathway and the other with slow nodal anterograde conduction.

Anomalous left coronary artery from the main pulmonary trunk: physiologic and clinical importance of its association with persistent ductus arteriosus.

Anomalous left coronary artery (ALCA) from the pulmonary trunk presents in early infancy with a clinical picture of failure to thrive, congestive heart failure (CHF), angina-like episodes, and mitral insufficiency. These manifestations which are due to myocardial ischemia may change in the presence of an associated lesion. We present a case and review two previous reports of a patent ductus arteriosus (PDA) associated with this anomaly.