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Riedy M, Zhang JF, Huang T, Swayampakula AK. Infantile-onset Pompe disease with neutropenia: Treatment decisions in the face of a unique phenotype. JIMD Rep 2023; 64:17-22. [PMID: 36636589 PMCID: PMC9830011 DOI: 10.1002/jmd2.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 02/01/2023] Open
Abstract
Infantile-onset Pompe disease manifests with early signs of cardiomyopathy during the first few days to weeks of life. We present the case of a newborn born via emergency cesarean section with atrial flutter and moderate biventricular hypertrophy who was diagnosed with Pompe disease on New York State newborn screen. Diagnosis was confirmed with repeat leukocyte acid alpha-glucosidase (GAA) enzyme activity, GAA gene sequencing, urine Hex4, and evaluation of Cross-Reactive Immunological Material (CRIM) status. The patient was also found to be persistently neutropenic which to our knowledge has not been previously reported in the literature in association with Pompe disease. This report highlights the impact that newborn screening had on time to diagnosis and initiation of treatment with enzyme replacement therapy. We also discuss how our patient's concurrent neutropenia impacted decision making related to immune tolerance induction prior to starting enzyme replacement therapy.
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Affiliation(s)
- Mary Riedy
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | - Jeff F. Zhang
- Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | - Taosheng Huang
- Division of Genetics, Department of PediatricsUniversity at BuffaloBuffaloNew YorkUSA
| | - Anil Kumar Swayampakula
- Division of Critical Care Medicine, Department of Pediatrics, John R. Oishei Children's HospitalUniversity at BuffaloBuffaloNew YorkUSA
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Menzele A, Aboalgasm H, Ballo R, Gwanyanya A. Hyperglycaemia-induced impairment of the autorhythmicity and gap junction activity of mouse embryonic stem cell-derived cardiomyocyte-like cells. Histochem Cell Biol 2022; 159:329-337. [PMID: 36547741 DOI: 10.1007/s00418-022-02170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
Diabetes mellitus with hyperglycaemia is a major risk factor for malignant cardiac dysrhythmias. However, the underlying mechanisms remain unclear, especially during the embryonic developmental phase of the heart. This study investigated the effect of hyperglycaemia on the pulsatile activity of stem cell-derived cardiomyocytes. Mouse embryonic stem cells (mESCs) were differentiated into cardiac-like cells through embryoid body (EB) formation, in either baseline glucose or high glucose conditions. Action potentials (APs) were recorded using a voltage-sensitive fluorescent dye and gap junction activity was evaluated using scrape-loading lucifer yellow dye transfer assay. Molecular components were detected using immunocytochemistry and immunoblot analyses. High glucose decreased the spontaneous beating rate of EBs and shortened the duration of onset of quinidine-induced asystole. Furthermore, it altered AP amplitude, but not AP duration, and had no impact on neither the expression of the hyperpolarisation-activated cyclic nucleotide-gated isoform 4 (HCN4) channel nor on the EB beating rate response to ivabradine nor isoprenaline. High glucose also decreased both the intercellular spread of lucifer yellow within an EB and the expression of the cardiac gap junction protein connexin 43 as well as upregulated the expression of transforming growth factor beta 1 (TGF-β1) and phosphorylated Smad3. High glucose suppressed the autorhythmicity and gap junction conduction of mESC-derived cardiomyocytes, via mechanisms probably involving TGF-β1/Smad3 signalling. The results allude to glucotoxicity related proarrhythmic effects, with potential clinical implications in foetal diabetic cardiac disease.
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Affiliation(s)
- Amanda Menzele
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Hamida Aboalgasm
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Robea Ballo
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Asfree Gwanyanya
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
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3
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Drago F, Tamborrino PP. Atrial Flutter in Pediatric Patients. Card Electrophysiol Clin 2022; 14:495-500. [PMID: 36153129 DOI: 10.1016/j.ccep.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atrial flutter (AFL) in pediatric patients is a rare condition as the physical dimensions of the immature heart are inadequate to support the arrhythmia. This low incidence makes it difficult for patients in this particular setting to be studied. AFL accounts for 30% of fetal tachyarrhythmias, 11% to 18% of neonatal tachyarrhythmias, and 8% of supraventricular tachyarrhythmias in children older than 1 year of age. Transesophageal overdrive pacing can be used, instead, with lower success rate (60%-70%). The recommended drugs are digoxin which can decrease the ventricular rate until the spontaneous interruption of the AFL. Digoxin can be combined with flecainide or amiodarone in case of failure.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza S. Onofrio 4, Rome 00165, Italy.
| | - Pietro Paolo Tamborrino
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza S. Onofrio 4, Rome 00165, Italy
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4
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Park SH, Lim G, Oh KW, Ko JK. Neonatal Atrial Flutter: Clinical Characteristics of 14 Cases in a Single Center. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.3.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: Atrial flutter is an uncommon arrhythmia in the neonatal period. This study aimed to describe the cause and clinical course of atrial flutter in neonates.Methods: The medical records of 14 patients diagnosed with atrial flutter at Ulsan University Hospital Neonatal Intensive Care Unit (NICU) between March 2008 and August 2020 were reviewed retrospectively.Results: All 14 cases occurred on the first day of birth. Of these, two were term infants, and 12 were preterm infants. Causes of atrial flutter included three cases of the umbilical venous catheter misplacement, one with a diabetic mother, and one ivolving atrial flutter after an intravenous aminophylline injection. Thirteen patients had structurally normal hearts with no congenital heart diseases. The patient, born to a diabetic mother, had an atrial septal defect and ventricular hypertrophy. Adenosine was administered first to differentiate it from paroxysmal supraventricular tachycardia. Synchronized cardioversion was attempted in 11 patients, while one received it after an esmolol injection that failed to convert to sinus rhythm. One patient had a recurrence after the intrusion of a peripherally inserted central catheter; however, atrial flutter disappeared after repositioning it. No patient had a recurrence after discharge.Conclusion: Neonatal atrial flutter is a rare tachyarrhythmia with the risk factors often unknown; however, it could occur in structural heart disease, mispositioning of the umbilical venous catheter, and if the mother has diabetes. During umbilical venous catheterization, clinicians should be cautious and ensure appropriate monitoring of infants in the NICU as it may cause complications.
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Chen H, Ma Y, Wang Y, Luo H, Xiao Z, Chen Z, Liu Q, Xiao Y. Progress of Pathogenesis in Pediatric Multifocal Atrial Tachycardia. Front Pediatr 2022; 10:922464. [PMID: 35813391 PMCID: PMC9256911 DOI: 10.3389/fped.2022.922464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
Abstract
Multifocal atrial tachycardia (MAT) is defined as irregular P-P, R-R, and P-R intervals, isoelectric baseline between P waves, and ventricular rate over 100 beats/min. Although the prognosis of pediatric MAT in most patients is favorable, adverse outcomes of MAT have been reported, such as cardiogenic death (3%), respiratory failure (6%), or persistent arrhythmia (7%), due to delayed diagnosis and poorly controlled MAT. Previous studies demonstrated that pediatric MAT is associated with multiple enhanced automatic lesions located in the atrium or abnormal automaticity of a single lesion located in the pulmonary veins via multiple pathways to trigger electrical activity. Recent studies indicated that pediatric MAT is associated with the formation of a re-entry loop, abnormal automaticity, and triggering activity. The occurrence of pediatric MAT is affected by gestational disease, congenital heart disease, post-cardiac surgery, pulmonary hypertension, and infectious diseases, which promote MAT via inflammation, redistribution of the autonomic nervous system, and abnormal ion channels. However, the pathogenesis of MAT needs to be explored. This review is aimed to summarize and analyze the pathogenesis in pediatric MAT.
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Affiliation(s)
- Huaiyang Chen
- Academy of Pediatrics, University of South China, Changsha, China.,Hunan Children's Hospital, Changsha, China
| | - Yingxu Ma
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Haiyan Luo
- Hunan Children's Hospital, Changsha, China
| | - Zhenghui Xiao
- Academy of Pediatrics, University of South China, Changsha, China.,Hunan Children's Hospital, Changsha, China
| | - Zhi Chen
- Hunan Children's Hospital, Changsha, China
| | - Qiming Liu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yunbin Xiao
- Academy of Pediatrics, University of South China, Changsha, China.,Hunan Children's Hospital, Changsha, China
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Braginsky L, Weiner SJ, Saade GR, Varner MW, Blackwell SC, Reddy UM, Thorp JM, Tita AT, Miller RS, McKenna DS, Chien EK, Rouse DJ, El-Sayed YY, Sorokin Y, Caritis SN. Intrapartum Fetal Electrocardiogram in Small- and Large-for-Gestational Age Fetuses. Am J Perinatol 2021; 38:1465-1471. [PMID: 34464982 PMCID: PMC8608729 DOI: 10.1055/s-0041-1735285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether intrapartum fetal electrocardiogram (ECG) tracings with ST-elevation or depression occur more frequently in each stage of labor in small-for-gestational age (SGA) or large-for-gestational age (LGA), as compared with appropriate-for-gestational age (AGA) fetuses. STUDY DESIGN We conducted a secondary analysis of a large, multicenter trial in which laboring patients underwent fetal ECG waveform-analysis. We excluded participants with diabetes mellitus and major fetal anomalies. Birth weight was categorized as SGA (<10th percentile), LGA (>90th percentile), or AGA (10-90th percentile) by using a gender and race/ethnicity specific nomogram. In adjusted analyses, the frequency of ECG tracings with ST-depression or ST-elevation without depression was compared according to birthweight categories and labor stage. RESULTS Our study included 4,971 laboring patients in the first stage and 4,074 in the second stage. During the first stage of labor, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (6.7 vs. 5.5%; adjusted odds ratio [aOR]: 1.41, 95% confidence interval [CI]: 0.93-2.13), or in ST-elevation without depression (35.8 vs. 34.1%; aOR: 1.17, 95% CI: 0.94-1.46). During the second stage, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (1.6 vs. 2.0%; aOR: 0.69, 95% CI: 0.27-1.73), or in ST-elevation without depression (16.2 vs. 18.1%; aOR: 0.90, 95% CI: 0.67-1.22). During the first stage of labor, there were no differences in the frequency of ST-depression in LGA fetuses compared with AGA fetuses (6.3 vs. 5.5%; aOR: 0.97, 95% CI: 0.60-1.57), or in ST-elevation without depression (33.1 vs. 34.1%; aOR: 0.80, 95% CI: 0.62-1.03); during the second stage of labor, the frequency of ST-depression in LGA compared with AGA fetuses (2.5 vs. 2.0%, aOR: 1.36, 95% CI: 0.61-3.03), and in ST-elevation without depression (15.5 vs. 18.1%; aOR: 0.83, 95% CI: 0.58-1.18) were similar as well. CONCLUSION The frequency of intrapartum fetal ECG tracings with ST-events is similar among SGA, AGA, and LGA fetuses. KEY POINTS · SGA and LGA neonates are at increased risk of cardiac dysfunction.. · Fetal ECG has been used to evaluate fetal response to hypoxia.. · Fetal ST-elevation and ST-depression occur during hypoxia.. · Frequency of intrapartum ST-events is similar among SGA, AGA and LGA fetuses..
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Affiliation(s)
- Lena Braginsky
- Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Steven J. Weiner
- Departments of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, District of Columbia
| | - George R. Saade
- Departments of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Michael W. Varner
- Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Sean C. Blackwell
- Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas
| | - Uma M. Reddy
- Departments of Obstetrics and Gynecology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - John M. Thorp
- Departments of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan T.N. Tita
- Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell S. Miller
- Departments of Obstetrics and Gynecology, Columbia University, New York City, New York
| | - David S. McKenna
- Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Edward K.S. Chien
- Departments of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
| | - Dwight J. Rouse
- Departments of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Yasser Y. El-Sayed
- Departments of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Yoram Sorokin
- Departments of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Steve N. Caritis
- Departments of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
Abstract
Introduction: The incidence of cardiac arrhythmia is approximately 1% in the neonatal period and 1–3% in late pregnancy. Atrial flutter (AF), a rhythm disorder based on the mechanism of reentry, represents approximately 32% of all neonatal cardiac arrhythmias. In the majority of cases, the flutter is converted to sinus rhythm using antiarrhythmic drugs, transesophageal overdrive pacing, or synchronized electrical cardioversion.
Case presentation: We present a case of a born on term, female infant who was noted to be tachycardic on the fetal monitor. Clinical examination revealed tachypnea and tachycardia with dysrhythmia, at a heart rate of 250 bpm. Electrocardiography showed AF with 2–3 : 1 atrioventricular conduction (atrial and ventricular rates were 350 bpm and 250–275 bpm, respectively). Echocardiography revealed no relevant structural disease. Therapy with amiodarone and prophylactic anticoagulant was initiated. As no control of ventricular rate was obtained and a succession of three ventricular extrasystoles was noted on the surface ECG, propranolol therapy was initiated, without success. Therefore, synchronized electrical cardioversion was applied, with conversion to sinus rhythm at a heart rate of 136 bpm. The neonate was discharged in good condition.
Conclusions: AF is one of the most common high ventricular rate arrhythmias during fetal age. Uncontrolled AF may precipitate heart failure, and prompt restoration to sinus rhythm may require electrical cardioversion in cases refractory to anti-arrhythmic drugs, in order to prevent possible complications.
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Falqui SG, Bardanzellu F, Mecarini F, Fanos V, Neroni P. Could the E/A ratio be included in the cardiological evaluation of the offspring of diabetic mothers? A case-control study in South Sardinia. J Matern Fetal Neonatal Med 2020; 35:2741-2750. [PMID: 32757681 DOI: 10.1080/14767058.2020.1798397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Diabetes mellitus (DM) is a chronic disease widespread in the world. Sardinia represents, together with Finland, the region with the highest incidence of type 1 DM (DM1), as well as a high prevalence of gestational DM (GDM). Despite the improvement in obstetric surveillance, perinatal and long-term adverse outcomes are still frequent in the offspring of diabetic mothers. During gestations complicated by DM, fetal heart is one of the most affected organ potentially undergoing structural heart defects or several degrees of fetal myocardium hypertrophy and impaired cardiac function. AIM The aim of our study was to evaluate, through echocardiographic examination, cardiac features and performance in a South Sardinian population of newborns of diabetic mothers comparing them to a group of control subjects. CONCLUSIONS In our sample, the E/A ratio resulted a significant marker of early diastolic dysfunction in asymptomatic neonates born by diabetic mothers, even if such result should be confirmed on larger samples.
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Affiliation(s)
- Stella Giulia Falqui
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
| | - Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
| | - Federico Mecarini
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
| | - Paola Neroni
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
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Wójtowicz-Marzec M, Wysokińska B, Respondek-Liberska M. Successful treatment of neonatal atrial flutter by synchronized cardioversion: case report and literature review. BMC Pediatr 2020; 20:370. [PMID: 32758206 PMCID: PMC7409680 DOI: 10.1186/s12887-020-02259-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/27/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Atrial flutter (AFL) is a supraventricular tachyarrhythmia. In the ECG tracing, it is marked by a fast, irregular atrial activity of 280-500 beats per minute. AFL is known to be a rare and also life-threatening rhythm disorder both at the fetus and neonatal period. AFL may result in circulatory failure, and in a more severe form, it may lead to a non-immune fetal hydrops. However, with early prenatal diagnosis and proper treatment, the majority of AFL cases show a good prognosis. CASE PRESENTATION We report a case of a neonate who was born at 34 weeks of gestational age by C-section because of risk for birth asphyxia, based on abnormal CTG tracing, which had no characteristic rhythms for fetal decelerations. A third day his heart rate was 220/bpm. ECG has shown supraventricular tachycardia with narrow QRS. The administration of adenosine resulted in the obvious appearance of "sawtooth wave" typical for AFL. Arrhythmia was resistant to the therapy of amiodaron. Then cardioversion was performed and the rhythm converted to normal. CONCLUSIONS As neonatal AFL might be resistant to conventional pharmacotherapy, one needs to remember about the possibility of electrical cardioversion in the pediatric cardiology referral center. Moreover, CTG monitoring is of limited use because it does not record fetal heart rhythms > 200/min and echocardiography at the reference center is practically the only method to monitor the condition of the fetus with abnormal rapid heart rhythm.
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Affiliation(s)
- Monika Wójtowicz-Marzec
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland
| | - Barbara Wysokińska
- Department of Paediatric Cardiology, Medical University of Lublin, Prof. A. Gębali 6, 20-093 Lublin, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Department for Fetal Malformations Diagnoses & Prevention, Medical University of Lodz, Rzgowska 281/289, 93-338 Łódź, Poland
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Pessa Valente F, Henrique Belarmino Góes G, Bernardi Fabro C, Luiz Tavares Albuquerque A, Celestino Sobral Filho D. Abordagem de Flutter Atrial Neonatal: Uma Série de Casos. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v32n4.115_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objetivo: Este estudo teve como objetivo analisar as opções terapêuticas dos pacientes com flutter atrial (FLA) neonatal, considerando os métodos diagnósticos disponíveis e o prognóstico desses pacientes. Metodologia: Foi realizado um estudo retrospectivo através da revisão dos prontuários de uma série de sete pacientes com fibrilação atrial (FA) diagnosticada durante o período fetal ou neonatal. O tempo de seguimento desses pacientes variou de 7 meses a 3 anos e 8 meses (média: 1 ano). Os dados clínicos para o diagnóstico incluíram frequência cardíaca sustentada superior a 180 bpm, que foi confirmada em todos os pacientes por um eletrocardiograma de 12 derivações. Resultados: Quatro (57,1%) dos sete pacientes estudados eram do sexo masculino. A maioria dos pacientes revelou arritmia cardíaca durante o período intrauterino, quando examinados por ultrassom fetal no terceiro trimestre de gestação (5 pacientes, ou seja 71,2%). Apenas à mãe do Paciente 2 foi administrada digoxina antes do parto. A taxa atrial da taquiarritmia revelou uma média de 375 bpm, com um aumento de até 500 bpm. A condução atrioventricular apresentou uma relação de 2:1 em todos os pacientes, com variações de 3:1 e 4:1 observadas nos Pacientes 1, 3 e 6. A frequência ventricular variou de 188 a 250 bpm. Todos os pacientes revelaram características típicas e anti-horárias do eletrocardiograma. A cardioversão elétrica sincronizada foi o tratamento de escolha em 6 pacientes (85,7%), com uma dose de 1 J/kg. Conclusão: Diagnóstico precoce, tratamento prévio e cardioversão elétrica sincronizada indicam um excelente prognóstico, e o tratamento de manutenção prolongada pode ser desnecessário.
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Pessa Valente F, Henrique Belarmino Góes G, Bernardi Fabro C, Luiz Tavares Albuquerque A, Celestino Sobral Filho D. Abordagem de Flutter Atrial Neonatal: Uma Série de Casos. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v32n4.3293_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objetivo: Este estudo teve como objetivo analisar as opções terapêuticas dos pacientes com flutter atrial (FLA) neonatal, considerando os métodos diagnósticos disponíveis e o prognóstico desses pacientes. Metodologia: Foi realizado um estudo retrospectivo através da revisão dos prontuários de uma série de sete pacientes com fibrilação atrial (FA) diagnosticada durante o período fetal ou neonatal. O tempo de seguimento desses pacientes variou de 7 meses a 3 anos e 8 meses (média: 1 ano). Os dados clínicos para o diagnóstico incluíram frequência cardíaca sustentada superior a 180 bpm, que foi confirmada em todos os pacientes por um eletrocardiograma de 12 derivações. Resultados: Quatro (57,1%) dos sete pacientes estudados eram do sexo masculino. A maioria dos pacientes revelou arritmia cardíaca durante o período intrauterino, quando examinados por ultrassom fetal no terceiro trimestre de gestação (5 pacientes, ou seja 71,2%). Apenas à mãe do Paciente 2 foi administrada digoxina antes do parto. A taxa atrial da taquiarritmia revelou uma média de 375 bpm, com um aumento de até 500 bpm. A condução atrioventricular apresentou uma relação de 2:1 em todos os pacientes, com variações de 3:1 e 4:1 observadas nos Pacientes 1, 3 e 6. A frequência ventricular variou de 188 a 250 bpm. Todos os pacientes revelaram características típicas e anti-horárias do eletrocardiograma. A cardioversão elétrica sincronizada foi o tratamento de escolha em 6 pacientes (85,7%), com uma dose de 1 J/kg. Conclusão: Diagnóstico precoce, tratamento prévio e cardioversão elétrica sincronizada indicam um excelente prognóstico, e o tratamento de manutenção prolongada pode ser desnecessário.
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12
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Pessa Valente F, Henrique Belarmino Góes G, Bernardi Fabro C, Luiz Tavares Albuquerque A, Celestino Sobral Filho D. Neonatal Atrial Flutter Approach: A Case Series. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v32n4.3293_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: This study set out to analyze the therapeutic options of patients with neonatal atrial flutter (AFL), considering the diagnostic methods available and the prognosis of these patients. Methodology: A retrospective study was performed by reviewing the medical records of a series of seven patients with atrial fibrillation (AF) diagnosed during fetal or neonatal period. The follow-up time of these patients ranged from 7 months to 3 years and 8 months (mean: 1 year). The clinical data for the diagnosis included sustained heart rate greater than 180 bpm, which was confirmed in all patients by a 12-lead electrocardiogram. Results: Four (57.1%) of the 7 patients studied were male. Most of the patients revealed cardiac arrhythmia during the intrauterine period when screened by fetal ultrasound in the third trimester of gestation (5 patients, i.e. 71.2%). Only the mother of Patient 2 was administered digoxin before childbirth. The atrial rate of the tachyarrhythmia revealed a mean of 375 bpm, with an increase of up to 500 bpm. Atrioventricular conduction presented a 2:1 ratio in all patients, with variations of 3:1 and 4:1 observed in Patients 1, 3 and 6. The ventricular rate ranged from 188 to 250 bpm. All patients revealed typical and counter-clockwise electrocardiogram characteristics. Synchronized electrical cardioversion was the treatment of choice in 6 patients (85.7%), with a dose of 1 J/kg. Conclusion: Early diagnosis, prior treatment, and synchronized electrical cardioversion indicate an excellent prognosis, and prolonged maintenance treatment may be unnecessary.
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Abstract
Fetal cardiac abnormalities are some of the commonest congenital disorders seen in prenatal life. They can be anatomical or functional and can develop de novo or as a consequence of either maternal or fetal disease. Untreated, morbidity and mortality rates are high for hypoplastic left heart disorders and for some fetal tachy and bradyarrhythmias. Optimum management strategies are often not clear because of the lack of knowledge about the precise natural history of some of these conditions. Prenatal therapy ranges from invasive fetal cardiac intervention to maternal administration of drugs for transplacental transfer to the fetus. This comprehensive review covers many fetal cardiac disorders and various prenatal therapeutic options that are available.
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Affiliation(s)
- Sailesh Kumar
- a Mater Research Institute / University of Queensland , Brisbane , Australia.,b Mater Centre for Maternal Fetal Medicine , Mater Mothers' Hospital , Brisbane , Australia.,c Faculty of Medicine , the University of Queensland , Brisbane , Australia
| | - Jade Lodge
- b Mater Centre for Maternal Fetal Medicine , Mater Mothers' Hospital , Brisbane , Australia
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14
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Abstract
Atrial flutter (AF) is an uncommon neonatal tachyarrhythmia that can present during the first few days after birth. The infant with AF may demonstrate an abrupt increase in heart rate greater than 220 bpm that is sustained despite vagal maneuvers. The diagnosis is made by electrocardiogram (ECG), and the treatments may include medication management and cardioversion. We present a case review of an infant diagnosed with AF and describe the incidence, pathophysiology, diagnosis, and management.
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15
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Schierz IAM, Pinello G, Piro E, Giuffrè M, La Placa S, Corsello G. Transitional hemodynamics in infants of diabetic mothers by targeted neonatal echocardiography, electrocardiography and peripheral flow study. J Matern Fetal Neonatal Med 2017; 31:1578-1585. [PMID: 28412852 DOI: 10.1080/14767058.2017.1320544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Metabolic alterations of intrauterine environment in diabetes mellitus (DM) lead to fetal cardiac dysfunctions that can persist after birth. The aim of the study was to assess the cardiovascular adaptation in infants born to diabetic mothers (IDM) with different degrees of glycometabolic control, in relation to revised guidelines for diagnosis of DM and quality improvements in neonatal care. MATERIALS AND METHODS An observational case-control study was conducted on IDM with gestational, type 1 and type 2 DM. Relevant maternal and neonatal anamnestic, clinical and laboratory data were analyzed. Electrocardiographic and echocardiographic analyses, including structural and systo-diastolic evaluation, were performed. RESULTS In 68 IDM enrolled, we observed a lower incidence of negative perinatal outcome than expected. Comparing to non-IDM, they presented larger fetal shunts, higher pulmonary pressures, early and atrial wave velocities. At 72 hours, kinesis and heart rate variability remained low. Cerebral blood flow velocities were higher. The most serious impairment of transition was in pregestational IDM. CONCLUSION Maternal DM impaired neonatal transitional hemodynamics also in asymptomatic IDM with good glycometabolic control. These results confirm the need for an early cardiologic and cerebrovascular evaluation, to identify IDM with delayed maturation at risk of worse long-term metabolic, cardiovascular, and neurodevelopmental outcome.
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Affiliation(s)
- Ingrid Anne Mandy Schierz
- a Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Giuseppa Pinello
- a Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Ettore Piro
- a Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Mario Giuffrè
- a Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Simona La Placa
- a Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
| | - Giovanni Corsello
- a Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro" , University of Palermo , Palermo , Italy
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de Almeida MM, Tavares WGDS, Furtado MMAA, Fontenele MMFT. Neonatal atrial flutter after insertion of an intracardiac umbilical venous catheter. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 26525686 PMCID: PMC4795732 DOI: 10.1016/j.rppede.2015.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: To describe a case of neonatal atrial flutter after the insertion of an intracardiac umbilical venous catheter, reporting the clinical presentation and reviewing the literature on this subject. Case description: A late-preterm newborn, born at 35 weeks of gestational age to a diabetic mother and large for gestational age, with respiratory distress and rule-out sepsis, required an umbilical venous access. After the insertion of the umbilical venous catheter, the patient presented with tachycardia. Chest radiography showed that the catheter was placed in the position that corresponds to the left atrium, and traction was applied. The patient persisted with tachycardia, and an electrocardiogram showed atrial flutter. As the patient was hemodynamically unstable, electric cardioversion was successfully applied. Comments: The association between atrial arrhythmias and misplaced umbilical catheters has been described in the literature, but in this case, it is noteworthy that the patient was an infant born to a diabetic mother, which consists in another risk factor for heart arrhythmias. Isolated atrial flutter is a rare tachyarrhythmia in the neonatal period and its identification is essential to establish early treatment and prevent systemic complications and even death.
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Affiliation(s)
- Marcos Moura de Almeida
- Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brasil.
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Flutter atrial neonatal após inserção de cateter umbilical intracardíaco. REVISTA PAULISTA DE PEDIATRIA 2016; 34:132-5. [DOI: 10.1016/j.rpped.2015.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/22/2015] [Accepted: 05/15/2015] [Indexed: 11/20/2022]
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Isik DU, Celik IH, Kavurt S, Aydemir O, Kibar AE, Bas AY, Demirel N. A case series of neonatal arrhythmias. J Matern Fetal Neonatal Med 2015; 29:1344-7. [PMID: 26037725 DOI: 10.3109/14767058.2015.1048679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Neonatal arrhythmias (NAs) are defined as abnormal heart rates in the neonatal period. They may occur as a result of various cardiovascular, systemic and metabolic problems. METHODS A retrospective chart review was performed on newborns who were diagnosed with NA during hospitalization in a neonatal intensive care unit (NICU), or who were admitted to the NICU because of an arrhythmia diagnosis in two NICUs in Turkey from May 2011 to June 2013. RESULTS Seventeen neonates with arrhythmias were identified. The incidence of NA was 0.4% and 0.3% in the two NICUs, and was 0.37% in the study population as a whole. Mean gestational age was 37 (29-40) weeks. Nine of the infants (53%) were diagnosed with fetal arrhythmia (FA) during the last week of gestation. The distribution of NA types was as follows: six (35%) supraventricular tachycardia (SVT), six (35%) premature atrial contractions (PACs), two (11%) premature ventricular contractions (PVCs), two (11%) multiple arrhythmias such as SVT + PAC and AV block + PVC, and one (5%) AV block. Wolff-Parkinson-White syndrome was present in one patient. An association of NA with congenital heart malformations was identified in five cases. CONCLUSIONS Cardiac arrhythmias are important causes of infant morbidity, and an occasional cause of infant mortality if undiagnosed and untreated. It is important for the physician to be aware of the etiology, development and natural history of arrhythmias in the fetal and neonatal period.
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Affiliation(s)
- Dilek Ulubas Isik
- a Department of Neonatology , Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Istemi Han Celik
- a Department of Neonatology , Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Sumru Kavurt
- b Department of Neonatology , Diyarbakir Women Health and Children Hospital , Diyarbakir , Turkey
| | - Ozge Aydemir
- c Department of Neonatology, Faculty of Medicine , Eskisehir Osmangazi University , Eskisehir , Turkey , and
| | - Ayse Esin Kibar
- d Department of Pediatric Cardiology , Ankara Children's Hematology and Oncology Hospital , Ankara , Turkey
| | - Ahmet Yagmur Bas
- a Department of Neonatology , Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Nihal Demirel
- a Department of Neonatology , Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital , Ankara , Turkey
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Abstract
Pregestational diabetes affects nearly 2% of all pregnancies. Moreover, Type 2 diabetes in child-bearing women is on the rise because of the childhood obesity epidemic. Pregestational diabetes can affect the fetal heart in several ways. First, the risk of fetal congenital heart disease is markedly increased; second, fetal hypertrophic cardiomyopathy may occur even with good glycemic control; third, studies have shown impaired function of the hearts of some infants and fetuses of diabetic pregnancies, which can occur with and without septal hypertrophy. Small-for-gestational-age infants of diabetic mothers may have diminished cardiovascular health in the long term. This review mainly discusses methods to detect fetal diabetic cardiomyopathy prenatally. The focus is on the noninvasive diagnostic markers that can serve as an outcome measure for future therapeutic trials, which are still lacking. There is some experimental research on treatment strategies to prevent fetal heart disease in diabetic pregnancies but little clinical data.
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Affiliation(s)
- Linda B Pauliks
- Penn State Hershey Medical College, Division of Pediatric Cardiology, Mailbox HP14, 500 University Drive, Hershey, PA 17033, USA
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