1
|
Randall MM, Burt T, Cruise S, Mesisca MK, Minahan T. Safety of adenosine for pediatric tachyarrhythmia treatment in the emergency department: a multi-hospital 10-year cross-sectional study. Int J Emerg Med 2024; 17:103. [PMID: 39215228 PMCID: PMC11363447 DOI: 10.1186/s12245-024-00683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Supraventricular tachycardia is the most common dysrhythmia in children. Initial vagal maneuvers are successful less than half of the time. Adenosine, a potent AV nodal blocker with a short half-life, is recommended as first line pharmacotherapy. Minor side effects from adenosine are common, but report of serious side effects such as sustained ventricular tachycardia, torsades de pointes, syncope or hypotension are confined to small case series or studies greater than 20 years old. We aimed to specifically identify the incidence of serious side effects of adenosine in children in the emergency department. METHODS Between 2002 and 2022, all children less than 18 years old who received adenosine for tachyarrhythmia treatment in two emergency departments were included. The electronic record was reviewed for demographic information, patient history, treatments given, and side effects or complications were observed. Electrocardiograms before, during and after adenosine administration were reviewed. RESULTS 77 patients met inclusion criteria. There were 74 patients with an initial rhythm of typical SVT. The other three patients included one with a junctional rhythm, one with atrial fibrillation, and one with an undetermined narrow complex tachycardia. 49 patients had cardiac rhythm monitoring during adenosine administration. 17 of these patients had three or more consecutive ventricular beats following adenosine, however no patients required treatment. No patients had syncope. One patient had brief hypotension after adenosine that normalized without intervention. Four patients were electrically cardioverted after adenosine, all for persistent dysrhythmias: two for persistent SVT with hypotension, one for atrial fibrillation and one for an undetermined rhythm. Twelve patients were placed on continuous antiarrhythmic medication for persistent SVT. Age, gender, prior SVT history, initial adenosine dose, and need for additional doses were not significant risk factors for a prolonged sinus pause or greater than two ventricular beats. CONCLUSIONS Adenosine treatment in typical supraventricular tachycardia in pediatric patients is safe.
Collapse
Affiliation(s)
- Melanie M Randall
- Loma Linda University Children's Hospital, 11234 Anderson Street, Loma Linda, CA, 92354, USA.
| | - Tristen Burt
- Riverside University Health System Medical Center, 26520 Cactus Avenue, Moreno Valley, CA, 92552, USA
| | - Scott Cruise
- Riverside University Health System Medical Center, 26520 Cactus Avenue, Moreno Valley, CA, 92552, USA
| | - Michael K Mesisca
- Riverside University Health System Medical Center, 26520 Cactus Avenue, Moreno Valley, CA, 92552, USA
| | - Thomas Minahan
- Riverside University Health System Medical Center, 26520 Cactus Avenue, Moreno Valley, CA, 92552, USA
| |
Collapse
|
2
|
Zachaj J, Kręglicki Ł, Sikora T, Moorthi K, Jaśkiewicz F, Nadolny K, Gałązkowski R. Successful Intraosseous (IO) Adenosine Administration for the Termination of Supraventricular Tachycardia (SVT) in a 3.5-Year-Old Child-Case Report and Literature Review. Healthcare (Basel) 2024; 12:1509. [PMID: 39120211 PMCID: PMC11311986 DOI: 10.3390/healthcare12151509] [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: 06/22/2024] [Revised: 07/23/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open
Abstract
Paediatric supraventricular tachycardia (SVT) is a common arrhythmia of great clinical significance. If not treated promptly, it can cause heart failure and cardiogenic shock. Depending on the patient's condition, SVT treatment involves vagal manoeuvres, pharmacological, or direct current cardioversion. The goal of acute SVT management is to immediately convert SVT to a normal sinus rhythm (NSR) and prevent its recurrence. Adenosine is recommended as the first-line treatment for stable SVT by the European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines, when vagal manoeuvres have proven ineffective. The ERC and AHA guidelines recommend the intravenous route of administration. The intraosseous (IO) administration technique is also possible, but still relatively unknown. The aim of this paper is to describe a 3.5-year-old child with SVT that was converted to NSR following IO administration of adenosine. Successful conversion was achieved after the second attempt with the adenosine dose. In the described case, there was no recurrence of SVT.
Collapse
Affiliation(s)
- Jakub Zachaj
- Medical Emergency Department, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland;
| | - Łukasz Kręglicki
- Polish Medical Air Rescue, Księżycowa 5, 01-934 Warsaw, Poland; (Ł.K.); (T.S.); (K.M.)
- Department of Emergency Medicine, Jagiellonian University Medical College, Michałowskiego 12, 31-126 Cracow, Poland
| | - Tomasz Sikora
- Polish Medical Air Rescue, Księżycowa 5, 01-934 Warsaw, Poland; (Ł.K.); (T.S.); (K.M.)
- Department of Emergency Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland
| | - Katarzyna Moorthi
- Polish Medical Air Rescue, Księżycowa 5, 01-934 Warsaw, Poland; (Ł.K.); (T.S.); (K.M.)
- Military Medical Institute, National Research Institute, Szaserów 128, 04-141 Warsaw, Poland
| | - Filip Jaśkiewicz
- Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, Pomorska 125, 90-419 Lodz, Poland;
| | - Klaudiusz Nadolny
- Faculty of Medicine, Department of Emergency Medical Service, Silesian Academy in Katowice, ul. Rolna 43, 40-555 Katowice, Poland;
| | - Robert Gałązkowski
- Medical Emergency Department, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland;
| |
Collapse
|
3
|
Arrhythmias in children: Too fast or too slow. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
4
|
Tester MA, Riehm KE, Perry F, Franciosi S, Escudero CA, Maghrabi K, Sneddon P, Sanatani S. Paediatric supraventricular tachycardia patients potentially more at risk of developing psychological difficulties compared to healthy peers. Acta Paediatr 2021; 110:1017-1024. [PMID: 32865825 DOI: 10.1111/apa.15556] [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: 06/05/2020] [Revised: 08/04/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
AIM Assess executive and socio-emotional/behavioural functioning in paediatric supraventricular tachycardia (SVT) patients. METHODS SVT patients aged 7-17 who had not undergone catheter ablation were included. Parents completed the Child Behaviour Checklist (CBCL/6-18) and the Behavior Rating Inventory of Executive Functioning (BRIEF). Participants age 11-17 years completed the Youth Self-Report (YSR/11-18) and the BRIEF Self-Report (BRIEF-SR). One-sample z test was used to compare questionnaire results to the average t-score range (M = 50, SD = 10). RESULTS Thirty (18 female) children/adolescents participated (M = 12.6 years old, SD = 3.2 years) with a mean SVT onset age of 7 years (SD = 4.3 years). BRIEF and BRIEF-SR results suggested no difference in executive functioning from average. Mean t-scores of CBCL/6-18 and YSR/11-18 subscales Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems, Diagnostic and Statistical Manual of Mental Disorders (DSM) Affective Problems, DSM Anxiety Problems and DSM Somatic Problems were significantly elevated compared to average. YSR/11-18 subscales Social Problems, Attention Problems, Internalizing Problems, DSM ADHD Problems and DSM Oppositional Defiant Problems had elevated mean t-scores compared to average. Effect sizes were small to medium (0.2 ≤ d ≤ 0.8). CONCLUSION Paediatric patients with SVT potentially have a greater risk of developing behaviour, especially internalizing, problems compared to similarly aged children/adolescents without SVT.
Collapse
Affiliation(s)
- Matthew A. Tester
- Children’s Heart Centre BC Children’s Hospital Vancouver BC Canada
- Department of Paediatrics University of British Columbia Vancouver BC Canada
| | - Kira E. Riehm
- Department of Mental Health Bloomberg School of Public Health Johns Hopkins University Baltimore MD USA
| | - Frances Perry
- Children’s Heart Centre BC Children’s Hospital Vancouver BC Canada
- Department of Paediatrics University of British Columbia Vancouver BC Canada
| | - Sonia Franciosi
- Children’s Heart Centre BC Children’s Hospital Vancouver BC Canada
- Department of Paediatrics University of British Columbia Vancouver BC Canada
| | | | | | - Penny Sneddon
- Department of Paediatrics University of British Columbia Vancouver BC Canada
- Department of Psychology BC Children’s Hospital Vancouver BC Canada
| | - Shubhayan Sanatani
- Children’s Heart Centre BC Children’s Hospital Vancouver BC Canada
- Department of Paediatrics University of British Columbia Vancouver BC Canada
| |
Collapse
|
5
|
Pauley R, Mercier EL, Kumar A, Trescher WH, Mainali G. Infant Stroke Associated With Left Atrial Thrombus and Supraventricular Tachycardia. Child Neurol Open 2021; 8:2329048X21995296. [PMID: 33644250 PMCID: PMC7894682 DOI: 10.1177/2329048x21995296] [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: 09/02/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 11/15/2022] Open
Abstract
We report a rare case of cardioembolic stroke in the setting of supraventricular tachycardia (SVT) in an infant. After a week of irritability, a 10-week-old male presented to the emergency department with SVT requiring treatment with adenosine. He developed right-sided hemiparesis and focal motor seizures. Imaging of the brain showed ischemic infarct in the left middle cerebral artery (MCA) territory. Echocardiogram showed a newly formed large left atrial intracardiac thrombus. A coagulopathy workup was negative. He was treated with beta-blocker and anticoagulation therapy. He had mild residual right hemiparesis. During childhood, he developed medically refractory focal epilepsy from the left hemisphere, requiring epilepsy surgery at age 10. A child presenting with sustained SVT can be at increased risk for intracardiac thrombi and stroke.
Collapse
Affiliation(s)
- Rachel Pauley
- Department of Neurology, Division of Child Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Elise L Mercier
- Department of Pediatrics, Division of Child Neurology, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Ashutosh Kumar
- Department of Pediatrics, Division of Child Neurology, Penn State Health College of Medicine, Hershey, PA, USA
| | - William H Trescher
- Department of Pediatrics, Division of Child Neurology, Penn State Health College of Medicine, Hershey, PA, USA
| | - Gayatra Mainali
- Department of Pediatrics, Division of Child Neurology, Penn State Health College of Medicine, Hershey, PA, USA
| |
Collapse
|
6
|
Paroxysmal Supraventricular Tachycardia in Wolff–Parkinson–White Syndrome in a Newborn—Case Report and Mini-Review. Medicina (B Aires) 2020; 56:medicina56110588. [PMID: 33167583 PMCID: PMC7694453 DOI: 10.3390/medicina56110588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/03/2022] Open
Abstract
Wolff–Parkinson–White (WPW) syndrome is a rare abnormal condition frequently associated with paroxysmal supraventricular tachycardia (PSVT) and is described as an arrhythmia under the form of increased heartbeat. Currently, there are various possible treatments going from medicines such as adenosine and beta-blockers to cardioversion. The unknown causes of this condition together with the different responses to treatment in each patient make it difficult to establish the best therapeutic approach. In this context, in the current paper, we were interested in reporting the therapeutic options and their efficiency in the case of associated heart or inflammatory conditions in a 13-day-old patient.
Collapse
|
7
|
Cheng L, Eilbert W. High-dose adenosine for treatment of refractory paroxysmal supraventricular tachycardia. Am J Emerg Med 2020; 38:1541.e3-1541.e4. [DOI: 10.1016/j.ajem.2020.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/25/2022] Open
|
8
|
Woodward S, Mundorff M, Weng C, Gamboa DG, Johnson MD. Incidence of supraventricular tachycardia after inhaled short-acting beta agonist treatment in children. J Asthma 2020; 58:471-480. [PMID: 31902263 DOI: 10.1080/02770903.2019.1709867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Albuterol can trigger supraventricular tachycardia (SVT). The clinical characteristics, incidence, and risk factors of SVT after inhaled SABA treatment in children are currently unknown. Through review of regional care delivery, we will describe cases of SVT during asthma treatment in hospital-based settings, define the incidence of SVT in our population, and evaluate risk factors of SABA-induced SVT. METHODS We identified hospital-based care episodes of children 0-18 years old between 2006 and 2015 recorded in the Intermountain Healthcare EDW with either 1) diagnosis codes for both asthma and SVT or 2) both SABA and adenosine listed as billed medications. Controls were matched with cases by age and sex to determine risk factors for SVT after SABA using conditional logistic regression. RESULTS Of 93 care episodes meeting criteria, we found 7 cases of SVT after SABA treatment in 6 patients over 10 years. In our population, the incidence of SVT is 3.9 per 10,000 episodes of SABA treatment, and 5.1 per 10,000 children with asthma receiving hospital-based asthma care. Two episodes of SVT followed treatment with only levalbuterol, three after only albuterol, and two after both albuterol and levalbuterol treatment. Five cases of SVT were converted to sinus rhythm with adenosine, one converted with synchronized electrical cardioversion, and one resolved spontaneously. No cases of SVT led to death. No examined variables were associated with SABA-induced SVT. CONCLUSIONS SVT is rare during hospital-based treatment for acute asthma using inhaled SABAs and has low morbidity and mortality.
Collapse
Affiliation(s)
- Stephanie Woodward
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Cindy Weng
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David G Gamboa
- Department of Pediatrics Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Michael D Johnson
- Department of Pediatrics Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Quattrocelli A, Lang J, Davis A, Pflaumer A. Age makes a difference: Symptoms in pediatric supraventricular tachycardia. J Arrhythm 2018; 34:565-571. [PMID: 30327703 PMCID: PMC6174476 DOI: 10.1002/joa3.12103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Supraventricular tachycardia is a group of rhythm disturbances that affect 1 in 300-1200 Australian children annually. The differentiation of supraventricular tachycardia (SVT) symptoms and age of onset according to their subtype is not well understood in the pediatric population. Most studies rely on ECG criteria only to characterize the subtype of the SVT, which is not applicable to all subtypes. The purpose of this study was to identify the symptoms and ages of onset of SVT subtypes, and to analyze whether ethnicity or severity correlated with the SVT subtype confirmed in an invasive Electrophysiology (EP) study. METHODS A retrospective analysis and prospective survey evaluated 364 patients who underwent an EP study at The Royal Children's Hospital, Melbourne between 2009 and 2015. Age of onset, symptoms, and ethnicity were collected by phone survey or medical records in addition to EP study diagnostic data, medication status, and follow-up information about their symptom status following EP procedure. Patients were grouped according to their SVT subtype. Data analysis was performed using chi-squared, Fisher's exact, and ANOVA statistical tests to determine associations between SVT substrates. RESULTS Two hundred and thirty-three suitable cases of SVT were identified (131 men, 102 women) aged between 0 and 18 years. Atrioventricular Reentrant Tachycardia (AVRT) (n = 153) was the most common SVT subtype, followed by Atrioventricular Nodal Reentrant Tachycardia (AVNRT) (n = 55), Atrial Tachycardia (AT) (n = 17), and other SVT subtypes (n = 8) which included Atrial Fibrillation, Atrial Flutter, and Junctional Tachycardia. There was a male predominance in all subtypes, except for AVNRT. AVNRT patients had palpitations, dyspnoea, dizziness, and anxiety more than any other group, AVRT patients complained of vomiting most and patients with AT had the most fatigue. The mean age of symptom onset varied among groups, being earlier in AVRT, later in AVNRT with a significant difference between AVRT with unidirectional retrograde accessory pathway (URAP) and AVNRT subtypes (P < 0.01). CONCLUSION Some specific symptoms were strong discriminators between different SVT subtypes. Ethnicity did not have strong correlations with SVT subtype incidence. This study was able to show clinical differences among children with SVT due to AVRT (URAP) compared to AVNRT, allowing the prognosis and intended management of pediatric SVT to be anticipated by less invasive means.
Collapse
Affiliation(s)
- Amanda Quattrocelli
- Cardiology DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- The University of MelbourneMelbourneVictoriaAustralia
| | - Janet Lang
- Cardiology DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Andrew Davis
- Cardiology DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- The University of MelbourneMelbourneVictoriaAustralia
- Murdoch Childrens Research InstituteMelbourneVictoriaAustralia
| | - Andreas Pflaumer
- Cardiology DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- The University of MelbourneMelbourneVictoriaAustralia
- Murdoch Childrens Research InstituteMelbourneVictoriaAustralia
| |
Collapse
|
10
|
L'Italien K, Conlon S, Kertesz N, Bezold L, Kamp A. Usefulness of Echocardiography in Children with New-Onset Supraventricular Tachycardia. J Am Soc Echocardiogr 2018; 31:1146-1150. [PMID: 30076010 DOI: 10.1016/j.echo.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Supraventricular tachycardia (SVT) is the most common sustained arrhythmia in children. Infants with SVT and ventricular preexcitation (Wolff-Parkinson-White syndrome) are known to have up to 30% prevalence of congenital heart disease (CHD). Infants without ventricular preexcitation who present with SVT at <1 year of age have a similar prevalence of CHD. However, for children without ventricular preexcitation who present with SVT at older ages, the prevalence of CHD is not known. The aim of this study was to determine the prevalence of CHD in older children and adolescents presenting with SVT without ventricular preexcitation, with the goal of providing guidance regarding the usefulness of echocardiography in this patient population. METHODS Children aged 2 to 18 years presenting with confirmed SVT between January 2011 and December 2015 were included in this retrospective review. Patients with any history of ventricular preexcitation or preexisting heart disease were excluded. Medical records were reviewed, and electrocardiographic and echocardiographic findings were classified as normal, incidental, or abnormal. RESULTS Two hundred ninety patients met the inclusion criteria. Echocardiographic examinations were completed on 224 patients. Only one patient was found to have CHD, a moderate primum atrial septal defect. This patient was noted to have electrocardiographic abnormalities consistent with primum atrial septal defect. CONCLUSIONS For older children and adolescents with no known heart disease presenting with SVT without ventricular preexcitation, echocardiography may not be a necessary part of initial evaluation when the results of physical examination and electrocardiography are normal.
Collapse
Affiliation(s)
- Kaitlin L'Italien
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
| | - Steven Conlon
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Naomi Kertesz
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Louis Bezold
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Anna Kamp
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
11
|
Wang SSY, Tang GWG, Williams G. Pulsus trigeminy and electrolyte derangements: a forgotten primary care presentation. J Prim Health Care 2018; 10:348-351. [DOI: 10.1071/hc18052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
12
|
Pediatric Tachyarrhythmias: Diagnosis and Management. CURRENT PEDIATRICS REPORTS 2017. [DOI: 10.1007/s40124-017-0148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
A Novel Method of Intraosseous Infusion of Adenosine for the Treatment of Supraventricular Tachycardia in an Infant. Pediatr Emerg Care 2017; 33:47-48. [PMID: 28045841 DOI: 10.1097/pec.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supraventricular tachycardia is a common arrhythmia faced by emergency physicians in the pediatric population. In most cases, antecubital intravenous access can be established, and adenosine can be administered in a rapid and timely fashion. The role and administration of intraosseous adenosine are poorly established. We describe a case where the administration of adenosine was successful via a mixed method administration.
Collapse
|
14
|
Batte A, Lwabi P, Lubega S, Kiguli S, Nabatte V, Karamagi C. Prevalence of arrhythmias among children below 15 years of age with congenital heart diseases attending Mulago National Referral Hospital, Uganda. BMC Cardiovasc Disord 2016; 16:67. [PMID: 27074797 PMCID: PMC4831118 DOI: 10.1186/s12872-016-0243-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Uganda, few children with congenital heart diseases (CHD) benefit from early corrective cardiac surgery. These children are at high risk of developing heart failure and electrolyte imbalances; factors which increase their risk of developing arrhythmias. This study aimed to determine the prevalence and factors associated with arrhythmias among children with congenital heart diseases receiving care at Mulago Hospital. METHODS This was a cross-sectional study carried out from August 2013 to March 2014 at Mulago Hospital. Children were consecutively enrolled into the study. Standard 12-lead electrocardiograms (ECGs) were performed on 194 children with CHD (age range 10 days-15 years). Data was analysed using SPSS 16.0. RESULTS Out of 194 children studied, 53/194 (27.3 %, 95 % CI 21.0 - 33.6) children had arrhythmias. Of the CHD children, 44/194 (22.7 %, 95 % CI 16.8 - 28.6) had first degree AV block while 9/194 (4.6 %, 95 % CI 1.7 - 7.6) children had either ectopic atrial rhythm, premature atrial contractions, junctional rhythm, complete atrioventricular (AV) dissociation or premature ventricular contractions. Children using digoxin were more likely to have first degree AV block (OR 3.75, 95 % CI 1.60-8.86) while those aged 5 years and below were less likely to have first degree AV block (OR 0.16, 95 % CI 0.07-0.37). CONCLUSION Arrhythmias are common among children with CHD receiving care from Mulago Hospital. These are associated with digoxin use, child's age and electrolyte imbalances; factors which can easily be assessed, managed and where possible modified in these children during their care.
Collapse
Affiliation(s)
- Anthony Batte
- />Child Health and Development Centre, Makerere University College of Health Sciences, P.O Box 6717, Kampala, Uganda
| | - Peter Lwabi
- />Uganda Heart Institute, P.O. Box 7051, Kampala, Uganda
| | | | - Sarah Kiguli
- />Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Violette Nabatte
- />Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Charles Karamagi
- />Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| |
Collapse
|
15
|
Schultz KE, Giese A, Groner A. A rare cause of vomiting in a 5-year-old girl. Pediatr Ann 2015; 44:e62-6. [PMID: 25806732 DOI: 10.3928/00904481-20150313-11] [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] [Indexed: 11/20/2022]
Abstract
A 5-year-old previously healthy girl presented to the emergency department (ED) with vomiting for 6 days. Her activity level was normal but her parents described progressive exercise intolerance with frequent recreational breaks approximately 2 days prior to presentation. In addition, the child complained of mild abdominal discomfort that began 24 hours prior to her presentation. She had no diarrhea or changes in her diet or oral intake; she had no dysuria or changes in urination. She had no cough, shortness of breath, dizziness, vision changes, falls, or decreased coordination.
Collapse
|
16
|
Pérez-Vilar S, Díez-Domingo J, Gomar-Fayos J, Pastor-Villalba E, Sastre-Cantón M, Puig-Barberà J. Post-licensure passive safety surveillance of rotavirus vaccines: Reporting sensitivity for intussusception. An Pediatr (Barc) 2014. [DOI: 10.1016/j.anpede.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
17
|
Pérez-Vilar S, Díez-Domingo J, Gomar-Fayos J, Pastor-Villalba E, Sastre-Cantón M, Puig-Barberà J. [Post-licensure passive safety surveillance of rotavirus vaccines: reporting sensitivity for intussusception]. An Pediatr (Barc) 2013; 81:77-85. [PMID: 24252603 DOI: 10.1016/j.anpedi.2013.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/12/2013] [Accepted: 10/14/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The aims of this study were to describe the reports of suspected adverse events due to rotavirus vaccines, and assess the reporting sensitivity for intussusception. MATERIAL AND METHODS Descriptive study performed using the reports of suspected adverse events following rotavirus vaccination in infants aged less than 10 months, as registered in the Pharmacovigilance Centre of the Valencian Community during 2007-2011. The reporting rate for intussusception was compared to the intussusception rate in vaccinated infants obtained using the hospital discharge database (CMBD), and the regional vaccine registry. RESULTS The adverse event reporting rate was 20 per 100,000 administered doses, with the majority (74%) of the reports being classified as non-serious. Fever, vomiting, and diarrhea were the adverse events reported more frequently. Two intussusception cases, which occurred within the first seven days post-vaccination, were reported as temporarily associated to vaccination. The reporting sensitivity for intussusception at the Pharmacovigilance Centre in the 1-7 day interval following rotavirus vaccination was 50%. CONCLUSIONS Our results suggest that rotavirus vaccines have, in general, a good safety profile. Intussusception reporting to the Pharmacovigilance Centre shows sensitivity similar to other passive surveillance systems. The intussusception risk should be further investigated using well-designed epidemiological studies, and evaluated in comparison with the well-known benefits provided by these vaccines.
Collapse
Affiliation(s)
- S Pérez-Vilar
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO-Salud Pública, Valencia. España.
| | - J Díez-Domingo
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO-Salud Pública, Valencia. España
| | - J Gomar-Fayos
- Servicio de Ordenación y Control del Medicamento, Dirección General de Farmacia y Productos Sanitarios, Valencia, España
| | - E Pastor-Villalba
- Servicio de Salud Infantil y de la Mujer, Dirección General de Salud Pública, Valencia, España
| | - M Sastre-Cantón
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO-Salud Pública, Valencia. España
| | - J Puig-Barberà
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO-Salud Pública, Valencia. España
| |
Collapse
|
18
|
DESAI VIBHAC, KELTON CHRISTINAM, CZOSEK RICHARDJ, HEATON PAMELAC. Frequencies, Costs, and Complications of Catheter Ablation for Tachyarrhythmias in Children: 2000-2009. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1468-80. [DOI: 10.1111/pace.12191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/16/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- VIBHA C.A. DESAI
- James L. Winkle College of Pharmacy; University of Cincinnati; Cincinnati Ohio
| | - CHRISTINA M.L. KELTON
- Carl H. Lindner College of Business and College of Pharmacy; University of Cincinnati; Cincinnati Ohio
| | - RICHARD J. CZOSEK
- Department of Pediatric Cardiology; The Heart Institute, Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - PAMELA C. HEATON
- James L. Winkle College of Pharmacy; University of Cincinnati; Cincinnati Ohio
| |
Collapse
|
19
|
Kelly A, Kennedy A, John BM, Duane B, Lemanowicz J, Little J. A comparison of heart rate changes associated with levalbuterol and racemic albuterol in pediatric cardiology patients. Ann Pharmacother 2013; 47:644-50. [PMID: 23613097 DOI: 10.1345/aph.1s003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To our knowledge, no data exist regarding the effect of levalbuterol and racemic albuterol on heart rate in pediatric cardiology patients. OBJECTIVE To compare heart rate change in pediatric cardiology patients receiving levalbuterol and/or racemic albuterol. The secondary objective was to identify characteristics associated with heart rate changes observed with these drugs. METHODS A review of electronic medical records at a pediatric academic hospital was conducted to determine the equivalence of heart rate change in patients receiving levalbuterol or racemic albuterol. Patients receiving at least 3 doses of levalbuterol and/or racemic albuterol during the study period were included if they were younger than 18 years and had a diagnosis of congenital heart disease (CHD), cardiomyopathy, or supraventricular tachycardia. Patients were excluded if they received a β-blocker or continuous racemic albuterol or did not have documented pre- and postdose heart rates. RESULTS One hundred ninety-two patients were included. One hundred forty-two received racemic albuterol, 40 received levalbuterol, and 10 received both racemic albuterol and levalbuterol. The mean increase in heart rate for patients receiving racemic albuterol and levalbuterol was 6.8 beats/min and 6.2 beats/min, respectively (p = 0.01). In patients with CHD, the racemic albuterol group experienced a mean heart rate increase of 6.6 beats/min compared to 6.3 beats/min in the levalbuterol group (p = 0.01). Equivalence was also determined in patients without surgical intervention and patients receiving concomitant cardiac and respiratory medications. Equivalence was not established in other analyzed subgroups secondary to insufficient sample sizes. CONCLUSIONS Racemic albuterol and levalbuterol were associated with increased heart rate in pediatric cardiology patients. This increase was found to be equivalent.
Collapse
Affiliation(s)
- Anne Kelly
- Department of Pharmacy, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
| | | | | | | | | | | |
Collapse
|
20
|
Chêne MA, Parlier G, Denis J, Siret D. Tachycardie supraventriculaire simultanée chez des jumeaux monozygotes prématurés. Arch Pediatr 2013; 20:192-5. [DOI: 10.1016/j.arcped.2012.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/05/2012] [Accepted: 11/08/2012] [Indexed: 11/15/2022]
|
21
|
Picchio FM, Prandstraller D, Bronzetti G, Cervi E. Follow-up of neonates with foetal and neonatal arrhythmias. J Matern Fetal Neonatal Med 2012; 25 Suppl 4:53. [DOI: 10.3109/14767058.2012.714980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
22
|
Hafez M, Abu-Elkheir M, Shokier M, Al-Marsafawy H, Abo-Haded H, El-Maaty MA. Radiofrequency catheter ablation in children with supraventricular tachycardias: intermediate term follow up results. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2012; 6:7-16. [PMID: 22259261 PMCID: PMC3256955 DOI: 10.4137/cmc.s8578] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The Purpose of the Study Radiofrequency (RF) catheter ablation represents an important advance in the management of children with cardiac arrhythmias and has rapidly become the standard and effective line of therapy for supraventricular tachycardias (SVTs) in pediatrics. The purpose of this study was to evaluate the intermediate term follow up results of radiofrequency catheter ablation in treatment of SVT in pediatric age group. Methods A total of 60 pediatric patients (mean age = 12.4 ± 5.3 years, ranged from 3 years to 18 years; male: female = 37:23; mean body weight was 32.02 ± 12.3 kg, ranged from 14 kg to 60 kg) with clinically documented SVT underwent an electrophysiologic study (EPS) and RF catheter ablation at Children’s Hospital Mansoura University, Mansoura, Egypt during the period from January 2008 to December 2009 and they were followed up until October 2011. Results The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 45, 75%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 6, 10%), and atrial tachycardia (AT; n = 9, 15%). The success rate of the RF catheter ablation was 93.3% for AVRT, 66.7% for AVNRT, and 77.8% for AT, respectively. Procedure-related complications were infrequent (7/60, 11.7%), (atrial flutter during RF catheter ablation (4/60, 6.6%); ventricular fibrillation during RF catheter ablation (1/60, 1.6%); transient complete heart block during RF catheter ablation (2/60, 3.3%)). The recurrence rate was 8.3% (5/60) during a follow-up period of 34 ± 12 months. Conclusion RF catheter ablation is an effective and safe method to manage children with SVT.
Collapse
Affiliation(s)
- Mm Hafez
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | | | | | | |
Collapse
|
23
|
Ukena J, Strominger MB, Balaguru D. Supraventricular tachycardia in a child undergoing strabismus surgery. J Pediatr Ophthalmol Strabismus 2011; 48:252-3. [PMID: 21766744 DOI: 10.3928/01913913-20110701-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
24
|
Abstract
Wolff-Parkinson-White (WPW) syndrome is a ventricular preexcitation that presents as supraventricular tachycardia. Health care professionals can attain optimal results in caring for infants with WPW syndrome by understanding both its pathophysiology and proper management to prevent and treat complications associated with it. This article reviews the prevalence, pathophysiology, clinical manifestations, diagnostic modalities, assessment, and management of WPW syndrome.
Collapse
|
25
|
Abstract
Amiodarone is a class 3 antiarrhythmic agent used for a broad range of arrhythmias including adenosine-resistant supraventricular tachycardia, junctional ectopic tachycardia, and ventricular tachycardia. Compared with adults, there are few data on its use in children with arrhythmias resistant to conventional therapy. National and international guidelines for cardiopulmonary resuscitation and emergency cardiovascular care recommend its use for a variety of arrhythmias based on case reports, cohort studies, and extrapolation from adult data. This article will review the historical development, chemical properties, metabolism, indications and contraindications, and adverse effects of amiodarone in infants and children. After completing this CME activity, the reader should be able to utilize amiodarone in the pediatric population for arrhythmias and identify complications associated with its use.
Collapse
|