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Sayar Y, Yıldırım M, Teber S. Management of neurological problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2023. [PMID: 38131516 DOI: 10.1002/ppul.26830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Home invasive mechanical ventilation (HIMV) has become a crucial long-term respiratory support for children with neurological disorders, but requires advanced technological skills and 24-h care. The increasing global population of children on HIMV is attributed to advancements in intensive care and improved survival rates. METHOD The manuscript will review the most common neurological problems encountered in children on HIMV. CONCLUSION The manuscript emphasizes the multidisciplinary nature of managing these patients, involving pediatric pulmonologists, pediatric neurologists, pediatric intensivists, nurses, therapists, dietitians, psychologists, and caregivers. The manuscript outlines the challenges posed by neurological disorders, such as spinal muscular atrophy, muscular dystrophy, cerebral palsy, spinal cord injuries, and neurodegenerative disorders, which may result in respiratory muscle weakness and impaired ventilation. The importance of individualized assessments, appropriate ventilator mode and equipment selection, training of caregivers, airway clearance techniques, nutritional support, regular follow-up visits, psychological and educational support, and addressing specific neurological issues such as involuntary movement disorders, prolonged seizures, sleep disorders, pain, sialorrhea, and immobilization-related complications are discussed. The treatment options for these specific challenges are outlined. This review highlights the complex nature of managing children with neurological disorders on HIMV and the importance of a collaborative approach among healthcare professionals and caregivers to optimize care and improve the quality of life for these children.
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Affiliation(s)
- Yavuz Sayar
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Miraç Yıldırım
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serap Teber
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
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Baban A, Cicenia M, Magliozzi M, Parlapiano G, Cirillo M, Pascolini G, Fattori F, Gnazzo M, Bruno P, De Luca L, Di Chiara L, Francalanci P, Udd B, Secinaro A, Amodeo A, Bertini ES, Savarese M, Drago F, Novelli A. Biallelic truncating variants in children with titinopathy represent a recognizable condition with distinctive muscular and cardiac characteristics: a report on five patients. Front Cardiovasc Med 2023; 10:1210378. [PMID: 37576110 PMCID: PMC10415037 DOI: 10.3389/fcvm.2023.1210378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background Monoallelic and biallelic TTN truncating variants (TTNtv) may be responsible for a wide spectrum of musculoskeletal and cardiac disorders with different age at onset. Although the prevalence of heterozygous TTNtv is relatively high in the general population, cardiac phenotyping (mainly cardiomyopathies, CMPs) in biallelic titinopathy has rarely been described in children. Methods We reviewed the medical records of pediatric patients with biallelic TTNtv and cardiac involvement. Clinical exome sequencing excluded pathogenic/likely pathogenic variants in major CMP genes. Results Five pediatric patients (four male) with biallelic TTNtv were included. Major arthrogryposis multiplex was observed in four patients; no patient showed intellectual disability. At a cardiac level, congenital heart defects (atrial and ventricular septal defects, n = 3) and left ventricular non-compaction (n = 1) were reported. All patients had dilated cardiomyopathy (DCM) diagnosed at birth in one patient and at the age of 10, 13, 14, and 17 years in the other four patients. Heart rhythm monitoring showed tachyarrhythmias (premature ventricular contractions, n = 2; non-sustained ventricular tachycardia, n = 2) and nocturnal first-degree atrio-ventricular block (n = 2). Cardiac magnetic resonance (CMR) imaging was performed in all patients and revealed a peculiar late gadolinium enhancement distribution in three patients. HyperCKemia was present in two patients and end-stage heart failure in four. End-organ damage requiring heart transplantation (HT) was indicated in two patients, who were operated on successfully. Conclusion Biallelic TTNtv should be considered when evaluating children with severe and early-onset DCM, particularly if skeletal and muscular abnormalities are present, e.g., arthrogryposis multiplex and congenital progressive myopathy. End-stage heart failure is common and may require HT.
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Affiliation(s)
- Anwar Baban
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marianna Cicenia
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Monia Magliozzi
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanni Parlapiano
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Cirillo
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Pascolini
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Fabiana Fattori
- Unit of Muscular and Neurodegenerative Disorders, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Gnazzo
- Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Pasqualina Bruno
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Lorenzo De Luca
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Luca Di Chiara
- Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paola Francalanci
- Department of Pathology, Bambino Gesù Children’s Hospital and Research Institute, IRCCS, Rome, Italy
| | - Bjarne Udd
- Folkhälsan Research Center, Helsinki, Finland
- Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
- Department of Neurology, Vaasa Central Hospital, Vaasa, Finland
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failureand Transplant, Mechanical Circulatory Support Complex Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Enrico Silvio Bertini
- Unit of Muscular and Neurodegenerative Disorders, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Savarese
- Folkhälsan Research Center, Helsinki, Finland
- Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Fabrizio Drago
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Racca F, Sansone VA, Ricci F, Filosto M, Pedroni S, Mazzone E, Longhitano Y, Zanza C, Ardissone A, Adorisio R, Berardinelli A, Bondone C, Briani C, Cairello F, Carraro E, Comi GP, Crescimanno G, D’Amico A, Deiaco F, Fabiano A, Franceschi F, Mancuso M, Massè A, Messina S, Mongini T, Moroni I, Moscatelli A, Musumeci O, Navalesi P, Nigro G, Origo C, Panicucci C, Pane M, Pavone M, Pedemonte M, Pegoraro E, Piastra M, Pini A, Politano L, Previtali S, Rao F, Ricci G, Toscano A, Wolfler A, Zoccola K, Sancricca C, Nigro V, Trabacca A, Vianello A, Bruno C. Emergencies cards for neuromuscular disorders 1 st Consensus Meeting from UILDM - Italian Muscular Dystrophy Association Workshop report. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2022; 41:135-177. [PMID: 36793651 PMCID: PMC9896597 DOI: 10.36185/2532-1900-081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/20/2022] [Indexed: 02/17/2023]
Abstract
Acute hospitalisation may be required to support patients with Neuromuscular disorders (NMDs) mainly experiencing respiratory complications, swallowing difficulties, heart failure, urgent surgical procedures. As NMDs may need specific treatments, they should be ideally managed in specialized hospitals. Nevertheless, if urgent treatment is required, patients with NMD should be managed at the closest hospital site, which may not be a specialized centre where local emergency physicians have the adequate experience to manage these patients. Although NMDs are a group of conditions that can differ in terms of disease onset, progression, severity and involvement of other systems, many recommendations are transversal and apply to the most frequent NMDs. Emergency Cards (EC), which report the most common recommendations on respiratory and cardiac issues and provide indications for drugs/treatments to be used with caution, are actively used in some countries by patients with NMDs. In Italy, there is no consensus on the use of any EC, and a minority of patients adopt it regularly in case of emergency. In April 2022, 50 participants from different centres in Italy met in Milan, Italy, to agree on a minimum set of recommendations for urgent care management which can be extended to the vast majority of NMDs. The aim of the workshop was to agree on the most relevant information and recommendations regarding the main topics related to emergency care of patients with NMD in order to produce specific ECs for the 13 most frequent NMDs.
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Affiliation(s)
- Fabrizio Racca
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy,Correspondence Fabrizio Racca Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, via Venezia 16, 15121 Alessandria, Italy E-mail:
| | - Valeria A. Sansone
- Neurorehabilitation Unit, the NeMO Clinical Center in Milan, University of Milan, Milan, Italy
| | - Federica Ricci
- Division of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Stefania Pedroni
- Neuromuscular Omnicentre (NeMO), Fondazione Serena Onlus, Milan, Italy
| | - Elena Mazzone
- Paediatric Neurology and NeMO Center, Catholic University and Policlinico Gemelli, Rome, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Christian Zanza
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Anna Ardissone
- Child Neurology Unit, Department of Pediatric Neuroscience Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rachele Adorisio
- Bambino Gesù Hospital and Research Institute- ERN GUARD Heart, Rome, Italy
| | | | - Claudia Bondone
- Pediatric Emergency Department, University Hospital “Città della Salute e della Scienza di Torino”, Turin, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Francesca Cairello
- Pediatric and Pediatric Emergency Unit, Pediatric Cardiology Service AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Elena Carraro
- Neuromuscular Omnicentre (NeMO), Fondazione Serena Onlus, Milan, Italy
| | - Giacomo P. Comi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy; Dino Ferrari Center, University of Milan, Milan, Italy
| | - Grazia Crescimanno
- Italian National Research Council, Institute for Biomedical Research and Innovation, Palermo, Italy; Regional Center for prevention and treatment of respiratory complications of rare genetic neuromuscular diseases, Villa Sofia-Cervello Hospital Palermo, Italy
| | - Adele D’Amico
- Neuromuscular and Neurodegenerative Unit, Department of Neurosciences. Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Fabio Deiaco
- Paediatric Emergency Department, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessia Fabiano
- Pneumology Unit Azienda USL Romagna Infermi Hospital, Rimini, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine Neurological Institute, University of Pisa, Pisa, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, Turin, Italy
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Tiziana Mongini
- Neuromuscular Unit, Department of Neurosciences RLM, University of Turin, Turin, Italy
| | - Isabella Moroni
- Child Neurology Unit, Department of Pediatric Neuroscience Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carlo Origo
- Pediatric Orthopedic and Traumatology Unit Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Chiara Panicucci
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marika Pane
- Paediatric Neurology and NeMO Center, Catholic University and Policlinico Gemelli, Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Pediatric Hospital Bambino Gesù Research Institute, Rome, Italy
| | - Marina Pedemonte
- Pediatric Neurology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Marco Piastra
- Pediatric Anesthesiology and Intensive Care Unit, Università Cattolica, Rome, Italy
| | - Antonella Pini
- Pediatric Neuromuscular Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy and Gaetano Torre for Muscular Dystrophy Association, Naples, Italy
| | | | - Fabrizio Rao
- Neuromuscular Omnicentre (NeMO), Fondazione Serena Onlus La Colletta Hospital, Arenzano (GE), Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine Neurological Institute, University of Pisa, Pisa, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Andrea Wolfler
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Khristian Zoccola
- Pediatric Orthopedic and Traumatology Unit Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Trabacca
- Scientific Institute IRCCS “E. Medea”, Unit for Severe disabilities in developmental age and young adults. (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - DINOGMI, University of Genoa, Genoa, Italy
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Lodato V, Parlapiano G, Calì F, Silvetti MS, Adorisio R, Armando M, El Hachem M, Romanzo A, Dionisi-Vici C, Digilio MC, Novelli A, Drago F, Raponi M, Baban A. Cardiomyopathies in Children and Systemic Disorders When Is It Useful to Look beyond the Heart? J Cardiovasc Dev Dis 2022; 9:47. [PMID: 35200700 PMCID: PMC8877723 DOI: 10.3390/jcdd9020047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiomyopathy (CMP) is a rare disease in the pediatric population, with a high risk of morbidity and mortality. The genetic etiology of CMPs in children is extremely heterogenous. These two factors play a major role in the difficulties of establishing standard diagnostic and therapeutic protocols. Isolated CMP in children is a frequent finding, mainly caused by sarcomeric gene variants with a detection rate that can reach up to 50% of analyzed cohorts. Complex multisystemic forms of pediatric CMP are even more heterogenous. Few studies in literature take into consideration this topic as the main core since it represents a rarity (systemic CMP) within a rarity (pediatric population CMP). Identifying etiology in this cohort is essential for understanding prognosis, risk stratification, eligibility to heart transplantation and/or mechanical-assisted procedures, preventing multiorgan complications, and relatives' recurrence risk calculation. The previous points represent a cornerstone in patients' empowerment and personalized medical care approach. The aim of this work is to propose a new approach for an algorithm in the setting of the diagnostic framework of systemic pediatric CMP. On the other hand, during the literature review, we noticed a relatively common etiologic pattern in some forms of complex/multisystem CMP. In other words, certain syndromes such as Danon, Vici, Alström, Barth, and Myhre syndrome share a common pathway of directly or indirectly defective "autophagy" process, which appears to be a possible initiating/triggering factor for CMPs. This conjoint aspect could be important for possible prognostic/therapeutic implications in this category of patients. However, multicentric studies detailed functional and experimental models are needed prior to deriving conclusions.
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Affiliation(s)
- Valentina Lodato
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Giovanni Parlapiano
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Federica Calì
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Massimo Stefano Silvetti
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Rachele Adorisio
- Heart Failure Clinic-Heart Failure, Heart Transplant, Mechanical Circulatory Support Unit, Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Michela Armando
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - May El Hachem
- Dermatology and Genodermatosis Units, Genetics and Rare Disease Research Division, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Antonino Romanzo
- Ophtalmology Unit, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Fabrizio Drago
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy;
| | - Anwar Baban
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
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Silvetti MS, Tamburri I, Campisi M, Saputo FA, Cazzoli I, Cantarutti N, Cicenia M, Adorisio R, Baban A, Ravà L, Drago F. ICD Outcome in Pediatric Cardiomyopathies. J Cardiovasc Dev Dis 2022; 9:jcdd9020033. [PMID: 35200687 PMCID: PMC8875861 DOI: 10.3390/jcdd9020033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Pediatric patients with cardiomyopathies are at risk of malignant arrhythmias and sudden cardiac death (SCD). An ICD may prevent SCD. The aim of this study was to evaluate ICD implantation outcomes, and to compare transvenous and subcutaneous ICDs (S-ICDs) implanted in pediatric patients with cardiomyopathies. Methods: The study is single center and retrospective, and includes pediatric patients with cardiomyopathies who required ICD implantation (2010–2021). Outcomes were recorded for appropriate/inappropriate ICD therapy and surgical complications. Transvenous ICD and S-ICD were compared. Data are presented as median values (25th–75th centiles). Results: Forty-four patients with cardiomyopathies (hypertrophic 39%, arrhythmogenic 32%, dilated 27%, and restrictive 2%) underwent transvenous (52%) and S-ICD (48%) implantation at 14 (12–17) years of age, mostly for primary prevention (73%). The follow-up period was 29 (14–60) months. Appropriate ICD therapies were delivered in 25% of patients, without defibrillation failures. Lower age at implantation and secondary prevention were significant risk factors for malignant ventricular arrhythmias that required appropriate ICD therapies. ICD-related complications were surgical complications (18%) and inappropriate shocks (7%). No significant differences in outcomes were recorded, either when comparing transvenous and S-ICD or comparing the different cardiomyopathies. Conclusions: In pediatric patients with cardiomyopathy, ICD therapy is effective, with a low rate of inappropriate shocks. Neither ICD type (transvenous and S-ICDs) nor the cardiomyopathies subgroup revealed divergent outcomes.
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Affiliation(s)
- Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
- Correspondence: ; Tel.: +39-06-6859-1
| | - Ilaria Tamburri
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Marta Campisi
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Ilaria Cazzoli
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Nicoletta Cantarutti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Marianna Cicenia
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Rachele Adorisio
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Anwar Baban
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Lucilla Ravà
- Epidemiology Institute, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
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