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Lukich SD, Sarin A, Pierce JM, Russell MW, Malas N. Syncope and Unresponsiveness in an Adolescent With Comorbid Cardiac Disease: An Illustrative Case Report and Literature Review of Functional Neurologic Symptom Disorder. J Acad Consult Liaison Psychiatry 2023; 64:392-402. [PMID: 37001641 DOI: 10.1016/j.jaclp.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND This case report with an associated literature review explores the challenges, opportunities, and current evidence in creating a thoughtful diagnostic and management plan for an adolescent with functional neurologic symptom disorder and comorbid cardiac disease. METHODS We performed a literature review utilizing PubMed to identify the current evidence base related to pediatric functional neurologic symptom disorder in the setting of comorbid cardiac disease. Ultimately, 25 manuscripts were identified for inclusion in this study. RESULTS We reported the recent epidemiology, screening, diagnostic, and treatment measures utilized in pediatric syncope with a focus on differentiating psychogenic causes from serious cardiac and benign etiologies. We further described how psychiatric and psychological factors influence assessment, management, and outcomes. CONCLUSIONS This study provides current, evidence-based suggestions for the assessment, diagnosis, and management of pediatric syncope, with an emphasis on recognizing psychogenic causes of syncope. It includes a description of a novel case of functional neurologic symptom disorder in a pediatric patient with structural cardiac disease. The study highlights how the absence of standardized guidelines, heterogeneity in care delivery, and lack of concurrent mental health management led to worse outcomes.
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Affiliation(s)
- Stevan Donald Lukich
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL.
| | - Aashima Sarin
- Central Michigan University Medical School, Mount Pleasant, MI
| | | | - Mark William Russell
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Nasuh Malas
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
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Akca T, Uysal F, Bostan OM, Genc A, Turkmen H. The Role of External Loop Recorders in Arrhythmia-Related Symptoms in Children: A Single Center Experience. Pediatr Cardiol 2022; 43:147-154. [PMID: 34389905 DOI: 10.1007/s00246-021-02705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
In this study, we report our experience with the use of external loop recorders (ELRs), in terms of diagnostic efficiency according to symptoms and symptom-rhythm correlation in pediatric patients. We evaluated ELRs applied to 178 patients between April 2017 and November 2020 at our center. The mean age of 172 patients included in the study was 13.6 ± 3.8 years, and 69.8% were female. ELR indications were palpitations in 98 (56.9%) cases, chest pain and palpitations in 43 (25%) cases, presyncope/syncope in 28 (16.2%) cases, and pacemaker/ implantable cardioverter-defibrillator (ICD) problems in 3 (0.2%) cases. ELR recording times were 14.2 ± 9.7 days on average, ranging from 2 to 67 days. While the symptom-rhythm correlation was 29.1% in total, when the indications were evaluated one by one, this correlation was found to be 30.2% in palpitations, 34.7% in chest pain and palpitations, and 10.7% in presyncope/syncope. The total diagnostic efficiency was 68.1%. In the follow-up of ELR cases, a total of 139 (80.8%) patients received clinical follow-up without medication, 15 (8.8%) patients received medical treatment, and 18 (10.4%) patients underwent EPS. The cardiac ELR system is useful in detecting underlying arrhythmias. Demonstrating sinus tachycardia at the time of the symptom may be seen as negative finding, but while experiencing symptoms, it is diagnostically valuable and may help avoid further investigation with costly and invasive diagnostic procedures. For diagnostic efficiency and cost effectiveness, the optimal recording time is 2 weeks, but it should be extended to 4 weeks in cases such as of presyncope/syncope that cannot be explained with a 2-week ELR use.
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Affiliation(s)
- Tugberk Akca
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey.
| | - Fahrettin Uysal
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey
| | - Ozlem Mehtap Bostan
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey
| | - Abdusselam Genc
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey
| | - Hasan Turkmen
- Faculty of Medicine, Department of Pediatric Cardiology, Bursa Uludag University, Gorukle Campuss, Nilufer, Bursa, Turkey
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Anderson H, Dearani J, Qureshi MY, Holst K, O'Leary P, Cannon B, Wackel P. Placement of Reveal LINQ Device in the Left Anterior Axillary Position. Pediatr Cardiol 2020; 41:181-185. [PMID: 31745583 DOI: 10.1007/s00246-019-02242-9] [Citation(s) in RCA: 3] [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: 06/27/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
Implantable loop recorders (ILR) are utilized for long-term rhythm monitoring. Typical placement of the Medtronic Reveal LINQ along the left parasternal border may compromise the quality and/or feasibility of future imaging studies. We sought to evaluate the utility of placing an ILR in the left anterior axillary position and the impact on the quality of cardiac imaging. We reviewed patients from May 2017 to June 2018 who had placement of a Reveal LINQ device in the left anterior axillary position. Demographic, procedural, and clinical data were collected via retrospective review. Cardiac magnetic resonance imaging (MRI) studies were reviewed for image quality after ILR placement. Eight patients met inclusion criteria for this study (median age 6 years, 50% female). Six patients (75%) had an ILR placed in the operating room, while all others were placed in the electrophysiology lab. All patients demonstrated acceptable R waves for diagnostic evaluation (median = 0.85 mV, range 0.24-1.7 mV). Cardiac MRI was obtained in 7 patients following ILR placement with diagnostic image quality and no adverse events. One device was explanted 28 days after placement due to concern for possible infection. No other devices required removal or revision (median follow up duration 11 months, IQR 8-13.5). ILR placement in the left anterior axillary position can record adequate signals in pediatric patients. In addition, axillary ILR device position may allow for completion of cardiac imaging, particularly cardiac MRI, without significant artifacts which is critical for patients with congenital heart disease.
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Affiliation(s)
- Heather Anderson
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Yasir Qureshi
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kimberly Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Patrick O'Leary
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bryan Cannon
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Philip Wackel
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Müller MJ, Paul T. [Syncope in children and adolescents]. Herzschrittmacherther Elektrophysiol 2018; 29:204-207. [PMID: 29761336 DOI: 10.1007/s00399-018-0562-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/03/2018] [Indexed: 10/16/2022]
Abstract
Syncope is common in children and adolescents. Neurally mediated syncope including pallid and cyanotic breath holding spells, vagovasal syncope and neurocardiogenic syncope is based on a common pathomechanism and accounts for approximately 75% of cases. A potentially life-threatening cardiac cause of syncope may be present in up to 6%. Detailed history, physical examination and 12-lead electrocardiogram (ECG) allow discrimination between benign and serious syncope in the majority of pediatric patients. Tilt-testing can be useful when diagnosis is unclear. In neurally mediated syncope, education on awareness of prodromes, modification of life-style and reassurance of the family on benign character of the disease is sufficient for preventing further syncopal episodes in the majority of cases. In pediatric patients unresponsive to these measures midodrine is often effective. Fludrocortisone and cardiac pacing may be considered in selected patients. β‑Blockers are not beneficial in pediatric neurally mediated syncope. Cardiac causes need specific disease-targeted therapy.
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Affiliation(s)
- Matthias J Müller
- Klinik für Pädiatrische Kardiologie und Intensivmedizin, Universitätsklinikum Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Thomas Paul
- Klinik für Pädiatrische Kardiologie und Intensivmedizin, Universitätsklinikum Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2017; 136:e60-e122. [DOI: 10.1161/cir.0000000000000499] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | | | - David G. Benditt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mitchell I. Cohen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Daniel E. Forman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Blair P. Grubb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mohamed H. Hamdan
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Andrew D. Krahn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mark S. Link
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Satish R. Raj
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Roopinder Kaur Sandhu
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Dan Sorajja
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Benjamin C. Sun
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Clyde W. Yancy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
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Nguyen HH, Law IH, Rudokas MW, Lampe J, Bowman TM, Van Hare GF, Avari Silva JN. Reveal LINQ Versus Reveal XT Implantable Loop Recorders: Intra- and Post-Procedural Comparison. J Pediatr 2017; 187:290-294. [PMID: 28545873 DOI: 10.1016/j.jpeds.2017.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/15/2017] [Accepted: 04/26/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the procedure, recovery, hospitalization times, and costs along with patient/parent satisfaction after newer-generation cardiac implantable loop recorder (Reveal LINQ; Medtronic Inc, Minneapolis, Minnesota) and previous-generation implantable loop recorder (Reveal XT; Medtronic Inc). STUDY DESIGN A prospective study of patients undergoing LINQ implantations between April 2014 and October 2015 was performed. Retrospective chart review of patients undergoing XT implantations was performed for comparison. RESULTS Thirty-one patients received LINQ and 15 patients received XT. Indications included syncope/palpitations (28/46, 61%), history of arrhythmias (9/46, 20%), arrhythmia burden in congenital heart disease (5/46, 10%), and monitoring in channelopathies (4/46, 9%). The LINQ group underwent more conscious sedation procedures than the XT group (8/31 vs 0/15, P = .04) with shorter procedural time (9 vs 34 minutes, P <.001), room occupation time (38 vs 81 minutes, P <.001), recovery time (21 vs 67 minutes, P <.001), and total hospital time (214 vs 264 minutes, P = .046). The LINQ group also had shorter return to activity time (2 vs 5 days, P = 1). Three device erosions in the LINQ group required reintervention. The LINQ group had fewer body image issues than the XT group (1/26 vs 5/14, P = .01) with both groups scoring 5/5 overall patient/parent satisfaction score at follow-up. Both groups had comparable total direct hospital costs (US $5905 vs $5438, P = .8). CONCLUSIONS LINQ offers better procedural and recovery time compared with XT. LINQ implantations under conscious sedation reduce total hospitalization time.
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Affiliation(s)
- Hoang H Nguyen
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Ian H Law
- Division of Cardiology, Department of Pediatrics, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Michael W Rudokas
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Jennifer Lampe
- Division of Cardiology, Department of Pediatrics, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Tammy M Bowman
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - George F Van Hare
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Jennifer N Avari Silva
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.
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8
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Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017; 14:e155-e217. [PMID: 28286247 DOI: 10.1016/j.hrthm.2017.03.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Indexed: 12/26/2022]
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9
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Cheung CC, Krahn AD. Loop recorders for syncope evaluation: what is the evidence? Expert Rev Med Devices 2016; 13:1021-1027. [DOI: 10.1080/17434440.2016.1243463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yang P, Pu L, Yang L, Li F, Luo Z, Guo T, Hua B, Li S. Value of Implantable Loop Recorders in Monitoring Efficacy of Radiofrequency Catheter Ablation in Atrial Fibrillation. Med Sci Monit 2016; 22:2846-51. [PMID: 27518153 PMCID: PMC4993216 DOI: 10.12659/msm.897333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/08/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the value of the implantable loop recorder (ILR) in diagnosing atrial fibrillation (AF) and assessing the postoperative efficacy of radiofrequency catheter ablation (RFCA). MATERIAL AND METHODS A total of 32 patients who successfully underwent RFCA were selected. These patients discontinued antiarrhythmic medication with no AF recurrence for more than 3 months after RFCA, and underwent ILR placement by a conventional method. The clinical manifestations and information on arrhythmias recorded by the ILR were followed up to assess the efficacy of AF RFCA. RESULTS The mean follow-up period was 24.7±12.5 months. Of 32 patients with ILR information, 27 had successful RFCA and 5 had recurrent AF. The follow-up results obtained by traditional methods showed 29 patients with successful RFCA and 3 with recurrent AF (P<0.05). Among the 18 patients with clinical symptoms, 13 had recorded cardiac arrhythmic events (72.2%) and 5 showed sinus rhythm (27.8%). The ILRs recorded 18 patients with arrhythmic events (56.3%), including 12 cases of atrial arrhythmias, among whom 5 recurred at 9, 12, 16, 17, and 32 months after AF RFCA; there were also 2 patients with ventricular tachycardia (VT) and 4 with bradycardia. CONCLUSIONS The value of ILR in assessing the efficacy of AF RFCA was superior to that of traditional methods. ILR can promptly detect asymptomatic AF, and can monitor electrocardiogram features after RFCA, thus providing objective evidence of efficacy.
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Affiliation(s)
- Ping Yang
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Lijin Pu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Liuqing Yang
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, U.S.A
| | - Fang Li
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Zhiling Luo
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Tao Guo
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Baotong Hua
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Shumin Li
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
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Avari Silva JN, Bromberg BI, Emge FK, Bowman TM, Van Hare GF. Implantable Loop Recorder Monitoring for Refining Management of Children With Inherited Arrhythmia Syndromes. J Am Heart Assoc 2016; 5:JAHA.116.003632. [PMID: 27231019 PMCID: PMC4937287 DOI: 10.1161/jaha.116.003632] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable loop recorders (ILRs) are conventionally utilized to elucidate the mechanism of atypical syncope. The objective of this study was to assess the impact of these devices on management of pediatric patients with known or suspected inherited arrhythmia syndromes. METHODS AND RESULTS A retrospective chart review was undertaken of all pediatric patients with known or suspected inherited arrhythmia syndromes in whom an ILR was implanted from 2008 to 2015. Captured data included categorization of diagnosis, treatment, transmitted tracings, and the impact of ILR tracings on management. Transmissions were categorized as symptomatic, autotriggered, or routine. Actionable transmissions were abnormal tracings that directly resulted in a change of medical or device therapy. A total of 20 patients met the stated inclusion criteria (long QT syndrome, n=8, catecholaminergic polymorphic ventricular tachycardia,n=9, Brugada syndrome, n=1, arrhythmogenic right ventricular cardiomyopathy, n=2), with 60% of patients being genotype positive. Primary indication for implantation of ILR included ongoing monitoring +/- symptoms (n=15, 75%), suspicion of noncompliance (n=1, 5%), and liberalization of recommended activity restrictions (n=4, 25%). A total of 172 transmissions were received in patients with inherited arrhythmia syndromes, with 7% yielding actionable data. The majority (52%) of symptom events were documented in the long QT syndrome population, with only 1 tracing (5%) yielding actionable data. Automatic transmissions were mostly seen in the catecholaminergic polymorphic ventricular tachycardia cohort (81%), with 21% yielding actionable data. There was no actionable data in routine transmissions. CONCLUSIONS ILRs in patients with suspected or confirmed inherited arrhythmia syndromes may be useful for guiding management. Findings escalated therapies in 30% of subjects. As importantly, in this high-risk population, the majority of symptom events represented normal or benign rhythms, reassuring patients and physicians that no further intervention was required.
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Affiliation(s)
- Jennifer N Avari Silva
- Division of Pediatric Cardiology, Washington University School of Medicine/Saint Louis Children's Hospital, Saint Louis, MO
| | - Burt I Bromberg
- Division of Pediatric Cardiology, Mercy Hospital, Saint Louis, MO
| | | | - Tammy M Bowman
- Division of Pediatric Cardiology, Washington University School of Medicine/Saint Louis Children's Hospital, Saint Louis, MO
| | - George F Van Hare
- Division of Pediatric Cardiology, Washington University School of Medicine/Saint Louis Children's Hospital, Saint Louis, MO
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Saygi M, Ergul Y, Ozyilmaz I, Sengul FS, Guvenc O, Aslan E, Guzeltas A, Akdeniz C, Tuzcu V. Using a Cardiac Event Recorder in Children with Potentially Arrhythmia-Related Symptoms. Ann Noninvasive Electrocardiol 2016; 21:500-7. [PMID: 26791967 DOI: 10.1111/anec.12339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/16/2015] [Accepted: 11/12/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In this study, we reported our experience with the use of cardiac event recorders in pediatric patients. METHODS We evaluated 583 patients fitted with an event recorder (15-30 days) between March 2010 and November 2014 at our clinic. Excluded from the study were 117 patients with no recorded events and six with records contaminated by electrocardiogram artifacts. All of the patients received electrocardiograms, Holter monitoring, and echocardiography before the cardiac event recording. RESULTS The patient sample consisted of 460 patients (64% female). The mean age was 12.8 ± 4.1 years. The median number of recorded events was 7. The indications included palpitations in 336 (73%) patients, syncope in 27 (6%) patients, and chest pain and palpitations in 97 (21%) patients. Whereas 64 patients (14%) had structural heart disease according to echocardiographic examination, the remaining patients had normal echocardiographic examination results. The most frequent cardiac comorbidities were mitral valve prolapse (6%), operated tetralogy of Fallot (1.5%), and complicated congenital heart diseases with single ventricle physiology (1%). The recorded events were sinus tachycardia in 113 (25%) patients, supraventricular tachycardia in 35 (8%) patients, ventricular extrasystole in 20 (4%) patients, supraventricular extrasystole in nine (2%) patients, and ventricular tachycardia in two (0.4%) patients. Based on the event recorder and follow-up electrocardiogram findings, 46 patients received an electrophysiology study/ablation. The symptom-rhythm correlation was 39%. CONCLUSION In the presence of possible arrhythmia-related symptoms in children, a cardiac event recorder can be considered a useful primary diagnostic method. More research on this topic is needed.
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Affiliation(s)
- Murat Saygi
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Isa Ozyilmaz
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Fatma Sevinc Sengul
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Osman Guvenc
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Eyup Aslan
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Celal Akdeniz
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Volkan Tuzcu
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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