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Rodríguez NA, Patel N, Dariolli R, Ng S, Aleman AG, Gong JQ, Lin HM, Rodríguez M, Josowitz R, Sol-Church K, Gripp KW, Lin X, Song SC, Fishman GI, Sobie EA, Gelb BD. HRAS-Mutant Cardiomyocyte Model of Multifocal Atrial Tachycardia. Circ Arrhythm Electrophysiol 2024; 17:e012022. [PMID: 38415356 PMCID: PMC11021157 DOI: 10.1161/circep.123.012022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Germline HRAS gain-of-function pathogenic variants cause Costello syndrome (CS). During early childhood, 50% of patients develop multifocal atrial tachycardia, a treatment-resistant tachyarrhythmia of unknown pathogenesis. This study investigated how overactive HRAS activity triggers arrhythmogenesis in atrial-like cardiomyocytes (ACMs) derived from human-induced pluripotent stem cells bearing CS-associated HRAS variants. METHODS HRAS Gly12 mutations were introduced into a human-induced pluripotent stem cells-ACM reporter line. Human-induced pluripotent stem cells were generated from patients with CS exhibiting tachyarrhythmia. Calcium transients and action potentials were assessed in induced pluripotent stem cell-derived ACMs. Automated patch clamping assessed funny currents. HCN inhibitors targeted pacemaker-like activity in mutant ACMs. Transcriptomic data were analyzed via differential gene expression and gene ontology. Immunoblotting evaluated protein expression associated with calcium handling and pacemaker-nodal expression. RESULTS ACMs harboring HRAS variants displayed higher beating rates compared with healthy controls. The hyperpolarization activated cyclic nucleotide gated potassium channel inhibitor ivabradine and the Nav1.5 blocker flecainide significantly decreased beating rates in mutant ACMs, whereas voltage-gated calcium channel 1.2 blocker verapamil attenuated their irregularity. Electrophysiological assessment revealed an increased number of pacemaker-like cells with elevated funny current densities among mutant ACMs. Mutant ACMs demonstrated elevated gene expression (ie, ISL1, TBX3, TBX18) related to intracellular calcium homeostasis, heart rate, RAS signaling, and induction of pacemaker-nodal-like transcriptional programming. Immunoblotting confirmed increased protein levels for genes of interest and suppressed MAPK (mitogen-activated protein kinase) activity in mutant ACMs. CONCLUSIONS CS-associated gain-of-function HRASG12 mutations in induced pluripotent stem cells-derived ACMs trigger transcriptional changes associated with enhanced automaticity and arrhythmic activity consistent with multifocal atrial tachycardia. This is the first human-induced pluripotent stem cell model establishing the mechanistic basis for multifocal atrial tachycardia in CS.
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Affiliation(s)
- Nelson A. Rodríguez
- Mindich Child Health & Development Inst, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nihir Patel
- Mindich Child Health & Development Inst, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rafael Dariolli
- Dept of Pharmacological Sciences & Systems Biology Ctr New York, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Simon Ng
- Mindich Child Health & Development Inst, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Angelika G. Aleman
- Mindich Child Health & Development Inst, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jingqi Q.X. Gong
- Dept of Pharmacological Sciences & Systems Biology Ctr New York, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hung-Mo Lin
- Yale Center for Analytical Sciences (YCAS), New Haven, CT
| | - Matthew Rodríguez
- Mindich Child Health & Development Inst, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rebecca Josowitz
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Katia Sol-Church
- Dept of Pathology, Univ of Virginia School of Medicine, Charlottesville, VA
| | - Karen W. Gripp
- Division of Medical Genetics; Al duPont Hospital for Children/Nemours, Wilmington, DE
| | - Xianming Lin
- Leon H. Charney Division of Cardiology; New York Univ School of Medicine
| | - Soomin C. Song
- Ion Lab, Dept of Pathology, NYU Langone Health, New York, NY
| | - Glenn I. Fishman
- Leon H. Charney Division of Cardiology; New York Univ School of Medicine
| | - Eric A. Sobie
- Dept of Pharmacological Sciences & Systems Biology Ctr New York, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bruce D. Gelb
- Mindich Child Health & Development Inst, Icahn School of Medicine at Mount Sinai, New York, NY
- Depts of Pediatrics & Genetics and Genomic Sciences; Icahn School of Medicine at Mount Sinai, New York, NY
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2
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Moulin T, Rouffiac S, Chaouch A, Emirali G, Folliguet T, Lellouche N. Junctional ectopic tachycardia and late recovery of postoperative complete heart block in a young adult. HeartRhythm Case Rep 2023; 9:898-901. [PMID: 38204819 PMCID: PMC10774523 DOI: 10.1016/j.hrcr.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Thibaut Moulin
- Department of Cardiology, AP-HP, University Hospital Henri Mondor, Créteil, France
| | - Ségolène Rouffiac
- Department of Cardiology, AP-HP, University Hospital Henri Mondor, Créteil, France
| | - Amine Chaouch
- Department of Cardiology, AP-HP, University Hospital Henri Mondor, Créteil, France
| | - Guner Emirali
- Department of Cardiac Surgery, AP-HP, University Hospital Henri Mondor, Créteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, AP-HP, University Hospital Henri Mondor, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology, AP-HP, University Hospital Henri Mondor, Créteil, France
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Vô C, Dib N, Bartoletti S, Gonzalez CM, Mondésert B, Gagnon MH, Fournier A, Khairy P. Navigating Arrhythmias in Tetralogy of Fallot Throughout the Lifespan: A Case-based Review. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:404-413. [PMID: 38161682 PMCID: PMC10755829 DOI: 10.1016/j.cjcpc.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/12/2023] [Indexed: 01/03/2024]
Abstract
Arrhythmias are a common complication associated with tetralogy of Fallot (ToF), one of the most prevalent forms of congenital heart disease. As illustrated by this case-based review, various forms of arrhythmias can be encountered across the lifespan of patients with ToF, from infancy to older adulthood. These include atrioventricular block, junctional ectopic tachycardia, and atrial and ventricular arrhythmias. Arrhythmias have important implications on the health and quality of life of patients with ToF and require treatment by caregivers with dedicated expertise. The choice of pharmacologic and/or interventional therapies to alleviate symptoms, avoid complications, and mitigate risks depends in part on the type, severity, and frequency of the arrhythmia, as well as on the particularities of individual clinical scenarios. Preventing, monitoring for, and managing arrhythmias are an integral component of the care of patients with ToF throughout their lifespan that is critical to optimizing health outcomes.
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Affiliation(s)
- Christophe Vô
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Nabil Dib
- Division of Pediatric Cardiac Surgery, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Stefano Bartoletti
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Cecilia M. Gonzalez
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Marie-Hélène Gagnon
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Paul Khairy
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
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4
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Yadav S, Ramakrishnan S. Pediatric cardiology: In search for evidence. Ann Pediatr Cardiol 2023; 16:311-315. [PMID: 38766456 PMCID: PMC11098287 DOI: 10.4103/apc.apc_47_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/01/2024] [Accepted: 03/15/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Satyavir Yadav
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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5
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Ying S, Zhang J, Fu NK, Zhang P. Ivabradine in the treatment of non-paroxysmal junctional tachycardia with interference atrioventricular dissociation: A case report. Ann Noninvasive Electrocardiol 2023:e13064. [PMID: 37157886 DOI: 10.1111/anec.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/10/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
Ivabradine reduces the heart rate by selectively inhibiting the If current of the sinoatrial node, mainly for the treatment of chronic heart failure with decreased left ventricular systolic function and inappropriate sinus tachycardia, but the inhibitory effect on the atrioventricular node is rarely reported. The patient was admitted to hospital mainly because of intermittent chest pain for 7 years, which worsened for 10 days. Admission electrocardiogram (ECG) considered sinus tachycardia, with QS wave and T wave inversion in II, III, aVF, V3 R-V5 R, V4 -V9 leads, and non-paroxysmal junctional tachycardia (NPJT) with interference atrioventricular dissociation. After treatment with ivabradine the ECG returned to normal conduction sequence. NPJT with interference atrioventricular dissociation is a fairly rare electrocardiographic phenomenon. This case reports for the first time that ivabradine is used in the treatment of NPJT with interference atrioventricular dissociation. It is speculated that ivabradine has a potential inhibitory effect on the atrioventricular node.
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Affiliation(s)
- Shuo Ying
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jing Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Nai-Kuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Peng Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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Ivabradine monotherapy in pediatric patients with focal atrial tachycardia: a single-center study. Eur J Pediatr 2023; 182:2265-2271. [PMID: 36869903 DOI: 10.1007/s00431-023-04891-8] [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: 09/22/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/05/2023]
Abstract
This study investigated the efficacy of ivabradine monotherapy in pediatric patients with focal atrial tachycardia (FAT). We prospectively enrolled 12 pediatric patients (7.5 ± 4.5 years; six girls) with FAT who were resistant to conventional antiarrhythmics and received ivabradine as monotherapy. Patients were classified as having tachycardia-induced cardiomyopathy (TIC) if they had a left ventricular ejection fraction (LVEF) of < 50% and a left ventricular end-diastolic dimension (LVDD) z-score of > 2 due to tachycardia. Oral ivabradine was initiated at 0.1 mg/kg every 12 h, increased to 0.2 mg/kg every 12 h if no restoration of stable sinus rhythm was observed after two doses, and discontinued after 48 h if neither rhythm nor heart rate control was observed. Of these patients, six (50%) had incessant atrial tachycardia, and 6 had frequent short episodes of FAT. Six patients were diagnosed with TIC, and their mean LVEF and mean LVDD z-score were 36.2 ± 8.7% (range, 27-48%) and 4.2 ± 1.7 (range, 2.2-7.3), respectively. Finally, six patients achieved either rhythm (n = 3) or heart rate control (n = 3) within 48 h of ivabradine monotherapy. One patient achieved rhythm/heart rate control with ivabradine at a dose of 0.1 mg/kg every 12 h, while the others achieved rhythm/heart rate control at a dose of 0.2 mg/kg every 12 h. Five patients received ivabradine monotherapy for chronic therapy, one (20%) of whom had FAT breakthrough 1 month after discharge, and metoprolol was added. Neither FAT recurrence nor adverse effect (with or without beta-blocker) was observed during a median follow-up of 5 months. CONCLUSION Ivabradine is well-tolerated and may provide early heart rate control in pediatric FAT and can be considered early, especially in the presence of left ventricular dysfunction. Further investigations are deserved to confirm the optimal dose and long-term efficacy in this population. WHAT IS KNOWN • Focal atrial tachycardia (FAT) is the most common arrhythmia associated with tachycardia-induced cardiomyopathy (TIC) in children, and the efficacy of conventional antiarrhythmic medications in the treatment of FAT is poor. • Ivabradine is currently the only selective hyperpolarization-activated cyclic nucleotide-gated (HCN) inhibitor, which can effectively low HR without negative effect on blood pressure or inotropy. WHAT IS NEW • Ivabradine (0.1-0.2 mg/kg every 12 h) can effectively suppress focal atrial tachycardia in 50% of pediatric patients. • Ivabradine provides early control of heart rate and hemodynamic stabilization in children with severe left ventricular dysfunction due to atrial tachycardia within 48 h.
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Joye R, Beghetti M, Wacker J, Malaspinas I, Bouhabib M, Polito A, Bordessoule A, Shah DC. Early and Late Postoperative Tachyarrhythmias in Children and Young Adults Undergoing Congenital Heart Disease Surgery. Pediatr Cardiol 2023; 44:312-324. [PMID: 36517587 PMCID: PMC9894958 DOI: 10.1007/s00246-022-03074-w] [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: 10/30/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
The population of patients with congenital heart disease is constantly growing with an increasing number of individuals reaching adulthood. A significant proportion of these children and young adults will suffer from tachyarrhythmias due to the abnormal anatomy, the hemodynamic burden, or as a sequela of surgical treatment. Depending on the underlying mechanism, arrhythmias may arise in the early postoperative period (hours to days after surgery) or in the late postoperative period (usually years after surgery). A good understanding of the electrophysiological characteristics and pathophysiological mechanisms is therefore crucial to guide the therapeutic approach. Here, we synthesize the current state of knowledge on epidemiological features, risk factors, pathophysiological insights, electrophysiological features, and therapy regarding tachyarrhythmias in children and young adults undergoing reparative surgery for congenital heart disease. The evolution and latest data on treatment options, including pharmacological therapy, ablation procedures, device therapy decision, and thromboprophylaxis, are summarized. Finally, throughout this comprehensive review, knowledge gaps and areas for future research are also identified.
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Affiliation(s)
- Raphael Joye
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland.
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Iliona Malaspinas
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Maya Bouhabib
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Angelo Polito
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Alice Bordessoule
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Dipen C Shah
- Electrophysiology Unit, Cardiology Division, Geneva University Hospital, Geneva, Switzerland
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Sagawa K, Suzuki T, Takei K, Miura M, Ueda H, Horigome H, Ono H, Ohashi N, Sato S, Fukunaga H, Aoki H, Miyazaki A, Sakaguchi H, Morishima E, Oki K, Sumitomo N. Control of Heart Rate in Infant and Child Tachyarrhythmia With Reduced Cardiac Function Using Landiolol (HEARTFUL) - Results of a Prospective, Multicenter, Uncontrolled Clinical Study. Circ J 2022; 87:130-138. [PMID: 35979562 DOI: 10.1253/circj.cj-21-0967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prospective Control of HEART rate in inFant and child tachyarrhythmia with reduced cardiac function Using Landiolol (HEARTFUL) study investigated the effectiveness and safety of landiolol, a short-acting β1 selective blocker, in children.Methods and Results: Twenty-five inpatients aged ≥3 months to <15 years who developed supraventricular tachyarrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, and inappropriate sinus tachycardia) were treated with landiolol. The primary endpoint, the percent of patients with a reduction in heart rate ≥20% from the initial rate of tachycardia, or termination of tachycardia at 2 h after starting landiolol, was achieved in 12/25 patients (48.0%; 95% CI 28.4-67.6), which exceeded the predetermined threshold (38.0%). At 2 h after starting landiolol administration, heart rate had decreased by ≥20% in 45.8% (11/24) and recovery to sinus rhythm was achieved in 40.0% (6/15) of the patients. Adverse reactions (ARs) occurred in 24.0% (6/25) of patients, and the study was discontinued in 4.0% (1/25) of the patients; however, none of these ARs were considered serious. The most common AR was hypotension (20.0% [5/25] of patients). CONCLUSIONS The HEARTFUL study has demonstrated the efficacy of landiolol, by reducing heart rate or terminating tachycardia, in pediatric patients with supraventricular tachyarrhythmias. Although serious ARs and concerns were not identified in this study, physicians should be always cautious of circulatory collapse due to hypotension.
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Affiliation(s)
- Koichi Sagawa
- Department of Pediatric Cardiology, Cardiovascular Center, Fukuoka Children's Hospital
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Osaka City General Hospital
| | - Kohta Takei
- Department of Pediatric Cardiology, Nagano Children's Hospital
| | - Masaru Miura
- Division of Cardiology, Tokyo Metropolitan Children's Medical Center
| | - Hideaki Ueda
- Department of Cardiology, Kanagawa Children's Medical Center
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Hospital
| | - Seiichi Sato
- Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center
| | - Hideo Fukunaga
- Department of Pediatrics, Juntendo University Faculty of Medicine
| | - Hisaaki Aoki
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | | | - Kaori Oki
- Clinical Development Planning, Ono Pharmaceutical Co., Ltd
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
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Kikano S, Kannankeril PJ. Sotalol vs amiodarone for postoperative junctional ectopic tachycardia: Citius, Altius, Fortius? Heart Rhythm 2021; 19:457-458. [PMID: 34864167 DOI: 10.1016/j.hrthm.2021.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Sandra Kikano
- Thomas P. Graham Jr. Division of Pediatric Cardiology and the Center for Pediatric Precision Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Prince J Kannankeril
- Thomas P. Graham Jr. Division of Pediatric Cardiology and the Center for Pediatric Precision Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee.
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Rochelson E, Valdés SO, Asadourian V, Patel R, Lemming K, Howard TS, Pham TDN, Miyake CY, Kim JJ. Sotalol versus amiodarone for postoperative junctional tachycardia after congenital heart surgery. Heart Rhythm 2021; 19:450-456. [PMID: 34801734 DOI: 10.1016/j.hrthm.2021.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Junctional ectopic tachycardia (JET) is a common arrhythmia after congenital heart disease surgery. There is variability in the choice of antiarrhythmic therapy, with amiodarone used commonly. Intravenous (IV) sotalol is a newly available agent that may be useful for JET. OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of IV sotalol for postoperative JET and compare outcomes with IV amiodarone. METHODS This is a retrospective single-center study of all patients who received IV sotalol or IV amiodarone for postoperative JET at Texas Children's Hospital from December 15, 2015, to December 15, 2020. Data included antiarrhythmic efficacy, hemodynamics, and adverse effects. Successful JET control was defined as a decrease in JET rate to <170 beats/min (or decrease by >20%), or conversion to sinus rhythm, with persistent control over 24 hours without requiring alternative antiarrhythmics or mechanical support. RESULTS A total of 32 patients (median age 71 days; interquartile range 17-221 days) received IV amiodarone (n = 20 [62%]) or IV sotalol (n = 12 [38%]) for postoperative JET. Amiodarone was successful in treating JET in 75% of cases; sotalol was successful in 83%. The JET rate decreased faster over the first 90 minutes after a sotalol bolus (25 beats/min per hour) than after an amiodarone bolus (8 beats/min per hour) (P < .01); no heart rate difference was seen after 24 hours. Amiodarone infusion was discontinued early because of hypotension/bradycardia in 2 patients; this was not required in any patients receiving sotalol. CONCLUSION For children with postoperative JET, both IV sotalol and amiodarone are safe and efficacious. IV sotalol may lead to a faster improvement in heart rate.
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Affiliation(s)
- Ellis Rochelson
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Santiago O Valdés
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | | | - Katherine Lemming
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Taylor S Howard
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Tam Dan N Pham
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Christina Y Miyake
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey J Kim
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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