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Sagawa K, Suzuki T, Takei K, Miura M, Ueda H, Horigome H, Ono H, Ohashi N, Sato S, Fukunaga H, Aoki H, Miyazaki A, Sakaguchi H, Morishima E, Oki K, Sumitomo N. Control of Heart Rate in Infant and Child Tachyarrhythmia With Reduced Cardiac Function Using Landiolol (HEARTFUL) - Results of a Prospective, Multicenter, Uncontrolled Clinical Study. Circ J 2022; 87:130-138. [PMID: 35979562 DOI: 10.1253/circj.cj-21-0967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prospective Control of HEART rate in inFant and child tachyarrhythmia with reduced cardiac function Using Landiolol (HEARTFUL) study investigated the effectiveness and safety of landiolol, a short-acting β1 selective blocker, in children.Methods and Results: Twenty-five inpatients aged ≥3 months to <15 years who developed supraventricular tachyarrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, and inappropriate sinus tachycardia) were treated with landiolol. The primary endpoint, the percent of patients with a reduction in heart rate ≥20% from the initial rate of tachycardia, or termination of tachycardia at 2 h after starting landiolol, was achieved in 12/25 patients (48.0%; 95% CI 28.4-67.6), which exceeded the predetermined threshold (38.0%). At 2 h after starting landiolol administration, heart rate had decreased by ≥20% in 45.8% (11/24) and recovery to sinus rhythm was achieved in 40.0% (6/15) of the patients. Adverse reactions (ARs) occurred in 24.0% (6/25) of patients, and the study was discontinued in 4.0% (1/25) of the patients; however, none of these ARs were considered serious. The most common AR was hypotension (20.0% [5/25] of patients). CONCLUSIONS The HEARTFUL study has demonstrated the efficacy of landiolol, by reducing heart rate or terminating tachycardia, in pediatric patients with supraventricular tachyarrhythmias. Although serious ARs and concerns were not identified in this study, physicians should be always cautious of circulatory collapse due to hypotension.
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Affiliation(s)
- Koichi Sagawa
- Department of Pediatric Cardiology, Cardiovascular Center, Fukuoka Children's Hospital
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Osaka City General Hospital
| | - Kohta Takei
- Department of Pediatric Cardiology, Nagano Children's Hospital
| | - Masaru Miura
- Division of Cardiology, Tokyo Metropolitan Children's Medical Center
| | - Hideaki Ueda
- Department of Cardiology, Kanagawa Children's Medical Center
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Hospital
| | - Seiichi Sato
- Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center
| | - Hideo Fukunaga
- Department of Pediatrics, Juntendo University Faculty of Medicine
| | - Hisaaki Aoki
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | | | - Kaori Oki
- Clinical Development Planning, Ono Pharmaceutical Co., Ltd
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
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Lin YS, Lin SC, Hsieh YT, Liu LY, Lin CH, Shen LJ, Huang CF. Formulation and stability of an extemporaneously compounded propafenone hydrochloride oral suspension for children with arrhythmia. Eur J Hosp Pharm 2022; 29:324-328. [PMID: 33608396 PMCID: PMC9614132 DOI: 10.1136/ejhpharm-2020-002567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In children, supraventricular tachycardia is the most common form of arrhythmia, and propafenone is an effective class Ic antiarrhythmic agent used in this population. No suitable paediatric-specific, dosing-flexible preparation is available in Taiwan. The objective of this study was to develop a formulation of propafenone oral suspension prepared from commercially available propafenone tablets and commercially available oral syrup vehicles for related patients. METHODS An oral suspension of propafenone hydrochloride at a concentration of 10 mg/mL was prepared by mixing finely grounded propafenone hydrochloride tablets and a 1:1 mixture of Ora-Plus and Ora-Sweet. The beyond-use date was determined by analysing the samples stored at room temperature or 2-8℃ at time 0 and on days 7, 14, 21, 28, 35, 42, 56, and 90. Parameters to be inspected included appearance, pH measurement, high-performance liquid chromatography analysis, and microbial limit tests. RESULTS On the basis of the physicochemical and microbial stability results, the 10 mg/mL oral suspension of propafenone hydrochloride was stable at 2-8℃ and room temperature for at least 90 days. The suspension did not exhibit significant changes in drug concentration or pH level at any time point. Moreover, no apparent changes or microbial contaminations were observed for at least 90 days. CONCLUSIONS Propafenone hydrochloride in a 10 mg/mL oral suspension prepared by diluting fine powder with a 1:1 mixture of Ora-Plus and Ora-Sweet and stored in high-density polyethylene bottles and has a beyond-use date of 90 days when stored at 2-8℃ or room temperature. This finding enables us to improve the accuracy of dosage administration and reduce the risk of medication errors affecting the paediatric population.
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Affiliation(s)
- Yi-Shiu Lin
- Department of Pharmacy, National Taiwan University Hospital, Taipei City, Taiwan
| | - Shu-Chiao Lin
- Department of Pharmacy, National Taiwan University Hospital, Taipei City, Taiwan
| | - Ya-Ting Hsieh
- Department of Pharmacy, National Taiwan University Hospital, Taipei City, Taiwan
| | - Ling-Yu Liu
- Department of Pharmacy, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chiu-Hsin Lin
- Department of Pharmacy, National Taiwan University Hospital, Taipei City, Taiwan
| | - Li-Jiuan Shen
- Department of Pharmacy, National Taiwan University Hospital, Taipei City, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Chih-Fen Huang
- Department of Pharmacy, National Taiwan University Hospital, Taipei City, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
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Cui X, Li R, Zhou W, Zhang X, Wang X, Zhang J. Safety and efficacy of zero-fluoroscopy catheter ablation for paroxysmal supraventricular tachycardia in Chinese children. Front Cardiovasc Med 2022; 9:979577. [PMID: 36158836 PMCID: PMC9500196 DOI: 10.3389/fcvm.2022.979577] [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: 06/27/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare the safety and efficacy of completely zero-fluoroscopy radiofrequency ablation (RFA) with that of conventional RFA guided by three-dimensional mapping in Chinese children with paroxysmal supraventricular tachycardia (PSVT). Methods The study had a single-center observational design and included 46 children aged 6–14 years who underwent RFA for PSVT at the Second Hospital of Hebei Medical University between March 2019 and September 2021. The children were divided according to whether they underwent zero-fluoroscopy RFA (zero-fluoroscopy group, n = 26) or routine RFA under X-ray guidance (conventional group, n = 20). Three-dimensional mapping was used in both groups. Baseline characteristics, total procedure time, RFA time, volume and duration of X-ray exposure, target mapping time, the immediate RFA success rate, incidence of complications, and recurrence rate were compared between the two groups. Results The children had a median age of 12 years (interquartile range 10, 13), 47.8% (22/46) were boys, and 52.2% (24/46) were girls. The mean body weight was 48.75 ± 15.26 kg. There was no significant between-group difference in the baseline data (P > 0.05). All children were followed up as outpatients at 1, 3, and 6 months postoperatively. The target mapping time was significantly longer in the zero-fluoroscopy group than in the conventional group (12.96 ± 2.24 min vs. 6.65 ± 2.56 min, P < 0.05); however, there was no significant between-group difference in the immediate success rate (100% vs. 100%), success rate at 6 months postoperatively (92.30% vs. 95.00%), complication rate (0% vs. 0.05%), recurrence rate (7.70% vs. 5.00%), RFA time (212.50 s vs. 214.00 s), or total procedure time (78.50 min vs. 74.00 min) (P > 0.05). Conclusion Zero-fluoroscopy catheter ablation can completely avoid fluoroscopy exposure in children without affecting the safety and efficacy of RFA.
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Affiliation(s)
- Xiaoran Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruibin Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenli Zhou
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaohui Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoning Wang
- Department of Pediatric Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jidong Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Jidong Zhang,
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Evaluation of Clinical Course and Maintenance Drug Treatment of Supraventricular Tachycardia in Children During the First Years of Life. A Cohort Study from Eastern Germany. Pediatr Cardiol 2022; 43:332-343. [PMID: 34524484 DOI: 10.1007/s00246-021-02724-9] [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: 05/15/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Supraventricular tachycardia (SVT) is considered the most common cause of arrhythmia in children and infants. Regarding the likelihood of a spontaneous resolution of SVTs during the first years of life, drug treatment aims to bridge the time until children 'grow out' out of the arrhythmia. The choice of antiarrhythmic agents and the planning of maintenance therapy are mainly based on clinical experience and retrospective single- and multi-institutional analyses and databases from all over the world approaching differently to this topic. The current study aimed to evaluate the clinical course, pharmacological treatment strategies, and constellations of risk for recurrences in the management of SVTs in children aged 3 < years. The database of the Heart Center Leipzig, Department of Pediatric cardiology, was searched for pediatric patients aged < 3 years with a clinically documented SVT between 2000 and 2019 that received pharmacologic treatment. Patients with complex congenital heart disease or arrhythmias following cardiac surgery were excluded. 69 patients were included. Pharmacologic treatment, follow-up schedule, recurrences, outcomes, and risk factors for complicated courses are reported. Drug therapy of SVTs in young children remains a controversial topic with heterogeneous treatment and follow-up strategies applied. Risk factors for recurrences and/or stubborn clinical courses are difficult rhythm control with 3 or more antiarrhythmic drugs, ectopic atrial tachycardias, and a first occurrence of the SVT in the fetal period. Prospective studies are needed to sufficiently evaluate optimal treatment strategies.
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Diagnostic Efficacy of a Single-Lead Ambulatory 14-Day ECG Monitor in Symptomatic Children. CJC Open 2021; 3:1341-1346. [PMID: 34901802 PMCID: PMC8640594 DOI: 10.1016/j.cjco.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background The CardioSTAT is a single-lead ambulatory electrocardiography monitor that has been validated for use in adult patients. Recording is made through 2 electrodes positioned in a lead-I configuration, and the device allows monitoring for 2, 7, or 14 days. We sought to investigate the efficacy of this device in children with paroxysmal palpitations. Methods In phase I, the quality of tracings from simultaneous CardioSTAT recordings and D1-lead recordings of a standard 12-lead electrocardiography machine in 23 children were compared. Phase II was a prospective observational cohort study comparing arrhythmia detection using the CardioSTAT vs currently used devices (24-hour Holter monitor and the Cardiomemo loop recorder) in 52 children complaining of palpitations. Results In Phase I, all but 3 rhythm strips were correctly identified. The pacing spikes on 3 strips were not adequately identified by the observers for the CardioSTAT recording. In Phase II, symptomatic episodes were reported in 42%, 73%, and 100% of subjects during monitoring with the Holter, Cardiomemo, and CardioSTATdevices, respectively. An abnormal rhythm was detected in 13%, 23%, and 35% of subjects by the Holter, Cardiomemo, and CardioSTAT monitors, respectively. The underlying rhythm during symptomatic events was determined in 90% of cases with the CardioSTAT monitor, whereas it was determined in only 19% and 29% of cases using the Holter and Cardiomemo monitors, respectively. Conclusions The CardioSTAT monitor provided good-quality tracings and was superior to the 24-hour Holter monitor and the Cardiomemo loop recorder in determining the presence or absence of pathologic arrhythmia in the study cohort.
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Kahr PC, Moffett BS, Miyake CY, Kim JJ, Valdes SO. "Second line medications" for supraventricular arrhythmias in children: In-hospital efficacy and adverse events during treatment initiation of sotalol and flecainide. J Cardiovasc Electrophysiol 2021; 32:2207-2215. [PMID: 33969576 DOI: 10.1111/jce.15077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 03/24/2021] [Accepted: 04/14/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Sotalol and flecainide are used as second line agents in children for the treatment of supraventricular arrhythmias (SA) refractory to anti-beta adrenergic antiarrhythmics or digoxin. Efficacy and adverse events in this cohort have not been well described. Here, we report our institutional experience of second line treatment initiation for SA in children. METHODS AND RESULTS Utilizing an institutional database, 247 patients initiated on sotalol and 81 patients initiated on flecainide were identified. Congenital heart disease (CHD) was present in 40% of patients. Arrhythmia-free discharge on single or dual agent therapy (in combination with other antiarrhythmics) was 87% for sotalol and 91% for flecainide. Neither age, sex, dosing, presence of CHD nor arrhythmia subtype were associated with alterations in in-hospital efficacy. Compared to baseline, QTc intervals in sotalol patients (436 [416-452 ms] vs. 415 [400-431 ms], p < .01) and QRS intervals in flecainide patients (75 [68-88 ms] vs. 62 [56-71 ms], p < .01) were prolonged. Dose reduction or discontinuation due to QRS prolongation occurred in 9% of patients on flecainide. QTc prolongation resulting in dose reduction/discontinuation of sotalol was encountered in 9 patients (4%) and death with documented torsade de pointes in 2 patients (1%), with 9 of 11 patients having underlying CHD. CONCLUSION In children requiring second line agents for treatment of SA, both sotalol and flecainide appear to be highly efficacious. Although predominantly safe in otherwise healthy patients, electrocardiogram changes can occur and children with underlying cardiac disease may have an increased risk of adverse events and rhythm-related side effects during initiation.
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Affiliation(s)
- Peter C Kahr
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Brady S Moffett
- Department of Pharmacy, Texas Children's Hospital, Houston, Texas, USA
| | - Christina Y Miyake
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
| | - Jeffrey J Kim
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Santiago O Valdes
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Dokter M, Talarico G, Armbrust S, Below E, Bockholdt B. [Fatal flecainide intoxication in a 17-year-old girl]. Anaesthesist 2018; 67:359-361. [PMID: 29594407 DOI: 10.1007/s00101-018-0434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 10/17/2022]
Abstract
A 17-year-old girl was found vomiting and somnolent at home and was taken to a hospital. The girl initially presented with ventricular tachycardia with broad QRS complexes which was very difficult to control. During the course a subsequent cardiogenic shock developed and despite exhaustion of all therapeutic options the fatal outcome could not be averted. The medicolegal autopsy revealed no evidence of any form of violence but the signs of medical treatment. Furthermore, no pathology of internal organs was detected. The toxicological analyses revealed a lethal intoxication with flecainide as the cause of death. The investigations of the police indicated that the girl took flecainide in suicidal intention.
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Affiliation(s)
- M Dokter
- Institut für Rechtsmedizin, Universitätsmedizin Greifswald, Kuhstraße 30, 17489, Greifswald, Deutschland.
| | - G Talarico
- Institut für Rechtsmedizin, Universitätsmedizin Greifswald, Kuhstraße 30, 17489, Greifswald, Deutschland
| | - S Armbrust
- Klinik für Kinder- und Jugendmedizin, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Neubrandenburg, Deutschland
| | - E Below
- Institut für Rechtsmedizin, Universitätsmedizin Greifswald, Kuhstraße 30, 17489, Greifswald, Deutschland
| | - B Bockholdt
- Institut für Rechtsmedizin, Universitätsmedizin Greifswald, Kuhstraße 30, 17489, Greifswald, Deutschland
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Sumitomo N, Horigome H, Miura M, Ono H, Ueda H, Takigiku K, Yoshimoto J, Ohashi N, Suzuki T, Sagawa K, Ushinohama H, Takahashi K, Miyazaki A, Sakaguchi H, Iwamoto M, Takamuro M, Tokunaga C, Nagano T. Study design for control of HEART rate in inFant and child tachyarrhythmia with heart failure Using Landiolol (HEARTFUL): A prospective, multicenter, uncontrolled clinical trial. J Cardiol 2017; 70:232-237. [PMID: 28073682 DOI: 10.1016/j.jjcc.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/29/2016] [Accepted: 12/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persistent tachycardia in pediatric patients after congenital heart surgery further deteriorates their hemodynamic condition, and may become fatal. Therefore, immediate control of the tachycardia is mandatory in these patients. For this purpose, quick-acting, short-acting, titratable intravenous agents are required. However, there are no agents with such characteristics among the drugs approved for control of pediatric arrhythmias in Japan, and thus novel and effective medications for these patients are awaited. Landiolol, an ultrashort-acting β-blocker, was approved in 2013 for tachyarrhythmias in adult patients with heart failure. However, its efficacy and safety in pediatric patients remain unclear. The aim of this prospective, multicenter, open-label phase IIb/III study is to investigate the efficacy and safety of landiolol in pediatric patients with tachyarrhythmias as well as heart failure. METHODS Eligible patients are aged ≥ 3 months and <15 years, and have tachyarrhythmia (atrial fibrillation, atrial flutter, supraventricular tachycardia) as well as heart failure. The primary endpoint of the study is ≥20% reduction from baseline heart rate or return to normal sinus rhythm within 2h after starting intravenous administration of landiolol. Patients will receive intravenous infusion of landiolol, starting at 1μg/kg/min. The dose will be increased by 1μg/kg/min every 15-20min until the tachycardia rate has decreased by >20% or tachycardia has terminated, and the dose will then be maintained or further increased depending on the patient's condition. The study was started in April 2015 and will end within a few years. CONCLUSIONS The study was designed and designated the "HEARTFUL study" in the hope of establishing a basis for control of HEART rate in inFant and child tachyarrhythmia Using Landiolol in children with heart failure.
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Affiliation(s)
- Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masaru Miura
- Division of Cardiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hideaki Ueda
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kiyohiro Takigiku
- Department of Pediatric Cardiology, Nagano Children's Hospital, Azumino, Japan
| | - Jun Yoshimoto
- Department of Pediatric Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Osaka City General Hospital, Osaka, Japan
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital Medical Center, Fukuoka, Japan
| | - Hiroya Ushinohama
- Department of Pediatric Cardiology, Fukuoka Children's Hospital Medical Center, Fukuoka, Japan
| | - Kazuhiro Takahashi
- Department of Pediatric Cardiology, Okinawa Children's Medical Center, Okinawa, Japan
| | - Aya Miyazaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mari Iwamoto
- Department of Pediatrics, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Motoki Takamuro
- Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Parker MH, Sanoski CA. Clinical Pearls in Using Antiarrhythmic Drugs in the Outpatient Setting. J Pharm Pract 2015; 29:77-86. [DOI: 10.1177/1933719115615878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A role for oral antiarrhythmic drugs (AADs) remains in clinical practice for patients with atrial and ventricular arrhythmias in spite of advances in nonpharmacologic therapy. Pharmacists play a vital role in the appropriate use of AAD dosing, administration, adverse effects, interactions, and monitoring. Pharmacists who are involved in providing care to patients with cardiac arrhythmias must remain updated regarding the efficacy and safety of the most commonly used AADs. This review will address key issues for appropriate initiation and maintenance of commonly selected Vaughan-Williams Class Ic and III agents in the outpatient setting.
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Affiliation(s)
- Mary H. Parker
- Clinical Pharmacy Specialist Pharmacy Service, Clinic Coordinator Ambulatory Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
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Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:223-48. [DOI: 10.1016/j.resuscitation.2015.07.028] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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12
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Flecainide use in children with cardiomyopathy or structural heart disease. Pediatr Cardiol 2015; 36:146-50. [PMID: 25107546 DOI: 10.1007/s00246-014-0978-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
Flecainide is frequently used for treatment of cardiac arrhythmias in children. Due to concerns regarding increased mortality, there has been hesitancy to use flecainide in children with congenital heart disease (CHD) or cardiomyopathy (CM). The objective of this study was to describe trends in use of flecainide in children with CHD or CM and assess its association with cardiac arrest or death. Data from 42 children's hospitals contained in the PHIS database (2004-2011) were analyzed. All patients with CHD or CM receiving anti-arrhythmic therapy for supraventricular arrhythmias were reviewed. Trends in flecainide use were analyzed, and the incidence of cardiac arrest or death was compared to patients receiving other anti-arrhythmics. There were 3,544 pts with CHD or CM who received anti-arrhythmic therapy (median age 73 days). Flecainide was administered in 229 pts (6.5%). There was a trend toward increased use of flecainide in this population, increasing from 4.6% in 2004 to 8.7% in 2011 (p = 0.07). The incidence of cardiac arrest in patients with CHD or CM receiving flecainide was 3.0% with an overall mortality of 4.3%. The mortality was 2.9% in pts with CM and nobody with single ventricle physiology died. Based on multivariable analysis, when compared to pts with CHD or CM receiving other anti-arrhythmics, there was no difference in the incidence of cardiac arrest (p = 0.31) or death (p = 0.28). Flecainide use in children with CHD or CM has increased in recent years. The incidence of cardiac arrest or death with flecainide administration in this cohort appears comparable to other anti-arrhythmic agents.
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Abstract
Supraventricular tachycardia (SVT) is the most common symptomatic tachyarrhythmia in childhood. Treatment involves vagal manoeuvres, pharmacological agents or electrical cardioversion. We report a child with recurrent SVT secondary to Wolff-Parkinson-White syndrome who is consistently able to revert her SVT by doing a handstand. This case highlights a simple non-invasive technique for the treatment of SVT.
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Affiliation(s)
- Michelle Hare
- Emergency Department, Sheffield Children's Hospital, Sheffield, UK
| | - Shammi Ramlakhan
- Emergency Department, Sheffield Children's Hospital, Sheffield, UK
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14
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Han CW, Yu HY, Shin JE, Eun HS, Lee SM, Park MS, Namgung R, Lee C, Park KI. Combination Therapies of Amiodarone and Digoxin for Refractory Supraventricular Tachycardia Accompanied by Congenital Heart Diseases in a Preterm Infant with Hydrops Fetalis. NEONATAL MEDICINE 2014. [DOI: 10.5385/nm.2014.21.1.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Chang Woo Han
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Yang Yu
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Seon Eun
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Lee
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Maltret A, Lacotte J. Tachycardies supraventriculaires de l’enfant : histoire naturelle et prise en charge. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2012. [DOI: 10.1016/s1878-6480(12)70826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, Rajka T, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support. Resuscitation 2011; 81:1364-88. [PMID: 20956047 DOI: 10.1016/j.resuscitation.2010.08.012] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Biarent
- Paediatric Intensive Care, Hôpital Universitaire des Enfants, 15 av JJ Crocq, Brussels, Belgium.
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodrίguez-Núñez A, Rajka T, Zideman D. Lebensrettende Maßnahmen bei Kindern („paediatric life support“). Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1372-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Jacombs ASW, Cross KM, Holland AJA, Wilkins BH. Supraventricular tachycardia as a presenting feature of volvulus in a 15-month-old boy. J Paediatr Child Health 2009; 45:389-90. [PMID: 22530763 DOI: 10.1111/j.1440-1754.2009.01519.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 15-month-old boy presented in shock with a supraventricular tachycardia following a 12-h history of worsening abdominal pain and vomiting. The supraventricular tachycardia reverted to sinus tachycardia with fluid resuscitation and adenosine. He was noted to have a distended and firm abdomen. A presumptive diagnosis of intestinal ischaemia was subsequently confirmed at laparotomy when an internal hernia with a distal small bowel volvulus and necrosis was found. Intestinal ischaemia presenting with a life-threatening cardiac dysrhythmia in a child appears not to have been reported previously.
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Affiliation(s)
- Anita S W Jacombs
- Department of Academic Surgery and Helen McMillan Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Australia
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20
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Recognition and treatment of unstable supraventricular tachycardia by pediatric residents in a simulation scenario. Simul Healthc 2009; 3:4-9. [PMID: 19088636 DOI: 10.1097/sih.0b013e31815bfa4e] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Supraventricular tachycardia (SVT) is the most frequent tachydysrhythmia in children. SVT with hemodynamic compromise should be terminated by immediate electrical cardioversion. Study objectives were to: (1) establish time to recognition and cardioversion of simulated unstable SVT; and (2) document delays and mistakes made during cardioversion. METHODS Ten teams of pediatric residents were presented with an unresponsive "patient" (Laerdal SimMan) in unstable SVT. Actions of team members and simulator timestamps of key events were recorded. A retrospective review of events and time logs was performed with primary outcome measure of time to successful cardioversion. RESULTS Median time to cardioversion was 8.9 minutes (range, 5.3 minutes to unsuccessful scenario terminated at 15 minutes). In 20% of scenarios, the patient was never cardioverted. Ninety percent of teams administered adenosine, but 44% of attempts demonstrated incorrect administration technique. Other maneuvers before cardioversion: 70% administered fluid, 60% attempted vagal maneuvers, 30% requested electrocardiogram, 30% requested antiarrhythmics. In 20% of scenarios, the rhythm was misidentified. When cardioversion was performed, 25% failed to use gel, 37.5% failed to synchronize, 25% used inappropriate energy doses. In 60% of scenarios, no oxygen was administered. In 90% there was no assignment of Glasgow Coma Scale, and no assessment of mental status in 30%. In 60% perfusion was not assessed. CONCLUSIONS Median time to cardioversion of 8.9 minutes is inconsistent with AHA recommendations for treatment of unstable SVT with "immediate cardioversion." Delays were secondary to lack of recognition of "unstable" SVT, due to failure to assess perfusion and mental status. Errors encountered during simulation identify curriculum reform targets.
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Abstract
The final common pathway to death in all of us is an arrhythmia, yet we still know far too little about the contribution of conduction abnormalities and arrhythmias to the compromised states of the human fetus. At no other time in the human life cycle is the human being at more risk of unexplained and unexpected death than during the prenatal period. The risk of sudden death from 20-40 weeks gestation is 6-12 deaths/1000 fetuses/year. This is equal to, and in some ethnic groups HIGHER than, the risk of death in the adult population with known coronary artery disease over the same time frame (6-12 deaths/1000 patients/year). Because only a small percentage of the United States population is pregnant each year, because fetal demise is not often acknowledged through public displays such as funerals, and finally because fetal death is culturally accepted to a much greater extent than it should be, this critically important area of women's healthcare has not had the technological advances that have been seen in adult cardiac intensive care and other areas of medicine. Fetal cardiac deaths may be preventable and the diseases that lead to these deaths are often treatable, especially if the sophistication of our modern ICU's could somehow be translated to the prenatal monitoring arena. This review article will outline recent advances in evaluating fetal electrophysiology, helping the perinatologist to better understand the nuances of fetal arrhythmias.
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Affiliation(s)
- Janette F Strasburger
- Children's Hospital of Wisconsin - Fox Valley, 200 Theda Clark Medical Plaza, Suite 480, Neenah, WI 54956-2884, USA.
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Forbes K, Kantoch MJ, Divekar A, Ross D, Rebeyka IM. Management of infants with idiopathic dilatation of the right atrium and atrial tachycardia. Pediatr Cardiol 2007; 28:289-96. [PMID: 17530322 DOI: 10.1007/s00246-006-0012-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
Idiopathic dilatation of the right atrium (IDRA) is a rare anomaly defined as isolated enlargement of the right atrium in the absence of other cardiac lesions known to cause right atrial dilatation. IDRA is a congenital anomaly with unknown pathogenesis and highly variable clinical presentation. Optimal management of severe IDRA is controversial and individualized. Literature reports of long-term follow-up have been limited. We describe a child with IDRA with rapid atrial tachycardia (AT) refractory to both medical and surgical management, and we provide long-term follow-up on our two previously reported cases, both of whom had documented AT. For infants with AT, the clinical course is unpredictable, and medical therapy is the first line of treatment. The decision to proceed with surgical resection of a giant right atrium should be made on an individual basis. Atrial resection along with a modified right atrial MAZE procedure could be considered in infants with life-threatening atrial tachyarrhythmia refractory to medical treatment. Surgical scarring of the right atrium may produce substrate for atrial arrhythmia, which may also be refractory to medical therapy. Histological examination of excised atrial tissue remains inconsistent and not contributory to the determination of the etiology of IDRA. Our three infants with IDRA illustrate unique features of their variable clinical courses, as well as continued difficulties with establishing clear guidelines with regard to surgical management of this unusual disorder.
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Affiliation(s)
- K Forbes
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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23
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Chang YB, Lee SH, Kang EY, Rhee KS, Joo CU. Results of radiofrequency catheter ablation in children and adolescent with tachyarrhythmia. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.11.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Young Beom Chang
- Department of Pediatrics, Institute of Cardiovascular Research, Chonbuk National University Medical School, Jeonju, Korea
| | - Seung Hyun Lee
- Department of Pediatrics, Institute of Cardiovascular Research, Chonbuk National University Medical School, Jeonju, Korea
| | - Eun Young Kang
- Department of Pediatrics, Institute of Cardiovascular Research, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyoung-Suk Rhee
- Department of Internal Medicine, Institute of Cardiovascular Research, Chonbuk National University Medical School, Jeonju, Korea
| | - Chan Uhng Joo
- Department of Pediatrics, Institute of Cardiovascular Research, Chonbuk National University Medical School, Jeonju, Korea
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Emmel M, Sreeram N, Schickendantz S, Brockmeier K. Experience with an ambulatory 12-lead Holter recording system for evaluation of pediatric dysrhythmias. J Electrocardiol 2006; 39:188-93. [PMID: 16580418 DOI: 10.1016/j.jelectrocard.2005.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 07/10/2005] [Accepted: 09/13/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND The 12-lead electrocardiogram demonstrates noninvasively many details concerning cardiac arrhythmias and their mechanism, but only for a limited period. A Holter system can record heart rhythm for a longer period, but shows 2 or 3 leads only. An ambulatory 12-lead Holter recording system combines the advantages of both. We report on our experience with the 12-lead Holter system in children. STUDY POPULATION Twenty-four patients (age range, 3-22 years) underwent one or more 12-lead Holter recordings. Twelve patients had suspected or documented tachyarrhythmia, and 12 patients had suspected or proven long QT syndrome (LQTS). RESULTS In the tachyarrhythmia group, 4 patients had supraventricular tachycardia and 7 ventricular tachycardia (VT). In the supraventricular tachycardia, group 1 patient had intra-atrial reentrant tachycardia with a single reentrant circuit, whereas another had multiple P-wave morphologies, suggesting multiple circuits. Two others had evidence for concealed atrioventricular accessory pathways. One patient had isolated supraventricular ectopy. In the VT group, 4 patients had uniform VT, and 3 patients had polymorphic VT. One patient with LQTS had macroscopic T-wave alternans. Two others showed intermittent extreme QT prolongation and T-wave notching during 12-lead Holter recording. THERAPEUTIC IMPLICATIONS Patients with uniform VT underwent catheter ablation, guided in 2 instances by intracardiac pace mapping and comparison with the 12-lead Holter QRS morphology. All reentrant supraventricular arrhythmias with single P-wave morphology were ablated. One patient with intra-atrial reentrant tachycardia and multiple circuits received an antitachycardia pacemaker. In the LQTS group, the neonate with T-wave alternans received mexiletine in addition to beta-blocker therapy. CONCLUSION In individual patients, the 12-lead Holter system provides important additional information about the arrhythmia and helps to plan appropriate therapy. Intermittent T-wave morphology changes can be diagnosed using 12-lead Holter recordings in patients with LQTS, allowing dynamic T-wave changes to be monitored. In specific cases, this may help identify patients with LQTS and also influence pharmacological therapy.
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Affiliation(s)
- M Emmel
- Department of Pediatric Cardiology, University of Cologne, 50937 Cologne, Germany
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Biarent D, Bingham R, Richmond S, Maconochie I, Wyllie J, Simpson S, Nunez AR, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2005. Resuscitation 2005; 67 Suppl 1:S97-133. [PMID: 16321719 DOI: 10.1016/j.resuscitation.2005.10.010] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bae EJ, Ban JE, Lee JA, Jin SM, Noh CI, Choi JY, Yun YS. Pediatric radiofrequency catheter ablation: results of initial 100 consecutive cases including congenital heart anomalies. J Korean Med Sci 2005; 20:740-6. [PMID: 16224145 PMCID: PMC2779268 DOI: 10.3346/jkms.2005.20.5.740] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Radiofrequency catheter ablation (RFCA) has recently become a management option for pediatric tachycardia. We reviewed the records of a total of 100 patients (aged 10 months to 19 yr) who had undergone RFCA, from March 2000 to June 2004. Types of arrhythmia (age, acute success rate) were as follows: atrioventricular reentrant tachycardia (AVRT, 9.0+/-3.7 yr, 66/67), atrioventricular nodal reentrant tachycardia (AVNRT, 13+/-2.5 yr, 16/16), ectopic atrial tachycardia (6.4+/-3.3 yr, 5/5), junctional ectopic tachycardia (10 month, 1/1), ventricular tachycardia (12+/-4.9 yr, 6/6), postsurgical intraatrial reentrant tachycardia (15.6+/-4.1 yr, 2/3), twin node tachycardia (4 yr, 0/1), and His bundle ablation (9 yr, 1/1). The age of AVNRT was older than that of AVRT (p=0.002). Associated cardiac disease was detected in 17 patients, including 6 univentricular patients, and 3 Ebstein's anomaly patients. RFCA for multiple accessory pathways required longer fluoroscopic times than did the single accessory pathway (53.9+/-4.8 vs. 36.2+/-24.1 min; p=0.03), and was associated with a higher recurrence rate (3/9 vs. 3/53; p=0.03). Regardless of the presence or absence of cardiac diseases, the overall acute success rate was 97% without major complications, the recurrence rate was 8.2%, and the final success rate was 97%. This experience confirmed the efficacy and safety of RFCA in the management of tachycardia in children.
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Affiliation(s)
- Eun-Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Eun Ban
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-A Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Mi Jin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chung-Il Noh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Yun Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Soo Yun
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Affiliation(s)
- V Lucet
- Unité de rythmologie pédiatrique, château des Côtes, 78350 Les Loges-en-Josas, France.
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El Hajjar M, Hermida JS, Caron FM, Nassif D, Bourges-Petit E, Maingourd Y. Myocardiopathie rythmique de l’enfant : un diagnostic difficile mais une forme curable de dysfonction ventriculaire gauche. Arch Pediatr 2004; 11:24-8. [PMID: 14700756 DOI: 10.1016/j.arcped.2003.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED Tachycardia-induced cardiomyopathy is a reversible left ventricular dysfunction caused by cardiac arrhythmia. Because of its reversibility, a correct diagnosis and treatment are necessary. The aim of our study was to precise the diagnostic procedures of the tachycardia-induced cardiomyopathy and to study the left ventricular function after the correction of the arrhythmia. PATIENTS AND METHODS A retrospective study done between 1992 and 2001. Children studied were followed-up for: an idiopathic form of cardiomyopathy, in which the etiological research showed a cardiac arrhythmia; a cardiac arrhythmia associated to a cardiomyopathy. An electrocardiogram recorded the cardiac arrhythmia. The left ventricular function was evaluated by an echocardiography before and every month after the correction of the cardiac arrhythmia. RESULTS Twelve children were included, ages ranged from 2 months to 15 years (median 11 years). Four patients presented a cardiac insufficiency associated to arrhythmia; three followed-up for an arrhythmia developed a cardiomyopathy; five whose cardiac arrhythmia was not easy to demonstrate had an idiopathic form of cardiomyopathy. The Wilcoxon test showed a significant amelioration (P < 0.01) of the left ventricular function after the correction of the cardiac arrhythmia. CONCLUSIONS Tachycardia-induced cardiomyopathy in children is curable and the diagnosis is quite difficult. Pediatricians and family doctors should try to look for specific signs of cardiac insufficiency or arrhythmia. Pediatric cardiologists should search a tachycardia-induced cardiomyopathy in every idiopathic form of cardiomyopathy.
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Affiliation(s)
- M El Hajjar
- Unité de cardiologie pédiatrique, hôpital Nord, 80054 Amiens, France.
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Holcberg G, Sapir O, Tsadkin M, Huleihel M, Lazer S, Katz M, Mazor M, Ben-Zvi Z. Lack of interaction of digoxin and P-glycoprotein inhibitors, quinidine and verapamil in human placenta in vitro. Eur J Obstet Gynecol Reprod Biol 2003; 109:133-7. [PMID: 12860328 DOI: 10.1016/s0301-2115(02)00513-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the effect of quinidine and verapamil, known antiarrhythmic agents and P-glycoprotein (Pgp) inhibitors, on digoxin transport from the maternal to the fetal compartment in the isolated perfused human placenta. STUDY DESIGN Isolated placental cotyledons from normal human placentae (n=20) were dually perfused with M199 medium enriched with albumin (0.3%) and glucose (0.1%). The maternal and the fetal circulation flow rates were 12 and 6 ml/min, respectively. Closed circulations were used to evaluate steady state transplacental gradient formation. In six placentae quinindine was added to the maternal circuit; after 45 min of perfusion, digoxin was added to the maternal circulation. The effect of verapamil on digoxin transfer from the maternal to the fetal compartments was explored in five placentae. In six additional placentae the transfer of digoxin was studied in the absence of quinidine. Transplacental passage of digoxin was calculated from repeated fetal and maternal perfusate samples. Digoxin levels were determined in perfusate samples by fluorescence polarization immunoassay. Antipyrine was added to the maternal reservoir of all placentae as reference substance. RESULTS The transfer of digoxin (alone) and in the presence of quinidine or verapamil was 10.93+/-3.71, 9.00+/-5.2 and 12.94+/-4.86%, respectively. The levels of digoxin in the fetal compartment, 0.62+/-0.20, 0.48+/-0.29 and 0.60+/-0.26 ng/ml, respectively, were not significantly affected by quinidine and verapamil. These Pgp modulators, also did not influence significantly the steady state levels of digoxin in the maternal compartment. CONCLUSION Neither quinidine nor verapamil affected the transplacental transfer of digoxin in vitro in normal human placentae. In contrast to the other tissues, they do not inhibit Pgp activity in term human placentae.
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Affiliation(s)
- Gershon Holcberg
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer-Sheva 84101, Israel.
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Abstract
Narrow QRS complex tachycardia is a common dysrhythmia in Emergency Medicine practice. Diagnosis and mechanism often can be made by 12-lead electrocardiographic (EKG) analysis but may subsequently require electrophysiologic testing. The clinical manifestations are varied and dependent upon heart rate, prior cardiac disease, and general physiologic status. Patient management is directed towards the etiology and mechanism of the dysrhythmia and includes vagal maneuvers, pharmacologic therapy, and cardioversion. Hemodynamically compromised patients must be promptly treated. Patients are often admitted to the hospital but selected patients can be safely discharged from the Emergency Department for outpatient evaluation and management. Pediatric and pregnant patients are, in general, treated the same as adults. Several case examples and EKGs are presented.
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Affiliation(s)
- Marc L Pollack
- Department of Emergency Medicine, York Hospital, York, Pennsylvania 17405, USA
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