1
|
Bertels RA, Kammeraad JAE, van Geloven N, Filippini LH, van der Palen RLF, Tak RO, Frerich S, Vanagt W, Rehbock JJB, Knobbe I, Kuipers IM, de Riva M, Zeppenfeld K, Blom NA. ECTOPIC trial: The efficacy of flEcainide Compared To metOprolol in reducing Premature ventrIcular contractions. A randomized open label cross-over study in pediatric patients. Heart Rhythm 2024:S1547-5271(24)03090-X. [PMID: 39089565 DOI: 10.1016/j.hrthm.2024.07.111] [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] [Received: 06/07/2024] [Revised: 07/15/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Frequent premature ventricular contractions (PVCs) in children are usually considered benign. Symptoms and/or left ventricular dysfunction are indications for treatment with anti-arrhythmic drugs (AAD). OBJECTIVE To evaluate the efficacy of flecainide versus metoprolol in reducing PVCs in children. METHODS A randomized open label cross-over trial children with a PVC-burden of >15% on Holter; successively treated with metoprolol and flecainide or vice versa, with a drug free interval of at least two weeks. Holter measurements were repeated before and after the start of the AAD. RESULTS Sixty patients were screened, 19 patients could be included. Median age was 13.9 years (IQR 5.5 years). Mean baseline PVC-burden was 21.7% (N=18, SD±14.0) before the start of flecainide and 21.2% (N=17, SD±11.5) before the start of metoprolol. In a mixed model analysis the estimated mean reduction in PVC-burden was 10.6 percentage-points (95%-CI 5.8-15.3) for flecainide and 2.4 percentage-points (95%-CI -2.7-7.5) for metoprolol, with a significant difference of 8.2 percentage-points (95%-CI of 0.86-15.46, P=0.031). Exploratory analysis revealed that 9/18 patients treated with flecainide and 1/17 patients treated with metoprolol, had a reduction to a PVC-burden below 5%. No discriminating factors between flecainide-responders and non-responders were found; the mean plasma level was not significantly different (0.34 mg/L versus 0.52 mg/L, P=0.277). CONCLUSIONS In children with frequent PVCs flecainide led to a significant greater reduction of PVC-burden, compared to metoprolol. Flecainide was effective in only a subgroup of patients, which appears to be unrelated to the plasma level. (Dutch Trial Register number 26689).
Collapse
Affiliation(s)
- Robin A Bertels
- Willem-Alexander Children's Hospital - Leiden University Medical Center; Albinusdreef 2, Leiden, the Netherlands.
| | - Janneke A E Kammeraad
- Erasmus MC - Sophia Children's Hospital; Dr. Molewaterplein 40, Rotterdam, the Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences - Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Luc H Filippini
- Juliana Children's Hospital - HAGA Hospital; Els Borst-Eilersplein 275, The Hague, the Netherlands
| | - Roel L F van der Palen
- Willem-Alexander Children's Hospital - Leiden University Medical Center; Albinusdreef 2, Leiden, the Netherlands
| | - Ramon O Tak
- Department of pediatrics - St Antonius Hospital; Koekoekslaan 1, Nieuwegein, the Netherlands
| | - Stefan Frerich
- MosaKids Children's Hospital - Maastricht University Medical Center; P. Debyelaan 25, Maastricht, the Netherlands
| | - Ward Vanagt
- Beatrix Children's Hospital - University Medical Center Groningen; Hanzeplein 14, Groningen, the Netherlands
| | - Jan J B Rehbock
- Department of pediatrics - HAGA Hospital Zoetermeer; Toneellaan 1, Zoetermeer, the Netherlands
| | - Ingmar Knobbe
- Emma Children's Hospital - Amsterdam University Medical Centers; Meibergdreef 9, Amsterdam, the Netherlands
| | - Irene M Kuipers
- Emma Children's Hospital - Amsterdam University Medical Centers; Meibergdreef 9, Amsterdam, the Netherlands
| | - Marta de Riva
- Department of Cardiology - Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology - Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Nico A Blom
- Willem-Alexander Children's Hospital - Leiden University Medical Center; Albinusdreef 2, Leiden, the Netherlands; Emma Children's Hospital - Amsterdam University Medical Centers; Meibergdreef 9, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Ljubas Perčić D, Krmek N, Benko I, Kniewald H, Bitanga S, Katavić M, Perčić M. Frequent accelerated idioventricular rhythm in an otherwise healthy child: a case report and review of literature. BMC Cardiovasc Disord 2023; 23:37. [PMID: 36670379 PMCID: PMC9862554 DOI: 10.1186/s12872-023-03074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Accelerated idioventricular rhythm (AIVR) is a wide QRS complex dysrhythmia that, as far as pediatric population is concerned, occurs mostly in children with underlying systemic or heart disease. Its clinical course is thought to be typically benign in otherwise healthy children and treatment to be completely needless. Existing guidelines/recommendations are based entirely on cases that had low daily burden of AIVR, and those referring to treatment itself are very unspecific. Pharmacologic therapy has been mostly unsuccessful and catheter ablation as a way of treatment has been only sporadically reported. This article is a case report with a literature review that aims to practically separate the age groups into newborn and older children and to emphasize the different clinical outcomes of children with occasional and frequent AIVR. There are only a few cases so far describing undesirable outcomes of this condition, and most of these patients had high daily burden of AIVR. To be more specific, among 38 healthy children older than 1 year reported in total, 6 had undesirable outcomes, short-term in terms of developing malignant arrhythmia or long-term in terms of developing cardiomyopathy/heart failure. CASE PRESENTATION An 11-year-old boy had been referred to our center for a workup of incidentally discovered wide-complex arrhythmia. He was asymptomatic, with no underlying cardiac or systemic diseases. Continuous heart rate monitoring detected AIVR during most time of monitoring. In 24-h Holter-ECG, wide QRS complexes accounted for 73%. With parental consent, we conducted an electrophysiological study accompanied by radiofrequent ablation of ectopic focus, which lead to an instantaneous sinus rhythm that continued during the entire follow-up. CONCLUSION AIVR is a rare dysrhythmia in the pediatric population, typically considered benign. Nevertheless, more than a few cases evidence its harmful potential, short-term in terms of developing malignant arrhythmia or long-term in terms of developing cardiomyopathy. Gathering more knowledge and experience along with conducting further studies is essential for the enhancement of understanding this condition, and selecting potentially vulnerable patients as well as their treatment.
Collapse
Affiliation(s)
- Daria Ljubas Perčić
- grid.412688.10000 0004 0397 9648Department of Neonatology, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Nikola Krmek
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Ivica Benko
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Hrvoje Kniewald
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Suzana Bitanga
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Matej Katavić
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Marko Perčić
- grid.412688.10000 0004 0397 9648Department of Cardiology, University Hospital “Sveti Duh”, Zagreb, Croatia
| |
Collapse
|
3
|
Cicenia M, Silvetti MS, Drago F. When Should Premature Ventricular Contractions Be Considered as a Red Flag in Children with Cardiomyopathy? J Cardiovasc Dev Dis 2021; 8:jcdd8120176. [PMID: 34940531 PMCID: PMC8707971 DOI: 10.3390/jcdd8120176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Premature ventricular contractions (PVCs) are common and generally benign in childhood and tend to resolve spontaneously in most cases. When PVCs occur frequently, an arrhythmia-induced cardiomyopathy may be present requiring medical or catheter ablation. PVCs are only rarely the manifestation of a cardiomyopathy. The purpose of this review is to provide some tips and tricks to raise the suspicion of a cardiac disease based on the presence and characteristics of PVCs in children.
Collapse
|
4
|
Doctor P, Balakrishnan P, Sriram C, Aggarwal S. Does Premature Ventricular Contractions Affect Exercise Capacity in Teenagers with Normal Hearts? Pediatr Cardiol 2021; 42:606-613. [PMID: 33394114 DOI: 10.1007/s00246-020-02521-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
Premature ventricular contractions (PVCs) are common in teenagers even in the absence of structural heart disease or channelopathy. The suppression of PVCs with exercise is a favorable prognostic indicator. There is a paucity of data regarding the relationship between exercise capacity and PVC burden in this population. Our objective was to evaluate the association between various exercise stress parameters and PVC burden ascertained with a 24 h Holter in children without structural heart disease and/or channelopathy. In this retrospective study, 447 patient's charts with a diagnosis of PVC were reviewed at a single tertiary center. The study cohort consisted of ninety one patients with no structural heart disease or channelopathy who underwent an echocardiogram, maximal stress test, and 24 h Holter monitor. The cohort was divided into two groups based on PVC burden by 24-h Holter monitoring: < 10% and ≥ 10%. Peak oxygen uptake (VO2 in ml/kg/min), an indicator of maximal aerobic capacity, was collected. Other exercise parameters included a) percentage of predicted VO2 (%VO2) based on age, weight, height, and gender b) percent oxygen pulse, c) Anaerobic threshold (AT), and d) Metabolic equivalents. Demographic and exercise stress test-derived parameters were compared between the two groups using student t test and a p value < 0.05 was considered significant. In our cohort of 91 patients, the mean (SD) age at exercise was 14.5 (3.2) years with 56 (62%) males. Left ventricle shortening fraction (LVFS) was ≥ 28% in all enrolled patients. PVCs were monomorphic in 72(80%) patients. The mean (SD) PVC burden was 14.43% (12.3) ranging from 0.1 to 49.8%. PVC burden was ≥ 10% in 48 (53%) patients. Eighty eight (97%) patients in the study cohort had suppression of PVCs with exercise. There were no significant differences between the two groups (< 10% vs. ≥ 10% PVC burden) with respect to demographic or exercise test-derived parameters. Univariate regression between PVC burden and %VO2 did not show significant correlation (r = - 0.04, p = 0.75). Children even with ≥ 10% PVC burden did not demonstrate any objective decrease in their exercise capacity. A plausible reason for no difference in exercise capacity in our cohort may be due to lower PVC load or shorter duration of PVCs compared to adults.
Collapse
Affiliation(s)
- Pezad Doctor
- Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA.
| | - Preetha Balakrishnan
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, 48201, USA
| | - Chenni Sriram
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, 48201, USA
| | - Sanjeev Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, 48201, USA
| |
Collapse
|
5
|
Bertels RA, Kammeraad JAE, Zeelenberg AM, Filippini LH, Knobbe I, Kuipers IM, Blom NA. The Efficacy of Anti-Arrhythmic Drugs in Children With Idiopathic Frequent Symptomatic or Asymptomatic Premature Ventricular Complexes With or Without Asymptomatic Ventricular Tachycardia: a Retrospective Multi-Center Study. Pediatr Cardiol 2021; 42:883-890. [PMID: 33515328 PMCID: PMC8110481 DOI: 10.1007/s00246-021-02556-7] [Citation(s) in RCA: 3] [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: 04/28/2020] [Accepted: 01/15/2021] [Indexed: 11/26/2022]
Abstract
The aim of the study is to compare the efficacy of flecainide, beta-blockers, sotalol, and verapamil in children with frequent PVCs, with or without asymptomatic VT. Frequent premature ventricular complexes (PVCs) and asymptomatic ventricular tachycardia (VT) in children with structurally normal hearts require anti-arrhythmic drug (AAD) therapy depending on the severity of symptoms or ventricular dysfunction; however, data on efficacy in children are scarce. Both symptomatic and asymptomatic children (≥ 1 year and < 18 years of age) with a PVC burden of 5% or more, with or without asymptomatic runs of VT, who had consecutive Holter recordings, were included in this retrospective multi-center study. The groups of patients receiving AAD therapy were compared to an untreated control group. A medication episode was defined as a timeframe in which the highest dosage at a fixed level of a single drug was used in a patient. A total of 35 children and 46 medication episodes were included, with an overall change in PVC burden on Holter of -4.4 percentage points, compared to -4.2 in the control group of 14 patients. The mean reduction in PVC burden was only significant in patients receiving flecainide (- 13.8 percentage points; N = 10; p = 0.032), compared to the control group and other groups receiving beta-blockers (- 1.7 percentage points; N = 18), sotalol (+ 1.0 percentage points; N = 7), or verapamil (- 3.9 percentage points; N = 11). The efficacy of anti-arrhythmic drug therapy on frequent PVCs or asymptomatic VTs in children is very limited. Only flecainide appears to be effective in lowering the PVC burden.
Collapse
Affiliation(s)
- Robin A Bertels
- Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands.
| | - Janneke A E Kammeraad
- Sophia Children's Hospital-Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, the Netherlands
| | - Anna M Zeelenberg
- Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands
| | - Luc H Filippini
- Juliana Children's Hospital-HAGA Hospital, Els Borst-Eilersplein 275, The Hague, the Netherlands
| | - Ingmar Knobbe
- VU Medical Center-Amsterdam UMC, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Irene M Kuipers
- Emma Children's Hospital-Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands
| | - Nico A Blom
- Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands
- Emma Children's Hospital-Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands
| |
Collapse
|
6
|
Speckle Tracking Echocardiography in Pediatric Patients with Premature Ventricular Contractions. Pediatr Cardiol 2020; 41:1587-1593. [PMID: 32683524 DOI: 10.1007/s00246-020-02415-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/11/2020] [Indexed: 01/25/2023]
Abstract
Premature ventricular contractions (PVCs) in pediatric patients without structural heart disease and normal left ventricular systolic function rarely require therapy, though it is unknown whether these patients have subclinical cardiac dysfunction. Speckle tracking echocardiography is an additional means of evaluating cardiac function in asymptomatic pediatric PVC patients with normal standard measures of left ventricular (LV) function. Asymptomatic pediatric patients (< 21 years) without congenital heart disease, LV ejection fraction (LVEF) ≥ 55% and PVC burden ≥ 5% on 24-h Holter monitor were included. Demographic information, exercise stress test results, standard echocardiographic measures of LV systolic function and PVC morphology by 12-lead ECG were collected. Peak global systolic longitudinal strain (GLS) from apical four-chamber view was analyzed offline. 29 patients were identified (mean age 11.7 ± 5.8 years, 49.2 ± 25.3 kg, 59% male). Mean PVC burden was 12.0 ± 7.0% (range 5-37.5%). 14/29 (48%) had exercise stress testing with evidence of PVCs; 9/14 (64%) had PVC suppression at a mean heart rate (HR) of 160 ± 23 bpm and 5/14 (36%) did not suppress at a mean maximum HR of 188 ± 9 bpm. All patients had normal strain values by speckle tracking echocardiography (mean LV GLS - 22.5 ± 2.0%, LV global circumferential strain - 25.3 ± 3.9 and RV GLS - 24.1 ± 3.0%). There was no correlation between PVC burden and cardiac function parameters. Asymptomatic pediatric patients without structural heart disease, preserved LVEF/shortening fraction and PVC burden ≥ 5% demonstrated normal cardiac function including strain patterns indicating no evidence of subclinical cardiac dysfunction. Larger scale studies and longitudinal evaluation of left ventricular function using speckle tracking echocardiography is warranted in this population.
Collapse
|
7
|
Chen B, Li J, Li S, Fang Y, Zhao P. Risk Factors for Left Ventricle Enlargement in Children With Frequent Ventricular Premature Complexes. Am J Cardiol 2020; 131:49-53. [PMID: 32718551 DOI: 10.1016/j.amjcard.2020.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
We aimed to assess the risk factors for left ventricle (LV) enlargement in children with idiopathic frequent ventricular premature complexes (VPC) and discuss the clinical features and treatment strategies. Children diagnosed with idiopathic frequent VPC at Xinhua Hospital affiliated to the Shanghai Jiao Tong University during 2013 to 2019 were retrospectively evaluated. Gender, age, body mass index, weight, number and sources of frequent VPC, and changes in the LV structure were analyzed and compared. A total of 29 patient showed changes in LV enlargement at diagnosis [age 7.3 ± 4.0 years, 8 (24.1%) had symptoms such as syncope, palpitations, fatigue, and dizziness], whereas 220 showed a normal LV structure [age 7.2 ± 4.5 years, 77 (32.3%) with symptoms]. Patients with LV enlargement showed a higher percentage of VPC on Holter recordings (30.2 ± 10.7 versus 9.4 ± 6.9, p < 0.05), higher prevalence of ventricular tachycardia [22 (75.9%) vs 36 (16.4%), p < 0.0001], higher number of couplets [26 (96.7%) vs 132 (60.0%), p = 0.002], higher number of trigeminy [27 (97.8%) vs 133 (83.2%), p < 0.001], higher QRS wave width [80.0 ± 5.9 vs 77.8 ± 6.8, p = 0.021], and higher incidence of right bundle branch block [11 (37.9%) vs 2 (0.9%), p < 0.001]. Multivariate analysis suggested that right bundle branch block (Odds Ratio = 143.9 p <0.001) and VPC burden (>20%) (Odds Ratio = 132.6, p <0.001) were the risk factors for LV enlargement in children with idiopathic frequent VPC. In conclusion, frequent VPC can induce prominent enlargement or LV dysfunction in children. LV enlargement are reversible after catheter ablation or medication.
Collapse
Affiliation(s)
- Bo Chen
- Department of Pediatric Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoyu Li
- Department of Pediatric Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shujing Li
- Department of Pediatric Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Fang
- Department of Pediatric Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pengjun Zhao
- Department of Pediatric Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
8
|
|
9
|
Cardiac function in children with premature ventricular contractions: the effect of omega-3 polyunsaturated fatty acid supplementation. Cardiol Young 2018; 28:949-954. [PMID: 29759092 DOI: 10.1017/s1047951118000574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Premature ventricular contractions are accepted as benign in structurally normal hearts. However, reversible cardiomyopathy can sometimes develop. Omega-3 polyunsaturated fatty acids have anti-arrhythmic properties in animals and humans.AimWe evaluated left ventricular function in children with premature ventricular contractions with normal cardiac anatomy and assessed the impact of omega-3 fatty acid supplementation on left ventricular function in a prospective trial. METHODS A total of 25 patients with premature ventricular contraction, with more than 2% premature ventricular contractions on 24-hour Holter electrocardiography, and 30 healthy patients were included into study. All patients underwent electrocardiography, left ventricular M-mode echocardiography, and myocardial performance index testing. Patients with premature ventricular contraction were given omega-3 fatty acids at a dose of 1 g/day for 3 months, and control echocardiography and 24-hour Holter electrocardiography were performed. Neither placebo nor omega-3 fatty acids were given to the control group. RESULTS Compared with the values of the control group, the patients with premature ventricular contraction had significantly lower fractional shortening. The myocardial performance index decreased markedly in the patient groups. The mean heart rate and mean premature ventricular contraction percentage of Group 2 significantly decreased in comparison with their baseline values after the omega-3 supplementation. CONCLUSION In conclusion, premature ventricular contractions can lead to systolic cardiac dysfunction in children. Omega-3 supplementation may improve cardiac function in children with premature ventricular contractions. This is the first study conducted in children to investigate the possible role of omega-3 fatty acid supplementation on treatment of premature ventricular contractions.
Collapse
|
10
|
Bertels RA, Harteveld LM, Filippini LH, Clur SA, Blom NA. Left ventricular dysfunction is associated with frequent premature ventricular complexes and asymptomatic ventricular tachycardia in children. Europace 2017; 19:617-621. [PMID: 28431063 DOI: 10.1093/europace/euw075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/05/2016] [Indexed: 01/08/2023] Open
Abstract
AIMS To assess the risk factors for left ventricular (LV) dysfunction in a paediatric population with idiopathic frequent premature ventricular contractions (PVCs) and asymptomatic ventricular tachycardias (VTs). METHODS AND RESULTS Paediatric patients with the diagnosis of idiopathic frequent PVCs and asymptomatic VTs were retrospectively evaluated. Frequent PVCs were defined as ≥5% on 24 h Holter recording. Left ventricular dysfunction was defined as a shortening fraction of ≤28%. Seventy-two children were identified. Six patients showed LV dysfunction at diagnosis [age 10 ± 7 years, 2 (33%) had symptoms such as syncope, palpitations, fatigue, and dizziness], and 66 showed normal LV function [age 8 ± 6 years, 22 (33%) with symptoms]. Patients with LV dysfunction had a higher percentage of PVCs on Holter recordings (47 ± 16 vs. 16 ± 11%, P = 0.006), higher prevalence of VT [5 (83%) vs. 27 (41%), P = 0.045] and sustained ventricular tachycardia (sVT) [3 (50%) vs. 4 (6%), P = 0.001], and a higher number of couplets [6 (100%) vs. 34 (52%), P = 0.030]. In patients with LV dysfunction, two responded to medication (Classes Ic and II) and five underwent ablation, of which one was unsuccessful. During follow-up, LV function normalized in five of six patients. In patients with a normal function, none developed LV dysfunction during the follow-up. CONCLUSION In children with idiopathic PVCs and asymptomatic VTs, development of LV dysfunction is associated with a higher burden of PVCs, the presence of sVTs, and couplets. Left ventricular dysfunction appears to be reversible if the burden of PVCs is decreased by medication or ablation.
Collapse
Affiliation(s)
- R A Bertels
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - L M Harteveld
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - L H Filippini
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Juliana Children's Hospital, The Hague, The Netherlands
| | - S A Clur
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - N A Blom
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Abadir S, Blanchet C, Fournier A, Mawad W, Shohoudi A, Dahdah N, Khairy P. Characteristics of premature ventricular contractions in healthy children and their impact on left ventricular function. Heart Rhythm 2016; 13:2144-2148. [DOI: 10.1016/j.hrthm.2016.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 11/25/2022]
|
12
|
Martin AP, Skinner JR. Ventricular extrasystoles and ventricular dysfunction: Too close for comfort? Heart Rhythm 2016; 13:2149-2150. [PMID: 27496585 DOI: 10.1016/j.hrthm.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew P Martin
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Auckland City Hospital, Auckland, New Zealand; Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Department of Child Health, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
13
|
Chantepie A, Soulé N, Poinsot J, Labarthe F, Lefort B. Myocardiopathie rythmique induite par des extrasystoles ventriculaires chez un enfant. Arch Pediatr 2016; 23:742-6. [DOI: 10.1016/j.arcped.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/26/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
|
14
|
Gopinathannair R, Etheridge SP, Marchlinski FE, Spinale FG, Lakkireddy D, Olshansky B. Arrhythmia-Induced Cardiomyopathies: Mechanisms, Recognition, and Management. J Am Coll Cardiol 2016; 66:1714-28. [PMID: 26449143 DOI: 10.1016/j.jacc.2015.08.038] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/28/2015] [Accepted: 08/17/2015] [Indexed: 12/19/2022]
Abstract
Arrhythmia-induced cardiomyopathy (AIC) is a potentially reversible condition in which left ventricular dysfunction is induced or mediated by atrial or ventricular arrhythmias. Cellular and extracellular changes in response to the culprit arrhythmia have been identified, but specific pathophysiological mechanisms remain unclear. Early recognition of AIC and prompt treatment of the culprit arrhythmia using pharmacological or ablative techniques result in symptom resolution and recovery of ventricular function. Although cardiomyopathy in response to an arrhythmia may take months to years to develop, recurrent arrhythmia can result in rapid decline in ventricular function with development of heart failure, suggesting residual ultrastructural abnormalities. Reports of sudden death in patients with normalized left ventricular ejection fraction cast doubt on the complete reversibility of this condition. Several aspects of AIC, including specific pathophysiological mechanisms, predisposing factors, optimal therapeutic strategies to prevent ultrastructural changes, and long-term risk of sudden death remain unresolved and need further research.
Collapse
Affiliation(s)
- Rakesh Gopinathannair
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
| | - Susan P Etheridge
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
| | | | - Francis G Spinale
- Department of Internal Medicine, University of South Carolina, Charleston, South Carolina
| | | | - Brian Olshansky
- Mercy Heart and Vascular Institute, Mercy Medical Center North Iowa, Mason City, Iowa
| |
Collapse
|
15
|
Guerrier K, Anderson JB, Czosek RJ, Mays WA, Statile C, Knilans TK, Spar DS. Usefulness of ventricular premature complexes in asymptomatic patients ≤21 years as predictors of poor left ventricular function. Am J Cardiol 2015; 115:652-5. [PMID: 25586334 DOI: 10.1016/j.amjcard.2014.12.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
Abstract
Although ventricular premature complexes (VPCs) have been shown to correlate with decreased cardiac function in adults, the correlation of left ventricular (LV) function to VPCs in asymptomatic children remains unclear. The aim of this study was to determine the correlation of VPC burden with LV function in asymptomatic pediatric patients with structurally normal hearts. This was a retrospective analysis of patients aged ≤21 years with echocardiograms and 24-hour Holter monitors with ≥0.5% VPCs completed within 60 days of each other. LV fractional shortening (FS) was compared with VPC burden and VPC characteristics. Normal LV function was defined as FS ≥28%. Correlation between VPC burden and LV function was determined by regression analysis. Wilcoxon's rank-sum test was used to compare LV function with VPC characteristics. This study included 123 patients (77 male [63%]). The median age was 11.6 years (interquartile range 5.8 to 14.3). The median VPC burden was 11.2% (interquartile range 4.8% to 18.9%), and median FS was 36% (interquartile range 33% to 38%). There was no significant correlation between VPC burden and LV FS (p = 0.50). The presence of uniform versus multiform VPCs (p = 0.29), ventricular couplets (p = 0.37), or runs of ventricular ectopy (p = 0.19) were not associated with a decrease in LV FS. Twenty-two patients (18%) had VPC burden >24%, none of which had decreased LV FS. In conclusion, there was no significant relation between VPC burden or VPC characteristics and LV systolic function in this pediatric population with structurally normal hearts.
Collapse
Affiliation(s)
- Karine Guerrier
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Jeffrey B Anderson
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard J Czosek
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Wayne A Mays
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher Statile
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Timothy K Knilans
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David S Spar
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
16
|
Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, Papez A, Phillips JR, Rhodes LA, Saul P, Stephenson E, Stevenson W, Zimmerman F. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm 2014; 11:e55-78. [PMID: 24814375 DOI: 10.1016/j.hrthm.2014.05.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Jane E Crosson
- Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David J Callans
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anne Dubin
- Lucile Packard Children's Hospital, Stanford School of Medicine, Stanford, California
| | | | - Susan Etheridge
- University of Utah and Primary Children's Medical Center, Salt Lake City, Utah
| | - Andrew Papez
- Phoenix Children's Hospital/Arizona Pediatric Cardiology Consultants Phoenix, Arizona
| | | | | | - Philip Saul
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | | | - William Stevenson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Zimmerman
- Advocate Heart Institute for Children Advocate Children's Hospital, Oak Lawn, Illinois.
| |
Collapse
|
17
|
Elektrokardiographie in der kinderärztlichen Praxis. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-2907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
18
|
Cohn HE, Arnold LW. Chest pain in young patients in an office setting: cardiac diagnoses, outcomes, and test burden. Clin Pediatr (Phila) 2012; 51:877-83. [PMID: 22752294 DOI: 10.1177/0009922812451650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study determined the incidence of cardiac diagnoses demonstrably related to chest pain in young patients and determined whether those with exertional chest pain were more likely to have a cardiac diagnosis. It evaluated the course of patients with chest pain after pediatric cardiology evaluation regarding interventions, outcomes, and additional test burden. This was a retrospective study of 203 patients with an office pediatric cardiology assessment of chest pain from January 2000 through December 2004. Fifteen patients (7.4%) had cardiac diagnoses, 5 (2.5%) had cardiac diagnoses demonstrably related to their chest pain complaints (arrhythmias, mitral valve prolapse), and none had ischemia. Exertional chest pain, in this study, did not increase the risk of having a cardiac diagnosis. Following evaluation, 80% of patients did not return for complaints of chest pain. Ten percent had 2 or more additional visits to any medical site for chest pain but no additional cardiac diagnoses were found.
Collapse
Affiliation(s)
- Herbert E Cohn
- Harvard Vanguard Medical Associates, Children's Hospital, Boston, MA 02215, USA
| | | |
Collapse
|