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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 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).
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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
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2
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Carney M, Kalhan T, Rochelson E. Tachycardia in a Premature Neonate. Neoreviews 2024; 25:e56-e59. [PMID: 38161184 DOI: 10.1542/neo.25-1-e56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Megan Carney
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Tamara Kalhan
- Department of Pediatrics, Division of Neonatology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Ellis Rochelson
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
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3
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Younger postnatal age is associated with a lower heart rate on Holter monitoring during the first week of life. Eur J Pediatr 2023; 182:2359-2367. [PMID: 36884089 PMCID: PMC10175328 DOI: 10.1007/s00431-023-04914-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
To evaluate heart rate (HR), the presence of extrasystoles and other Holter findings among healthy newborns, and to collect data for new normal limits for Holter parameters in newborns. For this cross-sectional study, 70 healthy term newborns were recruited to undergo 24-h Holter monitoring. Linear regression analysis was used in HR analyses. The age-specific limits for HRs were calculated using linear regression analysis coefficients and residuals. The mean (SD) age of the infants was 6.4 (1.7) days during the recording. Each consecutive day of age raised the minimum and mean HR by 3.8 beats per minute (bpm) (95% CI: 2.4, 5.2; P < .001) and 4.0 bpm (95% CI: 2.8, 5.2; P < .001), respectively. Age did not correlate with maximum HR. The lowest calculated limit for minimum HR ranged from 56 bpm (aged 3 days) to 78 bpm (aged 9 days). A small number of atrial extrasystoles and ventricular extrasystoles were observed in 54 (77%) and 28 (40%) recordings, respectively. Short supraventricular or ventricular tachycardias were found in 6 newborns (9%). CONCLUSION The present study shows an increase of 20 bpm in both the minimum and mean HRs of healthy term newborns between the 3rd and 9th days of life. Daily reference values for HR could be adopted in the interpretation of HR monitoring results in newborns. A small number of extrasystoles are common in healthy newborns, and isolated short tachycardias may be normal in this age group. WHAT IS KNOWN • The current definition of bradycardia in newborns is 80 beats per minute. • This definition does not fit into the modern clinical setting of continuously monitored newborns, where benign bradycardias are commonly observed. WHAT IS NEW • A linear and clinically significant increase in heart rate was observed in infants between the ages of 3 and 9 days. • It appears as though lower normal limits for heart rate could be applied to the youngest newborns.
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Uusitalo A, Tikkakoski A, Reinikainen M, Lehtinen P, Ylänen K, Korhonen P, Poutanen T. Extrasystoles or short bradycardias of the newborn seldom require subsequent 24-hour electrocardiographic monitoring. Acta Paediatr 2022; 111:979-984. [PMID: 35100437 PMCID: PMC10138749 DOI: 10.1111/apa.16259] [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: 07/05/2021] [Revised: 12/28/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
AIM To retrospectively assess the indications for and findings on 24-hour electrocardiographic (Holter) monitoring in newborns, focussing on bradycardias and extrasystoles. METHODS Data included 337 term-born infants. Holter indications were categorised into bradycardias below 80 beats per minute, extrasystoles, any tachycardia and other. Heart rate below 60 beats per minute, pathological atrioventricular conduction, supraventricular or ventricular tachycardia, or either atrial premature contractions over 10% or ventricular premature contractions over 5% of total beats were defined as significant arrhythmia on Holter. RESULTS The median age was 6 days (range: 2-62 days). Bradycardia (42%) or extrasystoles (32%) were the most common Holter indications. Fifty-three infants (16%) had significant arrhythmia on Holter. Heart disease or 12-lead electrocardiogram expressing extrasystoles or conduction abnormalities were associated with significant arrhythmias (p = 0.046 and p < 0.001, respectively). Twenty-seven of 109 infants (25%) with extrasystoles as a Holter indication had abnormal Holter results, but only seven (6.4%) had significant arrhythmia on Holter if the 12-lead electrocardiogram was normal. No pathology was found behind bradycardias below 80 beats per minute in the absence of heart disease. CONCLUSION Among term newborns with extrasystoles or bradycardias, Holter monitoring could be targeted to infants with heart disease or abnormal electrocardiograms.
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Affiliation(s)
- Asta Uusitalo
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Tampere Center for Child, Adolescent and Maternal Health Research Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology and Nuclear Medicine Tampere University Hospital Tampere Finland
| | - Miika Reinikainen
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Pieta Lehtinen
- Department of Clinical Physiology and Nuclear Medicine Tampere University Hospital Tampere Finland
| | - Kaisa Ylänen
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Tampere Center for Child, Adolescent and Maternal Health Research Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Päivi Korhonen
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Tampere Center for Child, Adolescent and Maternal Health Research Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Tuija Poutanen
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Tampere Center for Child, Adolescent and Maternal Health Research Faculty of Medicine and Health Technology Tampere University Tampere Finland
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Escudero CA, Tan RBM, Beach CM, Dalal AS, LaPage MJ, Hill AC. Approach to Wide Complex Tachycardia in Paediatric Patients. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:60-73. [PMID: 37969244 PMCID: PMC10642107 DOI: 10.1016/j.cjcpc.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2023]
Abstract
Wide complex tachycardia (WCT) is an infrequently encountered condition in paediatric patients and may be due to a variety of causes including supraventricular tachycardia with aberrant conduction, ventricular activation via an accessory pathway, ventricular pacing, or ventricular tachycardia. Immediate tachycardia termination is required in haemodynamically unstable patients. After stabilization or in those with haemodynamically tolerated WCT, a careful review of electrocardiographic tracings and diagnostic manoeuvres are essential to help elucidate the cause. Subacute and chronic management for WCT will depend on the underlying cause as well as features of the patient and the tachycardia presentation. This article will review the epidemiology, potential causes, and management of WCT in children. A detailed review of the pathophysiology, differential diagnosis, and diagnostic and treatment options is provided to enable the reader to develop a practical approach to managing this condition in young patients.
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Affiliation(s)
- Carolina A. Escudero
- Division of Cardiology, Department of Pediatrics, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Reina Bianca M. Tan
- Division of Cardiology, Department of Pediatrics, NYU Langone Health and Hassenfeld Children’s Hospital, New York, New York, USA
| | - Cheyenne M. Beach
- Section of Cardiology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Aarti S. Dalal
- Division of Cardiology, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Martin J. LaPage
- Division of Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison C. Hill
- Division of Cardiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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6
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Accelerated idioventricular rhythm in a healthy newborn: frightening but non-threatening. Cardiol Young 2022; 32:500-502. [PMID: 34365996 DOI: 10.1017/s1047951121003255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Accelerated idioventricular rhythm is a rare but benign form of ventricular tachycardia which might be challenging to differentiate from other more worrisome forms. We present the case of a healthy newborn diagnosed with an accelerated idioventricular rhythm which is spontaneously terminated without the need for medical therapy.
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7
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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.
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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
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8
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Rohit M, Kasinadhuni G. Management of Arrhythmias in Pediatric Emergency. Indian J Pediatr 2020; 87:295-304. [PMID: 32166608 DOI: 10.1007/s12098-020-03267-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/20/2020] [Indexed: 10/24/2022]
Abstract
Pediatricians often find it difficult to make specific diagnosis of arrhythmia based on ECG. This article is an effort to make the pediatricians understand common arrhythmias. Diagnosing arrhythmias is important as some arrhythmias, if not diagnosed or suspected, can lead to heart failure. With proper diagnosis, some of them can be cured with therapeutic ablation. Adenosine is not only a therapeutic drug but in many circumstances, it gives definite diagnosis also.
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Affiliation(s)
- Manojkumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical, Education and Research, Chandigarh, India.
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical, Education and Research, Chandigarh, India
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El Joueid N, Touma Boulos M, Abou Jaoude S, Daou L. Ventricular Tachycardia in an Infant Without Congenital Anomaly: A Case Report. Cardiol Res 2020; 11:61-65. [PMID: 32095198 PMCID: PMC7011923 DOI: 10.14740/cr1005] [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: 12/13/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022] Open
Abstract
Ventricular tachycardia (VT) is a serious form of arrhythmia that can be life-threatening; that’s why diagnosis and treatment are very important in order to avoid serious complications. We are reporting this case of VT which is a rare entity, especially, in healthy infants. This infant, without cardiac pathology known from birth, presented with poor food intake and grunting with hepatomegaly on clinical examination, and a heartbeat at 200/ min. The electrocardiogram (ECG) showed wide QRS complex tachycardia, and the echocardiogram showed a dilated and hypokinetic cardiomyopathy. The clinical signs and chest X-ray changes were consistent with mild cardiac failure. This presentation makes the diagnosis challenging, therefore, it is important to take a good history of the case with a complete clinical exam to achieve the correct diagnosis, and to avoid potential complications. VT of an infant may be benign but should not be diagnosed as such before eliminating serious causes.
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Affiliation(s)
- Nouhad El Joueid
- Pediatric Department, Hotel-Dieu de France University Hospital, Saint Joseph University, Medical School, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
| | - Marianne Touma Boulos
- Pediatric Department, Hotel-Dieu de France University Hospital, Saint Joseph University, Medical School, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
| | - Simon Abou Jaoude
- Cardiology Department, Hotel-Dieu de France University Hospital, Saint Joseph University, Medical School, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
| | - Linda Daou
- Pediatric Cardiology Department, Hotel-Dieu de France University Hospital, Saint Joseph University, Medical School, Alfred Naccache Boulevard, Achrafieh, Beirut,Lebanon
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Koutbi L, Aldebert P, Fouilloux V, Le Bel S, Deharo JC, Franceschi F. Percutaneous catheter ablation of malignant, recurrent ventricular arrhythmia in a 10-month-old toddler. HeartRhythm Case Rep 2019; 5:299-303. [PMID: 31285984 PMCID: PMC6587056 DOI: 10.1016/j.hrcr.2019.02.011] [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: 11/22/2022] Open
Affiliation(s)
- Linda Koutbi
- Unit of Arrhythmias, Department of Cardiology, Hôpital Timone, Aix-Marseille University, APHM, Marseille, France
| | - Philippe Aldebert
- Department of Paediatric Cardiology, Hôpital Timone, Aix-Marseille University, APHM, Marseille, France
| | - Virginie Fouilloux
- Department of Paediatric Cardiac Surgery, Hôpital Timone, Aix-Marseille University, APHM, Marseille, France
| | - Stéphane Le Bel
- Paediatric Cardiac Intensive Care Unit, Hôpital Timone, Aix-Marseille University, APHM, Marseille, France
| | - Jean-Claude Deharo
- Unit of Arrhythmias, Department of Cardiology, Hôpital Timone, Aix-Marseille University, APHM, Marseille, France.,Aix Marseille University, UMR MD2, Marseille, France
| | - Frédéric Franceschi
- Unit of Arrhythmias, Department of Cardiology, Hôpital Timone, Aix-Marseille University, APHM, Marseille, France.,Aix Marseille University, UMR MD2, Marseille, France
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Arnar DO, Mairesse GH, Boriani G, Calkins H, Chin A, Coats A, Deharo JC, Svendsen JH, Heidbüchel H, Isa R, Kalman JM, Lane DA, Louw R, Lip GYH, Maury P, Potpara T, Sacher F, Sanders P, Varma N, Fauchier L, Haugaa K, Schwartz P, Sarkozy A, Sharma S, Kongsgård E, Svensson A, Lenarczyk R, Volterrani M, Turakhia M, Obel IWP, Abello M, Swampillai J, Kalarus Z, Kudaiberdieva G, Traykov VB, Dagres N, Boveda S, Vernooy K, Kalarus Z, Kudaiberdieva G, Mairesse GH, Kutyifa V, Deneke T, Hastrup Svendsen J, Traykov VB, Wilde A, Heinzel FR. Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS). Europace 2019; 21:844–845. [DOI: 10.1093/europace/euz046] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
AbstractAsymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.
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Affiliation(s)
- David O Arnar
- Department of Medicine, Landspitali - The National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Hugh Calkins
- Department of Arrhythmia Services, Johns Hopkins Medical Institutions Baltimore, MD, USA
| | - Ashley Chin
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andrew Coats
- Department of Cardiology, University of Warwick, Warwickshire, UK
| | - Jean-Claude Deharo
- Department of Rhythmology, Hôpital Universitaire La Timone, Marseille, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Heidbüchel
- Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Ruan Louw
- Department Cardiology (Electrophysiology), Mediclinic Midstream Hospital, Centurion, South Africa
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Tatjana Potpara
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Frederic Sacher
- Service de Cardiologie, Institut Lyric, CHU de Bordeaux, Bordeaux, France
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Laurent Fauchier
- Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | - Kristina Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | | - Erik Kongsgård
- Department of Cardiology, OUS-Rikshospitalet, Oslo, Norway
| | - Anneli Svensson
- Department of Cardiology, University Hospital of Linkoping, Sweden
| | | | | | - Mintu Turakhia
- Stanford University, Cardiac Arrhythmia & Electrophysiology Service, Stanford, USA
| | | | | | - Janice Swampillai
- Electrophysiologist & Cardiologist, Waikato Hospital, University of Auckland, New Zealand
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze
| | | | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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Chiu SN, Wu WL, Lu CW, Wu KL, Tseng WC, Lin MT, Chang CC, Wang JK, Wu MH. Special electrophysiological characteristics of pediatric idiopathic ventricular tachycardia. Int J Cardiol 2017; 227:595-601. [DOI: 10.1016/j.ijcard.2016.10.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/28/2016] [Indexed: 11/15/2022]
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Koutbi L, Chenu C, Macé L, Franceschi F. Ablation of idiopathic ventricular tachycardia arising from posterior mitral annulus in an 11-month-old infant by transapical left ventricular access via median sternotomy. Heart Rhythm 2014; 12:430-2. [PMID: 25444854 DOI: 10.1016/j.hrthm.2014.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Linda Koutbi
- APHM, Department of Cardiology, Timone University Hospital, Marseille, France
| | - Caroline Chenu
- APHM, Department of Cardiac and Thoracic Surgery, Timone Children's Hospital, Marseille, France
| | - Loïc Macé
- APHM, Department of Cardiac and Thoracic Surgery, Timone Children's Hospital, Marseille, France
| | - Frédéric Franceschi
- APHM, Department of Cardiology, Timone University Hospital, Marseille, France.
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Abstract
UNLABELLED Cardiac arrhythmias are very frequent in fetuses and newborns. The prognosis depends on the nature of the arrhythmias but is most often either spontaneously benign or following short-term medication administration. A correct diagnosis is essential for both management and prognosis. It is based on echocardiography during the fetal period and mainly on history, physical exam, and electrocardiogram after birth, but other modalities are available to record transient arrhythmic events. Irregular rhythms are mostly benign and rarely require therapy. In most fetuses and infants, tachyarrhythmias resolve spontaneously or require short-term administration of antiarrhythmics. Approximately one third of these may recur later on, especially during adolescence. Persistent bradyarrhythmias might require pacemaker implantation when associated with failure to thrive or with risk of sudden death. CONCLUSION Arrhythmias in fetuses and infants are very common and mostly benign. History, physical exam, and recording of the arrhythmia are essential to make a correct diagnosis and establish an appropriate management for the rare potentially harmful arrhythmias.
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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.
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16
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Escudero C, Carr R, Sanatani S. The Medical Management of Pediatric Arrhythmias. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:455-72. [PMID: 22907424 DOI: 10.1007/s11936-012-0194-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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