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Cohen M. "A Fleck of Light: Drug Superiority for Idiopathic Pediatric PVCs". Heart Rhythm 2024:S1547-5271(24)03148-5. [PMID: 39154874 DOI: 10.1016/j.hrthm.2024.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Mitchell Cohen
- Co-Director of the Heart Center, Inova L.J. Murphy Children's Hospital, Professor of Pediatrics, UVA School of Medicine.
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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 crossover 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 left ventricular dysfunction are indications for treatment with antiarrhythmic drugs. OBJECTIVE This study aimed to evaluate the efficacy of flecainide vs metoprolol in reducing PVCs in children. METHODS A randomized open-label crossover trial was conducted of children with a PVC burden of >15% on Holter monitoring successively treated with metoprolol and flecainide, or vice versa, with a drug-free interval of at least 2 weeks. Holter measurements were repeated before and after the start of the antiarrhythmic drug. RESULTS Sixty patients were screened; 19 patients could be included. Median age was 13.9 years (interquartile range, 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, 0.86-15.46; P = .031). Exploratory analysis revealed that 9 of 18 patients treated with flecainide and 1 of 17 patients treated with metoprolol had a reduction to a PVC burden below 5%. No discriminating factors between flecainide responders and nonresponders were found; the mean plasma level was not significantly different (0.34 mg/L vs 0.52 mg/L; P = .277). CONCLUSION In children with frequent PVCs, flecainide led to a significantly greater reduction of PVC burden compared with metoprolol. Flecainide was effective in only a subgroup of patients, which appears to be unrelated to the plasma level.
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Affiliation(s)
- Robin A Bertels
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Luc H Filippini
- Juliana Children's Hospital, HAGA Hospital, The Hague, The Netherlands
| | - Roel L F van der Palen
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Ramon O Tak
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Stefan Frerich
- MosaKids Children's Hospital, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ward Vanagt
- Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan J B Rehbock
- Department of Pediatrics, HAGA Hospital Zoetermeer, Zoetermeer, The Netherlands
| | - Ingmar Knobbe
- Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Irene M Kuipers
- Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marta de Riva
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Blom
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands; Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Kunigeliene R, Kinciniene O, Usonis V, Lesinskiene S. The Relationship between Depression Symptoms and Physical Activity in Children with Idiopathic Ventricular Extrasystoles. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:213. [PMID: 38399501 PMCID: PMC10890611 DOI: 10.3390/medicina60020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Depression in childhood often co-occurs with anxiety disorders and a range of somatic symptoms. Recent studies have identified physical activity as a target for preventing the onset of depression. However, idiopathic ventricular extrasystoles (VEs) in children are sometimes associated with somatic symptoms and limitations in physical activity. The occurrence of arrhythmia can also be distressing for children and their parents. This study was conducted to determine the relationship between symptoms of depression, physical activity, and somatic symptoms in children with idiopathic VE. Materials and Methods: This study of children with structurally normal hearts and VE was approved by the local ethics committee (no. 2021/10-1383-859(1). The authors designed a questionnaire to assess symptoms, physical activity, and general well-being. As part of that, symptoms of depression were evaluated with a modified pediatric PHQ-9 (MP-PHQ-9) questionnaire, with scores ≤4 for no, 5-9 for mild, 10-14 for moderate, and ≥15 for severe depression. Children aged ≥12 years and parents who assessed their children's condition completed the questionnaires. All children also underwent 24-h electrocardiography and echocardiography to evaluate arrhythmia frequency and cardiac condition. Results: Questionnaires were completed by 60 children's parents and 39 children (≥12 years old). The median children's age was 13 years. Palpitations were experienced by 26 (43.3%), chest pain by 13 (21.7%), and exercise intolerance by 15 (25%) children. All patients had normal ventricular function and hemodynamically normal hearts. The median score of the MP-PHQ-9 completed by parents was 2, and by children was 4. The median VE frequency was 4.77 (0.1-32.77) % per 24 h. We found that 31 (51.7%) children engaged in extra-sports participation with a median time of 3.75 h per week. Eleven of the children were suspended from sports. There was no significant difference between VE frequency and MP-PHQ-9 scores. Higher MP-PHQ-9 scores were noted for symptomatic children who engaged in <5 h per week of physical activity. Conclusions: Higher depression scores were found for children with somatic symptoms than those without symptoms. Children who were physically active for less than 5 h per week also had higher depression risk scores than those who were more active. Our research has shown that parents underestimate the signs of depression in their children.
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Affiliation(s)
- Rita Kunigeliene
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
| | - Odeta Kinciniene
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
| | - Vytautas Usonis
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
| | - Sigita Lesinskiene
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
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Dalili M, Kargarfard M, Tabib A, Fathollahi MS, Brugada P. Ventricular tachycardia ablation in children. Indian Pacing Electrophysiol J 2023; 23:99-107. [PMID: 36906176 PMCID: PMC10323183 DOI: 10.1016/j.ipej.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/21/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION The ablation of ventricular tachycardia, including premature ventricular contractions, is an approved, albeit infrequent procedure in pediatric patients. Data are scarce regarding the outcomes of this procedure. The purpose of this study was to share a high-volume center experience and patient outcomes for catheter ablation of ventricular ectopy and ventricular tachycardia in pediatric population. METHODS Data were retrieved from the institutional data bank. Outcomes over time were evaluated, and procedural details were compared. RESULTS A total of 116 procedures were performed on 102 pediatric patients between July 2009 and May 2021 at the Rajaie Cardiovascular Medical and Research Center in Tehran, Iran. Ablation was not performed in 4 procedures (3.4%) due to high-risk substrates. Of the remaining 112 ablations performed, 99 (88.4%) were successful. However, one patient died due to a coronary complication. There were no significant differences observed in early ablation results based on patients' age, sex, cardiac anatomy, or ablation substrates (P > 0.05). Follow-up records were available for 80 procedures, and 13 (16.3%) of those experienced recurrence. During long-term follow-up, none of the variables mentioned above were statistically different between patients with or without arrhythmia recurrence. CONCLUSION The overall success rate of pediatric ventricular arrhythmia ablation is favorable. We found no significant predictor for the procedural success rate concerning acute and late outcomes. Larger multicenter studies are needed to elucidate the predictors and outcomes of the procedure.
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Affiliation(s)
- Mohammad Dalili
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Kargarfard
- Department of Pediatrics, Children's Hospital, School of Medicine, Hormozgan University of Medical Science, Bandar Abbas, Iran
| | - Avisa Tabib
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mahmood Sheikh Fathollahi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Pedro Brugada
- Cardiovascular Division, Free University of Brussels (UZ Brussel) VUB, Brussels, Belgium
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Oeffl N, Schober L, Faudon P, Schweintzger S, Manninger M, Köstenberger M, Sallmon H, Scherr D, Kurath-Koller S. Antiarrhythmic Drug Dosing in Children-Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050847. [PMID: 37238395 DOI: 10.3390/children10050847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Antiarrhythmic drugs represent a mainstay of pediatric arrhythmia treatment. However, official guidelines and consensus documents on this topic remain scarce. There are rather uniform recommendations for some medications (including adenosine, amiodarone, and esmolol), while there are only very broad dosage recommendations for others (such as sotalol or digoxin). To prevent potential uncertainties and even mistakes with regard to dosing, we summarized the published dosage recommendations for antiarrhythmic drugs in children. Because of the wide variations in availability, regulatory approval, and experience, we encourage centers to develop their own specific protocols for pediatric antiarrhythmic drug therapy.
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Affiliation(s)
- Nathalie Oeffl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Lukas Schober
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Patrick Faudon
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Sabrina Schweintzger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Martin Köstenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Hannes Sallmon
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
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Hasdemir C, Payzin S. Pro-arrhythmia with antiarrhythmic drugs in patients with idiopathic ventricular arrhythmia: A common problem with vague definitions and complex interactions. J Cardiovasc Electrophysiol 2022; 33:1636. [PMID: 35445781 DOI: 10.1111/jce.15507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Serdar Payzin
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
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Muser D, Santangeli P, Nucifora G. Procainamide for the Rapid Suppression of Premature Ventricular Contractions: An (Almost) Forgotten Tool in the Cardiologist's Armamentarium. Diagnostics (Basel) 2021; 11:diagnostics11020357. [PMID: 33672729 PMCID: PMC7924344 DOI: 10.3390/diagnostics11020357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA 3400, USA; (D.M.); (P.S.)
| | - Pasquale Santangeli
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA 3400, USA; (D.M.); (P.S.)
| | - Gaetano Nucifora
- Cardiac Imaging Unit, NorthWest Heart Centre, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
- Correspondence: or
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