1
|
Penfold MP, Cannon BC, Wackel PL. Empiric Slow Pathway Cryoablation in Symptomatic Children Without Documented Supraventricular Tachycardia. Pediatr Cardiol 2024; 45:921-925. [PMID: 36462026 DOI: 10.1007/s00246-022-03065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
In symptomatic children without documented supraventricular tachycardia (SVT) and non-inducible atrioventricular nodal reentry tachycardia (AVNRT) the benefit of empiric slow pathway (SP) ablation is unknown. We evaluated 62 symptomatic patients without documented SVT that underwent electrophysiology study (EPS). The purpose of this study was to determine if symptoms improved after empiric SP ablation in children without documented SVT and without inducible AVNRT. Sixty-two symptomatic patients without previously documented SVT underwent EPS; 31 (50%) had inducible AVNRT and underwent SP ablation, 20 (32%) were non-inducible and underwent empiric SP ablation, 11 (18%) were non-inducible and had no ablation. After a mean follow-up of 23 ± 18 months there was no significant difference in freedom from symptoms within the non-inducible cohort regardless of whether empiric SP ablation was performed (p = 0.135). There was a significant improvement in symptoms at follow-up after SP ablation when comparing inducible and non-inducible patients (p = 0.020). During follow-up no patients had documented SVT. Symptomatic children without documented SVT do not benefit from empiric SP ablation when AVNRT cannot be induced.
Collapse
Affiliation(s)
- Michael P Penfold
- Department of Pediatrics, Mayo Clinic, Rochester, MN, 200 1st SW55901, USA.
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, 200 1 st SW55901, USA
| | - Philip L Wackel
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, 200 1 st SW55901, USA
| |
Collapse
|
2
|
Leng T, Griffeth E, Stephens EH, Dearani JA, Cannon BC, Ackerman MJ, Wackel PL. Utility of routine follow-up defibrillation safety margin testing in young patients with epicardial implantable cardioverter-defibrillators. Pacing Clin Electrophysiol 2024; 47:392-397. [PMID: 38341633 DOI: 10.1111/pace.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Routine defibrillation threshold testing (DFT) of transvenous implantable defibrillators (ICDs) has largely been in decline. In patients with non-transvenous ICDs that utilize subcutaneous and pleural ICD leads, serial DFT testing can detect a significant number of failures. Data about the utility of follow-up defibrillation safety margin testing (DSM) testing in pediatric patients and young adults with an epicardial ICD are lacking. METHODS Patients aged < 25 years old who underwent epicardial ICD placement at Mayo Clinic from 2014 to 2023 with at least one follow-up DSM test were included. The patients were divided into a "routine" (R) and "clinically indicated" (CI) group based on the index of clinical concern. Inadequate DSM was defined as unsuccessful defibrillation at an output of less than 10 J below the maximum output of the device. The purpose of this study was to assess the utility of follow-up DSM testing. RESULTS An epicardial ICD system was placed in 122 patients. A total of 26 patients met inclusion criteria and underwent a total of 47 DSM follow up tests. Inadequate DSM occurred in 1/33 (3%) in the R group and 2/14 (14%) DSM tests in the CI group. The median follow-up period was 54 and 36 months for the R and CI group, respectively. CONCLUSIONS Our data suggest that epicardial ICDs are reliable and routine follow-up DSM testing may not be necessary for all patients. DSM testing should be performed in individuals with epicardial ICD systems when there is clinical concern about lead or coil performance.
Collapse
Affiliation(s)
- Tomas Leng
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elaine Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan C Cannon
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Ackerman
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip L Wackel
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Cannon BC. Location, location, location…. Heart Rhythm 2023; 20:1750-1751. [PMID: 37769792 DOI: 10.1016/j.hrthm.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
4
|
Griffeth EM, Dearani JA, Schaff HV, Johnson JN, Ackerman MJ, Bos JM, Alzate-Aguirre M, Todd A, Cannon BC, Wackel PL, Stephens EH. Septal Myectomy Outcomes in Children and Adolescents With Obstructive Hypertrophic Cardiomyopathy. Ann Thorac Surg 2023; 116:499-507. [PMID: 37116851 PMCID: PMC10524729 DOI: 10.1016/j.athoracsur.2023.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Little data exist regarding characteristics and outcomes of pediatric patients undergoing septal myectomy. We evaluated this in a large referral population. METHODS Septal myectomy was performed in 199 consecutive patients aged ≤18 years with obstructive hypertrophic cardiomyopathy from January 1, 1976, to June 30, 2021. RESULTS Median age was 13 years (interquartile range [IQR], 8-15 years). Left ventricular myectomy approaches included transaortic (163 of 198 [82%]), transapical (16 of 198 [8%]), and combined (19 of 198 [10%]). Right ventricular interventions included myectomy (13 of 199 [7%]) and patch reconstruction of the outflow tract (15 of 199 [8%]). Maximum left ventricular outflow tract gradients decreased after myectomy (prebypass: 50 mm Hg [IQR, 31-73 mm Hg] vs postbypass: 4 mm Hg [IQR, 0-9 mm Hg], P < .001), and this was sustained long-term (5 mm Hg [IQR, 5-10 mm Hg] at 10 years). Iatrogenic aortic and mitral valve injuries occurred in 13 of 199 (7%) and 1 of 199 (1%), respectively; however, all were successfully repaired. Operative mortality was 2 of 199 (1%). The cumulative incidence of redo myectomy was low, at 5.8% at 5 and 8.3% at 10 years. Redo myectomy patients had higher maximum left ventricular outflow tract gradients on echocardiography at predischarge and 1 year and were younger at the index operation (8 years [IQR, 2.5-10 years] vs 13 years [IQR, 9-16 years], P < .001). Overall survival at 10 years was 90%, relative to 47% in a previously reported pediatric nonoperative cohort. CONCLUSIONS Pediatric septal myectomy provides safe, effective, and durable relief of ventricular outflow tract obstruction. Iatrogenic valve injury remains a low but nonnegligible risk. Recurrent obstruction requiring redo myectomy is infrequent and can be identified early. Long-term survival in this pediatric septal myectomy cohort appears to fare better than pediatric hypertrophic cardiomyopathy cohorts managed nonoperatively.
Collapse
Affiliation(s)
- Elaine M Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Michael J Ackerman
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - J Martijn Bos
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Mateo Alzate-Aguirre
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Austin Todd
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Philip L Wackel
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
5
|
Griffeth EM, Krishnan P, Dearani JA, Pahwa S, Ackerman MJ, Wackel PL, Todd A, Cannon BC. Pediatric Epicardial Devices: Early and Midterm Outcomes. World J Pediatr Congenit Heart Surg 2023:21501351231157374. [PMID: 36851830 DOI: 10.1177/21501351231157374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Lead performance is suboptimal in young patients and a main cause of device system failure. Our objective was to assess early and midterm outcomes after epicardial device implantation in a contemporary pediatric cohort. METHODS A total of 116 consecutive pediatric patients underwent 137 epicardial device implantations from 2010 to 2019. Forty pacemakers and 97 implantable cardioverter defibrillators (ICDs) were implanted. Lead failure was defined as leads repaired, replaced, or abandoned due to fracture, dislodgement, or dysfunction. Freedom from device system failure was determined using Kaplan-Meier analysis. RESULTS Mean age at implantation was 10 ± 5 years, 46 (34%) were younger than 8 years old, 41 (30%) had prior cardiac surgery, and 38 (28%) had prior devices. Main indications were acquired heart block (17/40 [43%]), sinus node dysfunction (14/40 [35%]), and congenital heart block (7/40 [18%]) for pacemakers, and hypertrophic cardiomyopathy (46/97 [47%]), long QT syndrome (31/97 [32%]), and ventricular arrhythmia (17/97 [18%]) for ICDs. There were no early deaths. Three-year freedom from device system failure was 80% (95% CI 73%, 88%) for all patients and 88% (95% CI 79%, 99%) for patients <8 years old. Device system failure causes included lead fracture (20/34 [59%]), lead dysfunction (5/34 [15%]), lead dislodgement (5/34 [15%]), infection (3/34 [9%]), and pericarditis (1/34 [3%]). Reintervention was required in 26/34 (76%) device system failures. CONCLUSIONS Epicardial device implantation is safe, shows acceptable midterm outcomes in children, and is an effective option in patients younger than 8 years old. Close device surveillance continues to be essential to detect lead failure early and ensure timely reintervention.
Collapse
Affiliation(s)
- Elaine M Griffeth
- Department of Cardiovascular Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Prasad Krishnan
- Department of Cardiovascular Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Siddharth Pahwa
- Department of Cardiovascular Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | | | - Philip L Wackel
- Division of Pediatric Cardiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Austin Todd
- Department of Quantitative Health Sciences, 6915Mayo Clinic, Rochester, MN, USA
| | - Bryan C Cannon
- Division of Pediatric Cardiology, 6915Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
6
|
Huang AL, MacNamara J, Link MS, Martinez M, Dearani JA, Cannon BC, Levine BD, Ackerman MJ. Asymptomatic Apical Hypertrophic Cardiomyopathy in an Elite Competitive Athlete. JACC Case Rep 2022; 6:101705. [PMID: 36704059 PMCID: PMC9871207 DOI: 10.1016/j.jaccas.2022.101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Abstract
A 17-year-old male elite athlete presented for evaluation after an abnormal pre-competitive college screening electrocardiogram. Subsequent evaluation revealed the presence of hypertrophic cardiomyopathy. He remained asymptomatic throughout four years of follow-up. Through shared decision making, he continued to play competitively and is now a professional athlete. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Athena L. Huang
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James MacNamara
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mark S. Link
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | | | - Michael J. Ackerman
- Mayo Clinic, Rochester, Minnesota, USA,Address for correspondence: Dr Michael J. Ackerman, Mayo Clinic, Guggenheim Building, Room 501, 200 First Street SW, Rochester, Minnesota 55905, USA.
| |
Collapse
|
7
|
Dubin AM, Bar‐Cohen Y, Berul CI, Cannon BC, Saarel EV, Shah MJ, Triedman JK. Pediatric Electrophysiology Device Needs: A Survey from the Pediatric and Congenital Electrophysiology Society Taskforce on Pediatric‐Specific Devices. J Am Heart Assoc 2022; 11:e026904. [DOI: 10.1161/jaha.122.026904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background
There are few US Food and Drug Administration (FDA)–approved devices specifically aimed at the pediatric patient with arrhythmia. This has led to a high off‐label utilization of devices in this vulnerable population. The Pediatric and Congenital Electrophysiology Society (PACES), the international organization representing pediatric and congenital heart disease arrhythmia specialists, developed a task force to comprehensively address device development issues relevant to pediatric patients with congenital arrhythmia.
Methods and Results
As a first step, the taskforce developed a 26‐question survey for the pediatric arrhythmia community to assess providers’ understanding of the FDA approval process, specifically in regard to pediatric labeling. There were 92/211 respondents (44%) with a >90% completion rate. The vast majority of respondents believed there was a paucity of devices available for children (96%). More than 60% of respondents stated that they did not understand the FDA regulatory process and were not aware of whether the devices they used were labeled for pediatric use.
Conclusions
Pediatric electrophysiologists are keenly aware of the deficit of available pediatric devices for their patients. The majority do not understand the FDA approval process and could benefit from additional educational resources regarding this. A collaborative forum including PACES, FDA, patients and their families, and Industry would be an important next step in clarifying opportunities and priorities to serve this vulnerable population.
Collapse
Affiliation(s)
- Anne M. Dubin
- Lucile Packard Children’s Hospital at Stanford Stanford University Palo Alto CA
| | - Yaniv Bar‐Cohen
- Children’s Hospital Los Angeles University of Southern California Los Angeles CA
| | | | | | | | - Maully J. Shah
- Children’s Hospital of Philadelphia University of Pennsylvania Philadelphia PA
| | | |
Collapse
|
8
|
Tobert KE, Bos JM, Cannon BC, Ackerman MJ. Outcomes of Athletes With Genetic Heart Diseases and Implantable Cardioverter-Defibrillators Who Chose to Return to Play. Mayo Clin Proc 2022; 97:2028-2039. [PMID: 35985858 DOI: 10.1016/j.mayocp.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate outcomes for athletes with a genetic heart disease (GHD) and an implantable cardioverter-defibrillator (ICD) after return-to-play (RTP) approval. PATIENTS AND METHODS We conducted a retrospective review of athletes with GHD and an ICD who were evaluated and treated in Mayo Clinic's Genetic Heart Rhythm Clinic between July 2000 and July 2020. Data on frequency of GHD-associated breakthrough cardiac events (BCEs), inappropriate shocks, and ICD-related complications were collected and analyzed. RESULTS There were 125 (57 [45.6%] female) GHD-positive athletes with an ICD (mean age at RTP was 19.8±11.6 years); 56 of 125 (44.8%) had long QT syndrome. Overall, 42 ventricular fibrillation-terminating ICD therapies were given to 23 athletes (18.4%) over an average follow-up of 3.6±3.5 years. Athletes with an ICD were more likely to experience a BCE during athletic follow-up (n=28 of 125, 22.4%) compared with those without an ICD (n=4 of 533, 0.8%; P<.0001). The BCE rate for athletes with ICDs was 6.3 events per 100 athlete-years of follow-up; this included 5.1 ventricular fibrillation-terminating events per 100 athlete-years compared with 0.3 BCEs per 100 patient-years for athletes without ICDs. In total, 6 (4.8%) athletes experienced at least one inappropriate shock (1.34 per 100 athlete-years) and 28 (29.6%) athletes had at least one other device-related complication (5.02 per 100 patient-years). However, none of these other complications occurred during sports. CONCLUSION This 20-year single-center study provides the longest spanning retrospective review of outcomes for athletes with ICDs given RTP approval. For athletes with GHD and an ICD, no sports-associated deaths or reports of sports-related ICD damage occurred.
Collapse
Affiliation(s)
- Kathryn E Tobert
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - J Martijn Bos
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Bryan C Cannon
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA
| | - Michael J Ackerman
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
9
|
Tan NY, Amin M, Dearani JA, McLeod CJ, Stephens EH, Cannon BC, Miranda WR, Connolly HM, Egbe A, Asirvatham SJ, Madhavan M. Cardiac Implantable Electronic Devices in Ebstein Anomaly: Management and Outcomes. Circ Arrhythm Electrophysiol 2022; 15:e010744. [PMID: 35763435 DOI: 10.1161/circep.121.010744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optimal management of cardiac implantable electronic devices (CIEDs) in patients with Ebstein anomaly during tricuspid valve (TV) surgery is unknown. Thus, we aimed to characterize CIED management/outcomes in patients with Ebstein anomaly undergoing TV surgery. METHODS Patients at the Mayo Clinic from 1987 to 2020 with Ebstein anomaly and CIED procedure were reviewed for procedural details, complications, echocardiogram, and lead parameters. Five-year cumulative incidence of CIED complications were estimated using the Kaplan-Meier method. RESULTS Ninety-three patients were included; 51 were female, and mean age was 40.7±17.5 years. A new CIED was implanted in 45 patients at the time of TV surgery with the majority receiving an epicardial (n=37) CIED. Among 34 patients who had preexisting CIED (11 epicardial, 23 transvenous) at time of TV surgery, 20 had a transvenous right ventricular lead managed by externalizing the lead to the TV (n=15) or extracting the transvenous lead with epicardial lead implantation (n=5). Fourteen patients underwent CIED implantation (4 epicardial, 10 transvenous) without concurrent surgery. Placement of lead across the TV was avoided in 85% of patients. The 5-year cumulative incidence of CIED complications was 24% with no significant difference between epicardial and transvenous CIEDs (26% versus 23%, P=0.96). Performance of lead parameters was similar in epicardial and transvenous leads during median (interquartile range) follow-up of 44.5 (61.1) months. CONCLUSIONS In patients with Ebstein anomaly undergoing TV surgery, the use of epicardial leads and externalization of transvenous leads to the TV can avoid lead placement across the valve leaflets. Lead performance and CIED complications was similar between epicardial and transvenous CIEDs.
Collapse
Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Diseases (N.Y.T., W.R.M., H.M.C., A.E., S.J.A., M.M.), Mayo Clinic, Rochester, MN
| | - Mustapha Amin
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (M.A.)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery (J.A.D., E.H.S.), Mayo Clinic, Rochester, MN
| | | | - Elizabeth H Stephens
- Department of Cardiovascular Surgery (J.A.D., E.H.S.), Mayo Clinic, Rochester, MN
| | - Bryan C Cannon
- Division of Pediatric Cardiology (B.C.C.), Mayo Clinic, Rochester, MN
| | - William R Miranda
- Department of Cardiovascular Diseases (N.Y.T., W.R.M., H.M.C., A.E., S.J.A., M.M.), Mayo Clinic, Rochester, MN
| | - Heidi M Connolly
- Department of Cardiovascular Diseases (N.Y.T., W.R.M., H.M.C., A.E., S.J.A., M.M.), Mayo Clinic, Rochester, MN
| | - Alexander Egbe
- Department of Cardiovascular Diseases (N.Y.T., W.R.M., H.M.C., A.E., S.J.A., M.M.), Mayo Clinic, Rochester, MN
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases (N.Y.T., W.R.M., H.M.C., A.E., S.J.A., M.M.), Mayo Clinic, Rochester, MN
| | - Malini Madhavan
- Department of Cardiovascular Diseases (N.Y.T., W.R.M., H.M.C., A.E., S.J.A., M.M.), Mayo Clinic, Rochester, MN
| |
Collapse
|
10
|
Sagray E, Wackel PL, Cannon BC. Cardiac arrhythmias in Primary Hypokalemic Periodic Paralysis: Case report and Literature Review. HeartRhythm Case Rep 2022; 8:719-723. [PMID: 36310724 PMCID: PMC9596356 DOI: 10.1016/j.hrcr.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
11
|
Griffeth E, Dearani JA, Pahwa S, Cannon BC, Todd A, Krishnan P. PO-663-06 PEDIATRIC EPICARDIAL DEVICES: EARLY & MIDTERM OUTCOMES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
12
|
Garmany R, Neves R, Ali Ahmed F, Tester DJ, Cannon BC, Giudicessi JR, Ackerman MJ. Red herring pathogenic variants: a case report of premature ventricular contraction-triggered ventricular fibrillation with an incidental pathogenic LMNA variant. Eur Heart J Case Rep 2022; 6:ytac115. [PMID: 35528128 PMCID: PMC9071339 DOI: 10.1093/ehjcr/ytac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/18/2021] [Accepted: 03/08/2022] [Indexed: 12/04/2022]
Abstract
Background Pathogenic variants in the lamin A/C gene (LMNA) can lead to a wide range of phenotypes from dilated and arrhythmogenic cardiomyopathies and conduction abnormalities to partial lipodystrophies. This case highlights a coincidental pathogenic LMNA variant identified in a patient with sudden cardiac arrest (SCA). We demonstrate the need for careful interpretation of pathogenic variants identified in cardiomyopathy genes by highlighting a case in which a coincidental pathogenic LMNA variant was found in a patient with premature ventricular complex (PVC)-induced ventricular fibrillation (VF). Case summary We present the case of a 16-year-old male with SCA secondary to VF. Genetic testing identified a maternally inherited pathogenic variant in LMNA annotated c.1961dup; p.T655Nfs*49. The patient received an implantable cardiac defibrillator and was discharged on nadolol. The patient's two brothers were also variant-positive. However, the patient and both brothers had normal chamber dimensions on echocardiogram and no late gadolinium enhancement on cardiac magnetic resonance imaging. The family members with the variant were recommended to have prophylactic implantable cardiac defibrillators and thus sought a second opinion. The patient received an appropriate shock and device interrogation identified PVCs. Electrophysiology study identified PVC-induced VF which was ablated with no recurrent ventricular arrhythmias/implantable cardioverter defibrillator therapies over 8 months of follow-up. Although the variant in LMNA could lead to cardiac arrest, the clinical phenotype was consistent with a non-genetic aetiology. The family members were told to have periodic cardiac evaluation. Discussion This case demonstrates the identification of a coincidental pathogenic variant in a cardiomyopathy gene in a patient with cardiac arrest. Although this variant could lead to cardiomyopathy, it appears the cardiac arrest was not due to the pathogenic variant. This highlights the need to consider the clinical phenotype when interpreting genetic test results for cardiomyopathies even in the presence of a positive genetic test result.
Collapse
Affiliation(s)
- Ramin Garmany
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic Alix School of Medicine and the Mayo Clinic Medical Scientist Training Program, Rochester, MN 55905, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | - Raquel Neves
- Department of Cardiovascular Medicine/Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Guggenheim 501, 200 First Street SW, Rochester, MN 55905, USA
| | - Fatima Ali Ahmed
- Department of Cardiovascular Medicine/Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Guggenheim 501, 200 First Street SW, Rochester, MN 55905, USA
| | - David J. Tester
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | - Bryan C. Cannon
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905, USA
| | - John R. Giudicessi
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
- Department of Cardiovascular Medicine/Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Guggenheim 501, 200 First Street SW, Rochester, MN 55905, USA
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael J. Ackerman
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
- Department of Cardiovascular Medicine/Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Guggenheim 501, 200 First Street SW, Rochester, MN 55905, USA
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
13
|
Lador A, Giudicessi JR, Barake WM, Noseworthy PA, Kapa S, McLeod CJ, Cannon BC, Asirvatham SJ, Ackerman MJ. Premature Ventricular Contraction-Triggered Ventricular Fibrillation and Sudden Cardiac Arrest in the Young. JACC Clin Electrophysiol 2022; 8:380-382. [PMID: 35331434 DOI: 10.1016/j.jacep.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
|
14
|
Moltedo JM, Abello MS, Doiny D, Falconi EC, Diaz CJ, Majdalani MG, Cannon BC. Mejora progresiva de los umbrales de captura auricular y ventricular, detección e impedancias en los cables de estimulación epicárdica en adultos jóvenes que se someten a conversión de Fontan. Arch Cardiol Mex 2021; 91:439-443. [PMID: 33621222 PMCID: PMC8641458 DOI: 10.24875/acm.20000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: Patients with univentricular hearts who require permanent pacing systems typically require placement of epicardial leads. It is frequently difficult to find a position with good thresholds due to epimyocardial fibrosis or fat. The goal of the study is to assess the progression of capture thresholds (CT), sensing parameters (P waves and R waves), and impedances (imp) of steroid eluting epicardial pacing leads in young adults who underwent Fontan conversion and a pacemaker implant. Methods: All patients undergoing Fontan conversion in two institutions were retrospectively identified. Demographic data, congenital heart defects, pacing leads used, and pacing parameters were analyzed at implant, at 6 weeks and 12 months after implant. Results: Twenty patients were identified (twelve males); mean age at conversion was 24.9 ± 5.4 years (range 18-35). Epicardial bipolar steroid eluting leads were used. The site of implant both in the atria and the ventricles varied depending on the parameters. At implant, mean atrial and ventricular impedances were 617 ± 171 W and 1061 ± 771 W, respectively, mean P wave amplitude was 2 ± 0.7 mV, and mean R wave amplitude was 12.5 ± 7.7 mV. Mean CT was 1.7 ± 0.8 V at 0.5 ms for the atrium and 2.2 ± 1.2 V at 0.5 ms for the ventricle. Ventricular CT and impedance showed an improvement within the first 12 months after implant, with four patients having a decrease in threshold of more than 2 V. Conclusion: In patients undergoing Fontan conversion, implant ventricular CT and impedances are frequently higher than expected but typically improve during follow-up. Acceptance of higher initial threshold values may be a potential strategy in this patient population.
Collapse
Affiliation(s)
- Jose M Moltedo
- Sanatorio Finochietto, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - David Doiny
- Sanatorio Finochietto, Ciudad Autónoma de Buenos Aires, Argentina
| | - Estela C Falconi
- Sanatorio Finochietto, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carlos J Diaz
- Sanatorio Finochietto, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | |
Collapse
|
15
|
Huang Y, Dearani JA, Lahr BD, Stephens EH, Madhavan M, Cannon BC, Schaff HV. Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease. J Thorac Cardiovasc Surg 2021; 163:2185-2193.e4. [PMID: 34753592 DOI: 10.1016/j.jtcvs.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/22/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate outcomes of surgical management of lead-induced tricuspid regurgitation (TR) in patients with congenital heart disease. METHODS We analyzed data of 54 consecutive patients who underwent tricuspid valve (TV) surgery from 1998 to 2015 for lead-induced TR. Primary end points, including mortality, TV reinterventions, and longitudinal TR measurements, were analyzed with the Kaplan-Meier method or with repeated measures proportional odds modeling. RESULTS The median age of patients was 48.2 years (interquartile range, 37.3-59.0 years); 31 (57.4%) were female; 2 (3.7%) were children. Thirty patients (55.6%) underwent TV repair and 24 (44.4%) had replacement, and 52 underwent concomitant cardiac procedures. Thirty-day mortality was 1.9% (repair: 3.3%, replacement: 0.0%). Five-year survival was 80.4% overall and 79.7% and 81.4% for the repair and replacement groups, respectively. In response to surgery, TR improved in both groups (each P < .001) but more with replacement than repair (P < .001); longitudinal analysis showed that TR trends observed early on favoring replacement were sustained across follow-up (P < .001). The model-estimated risk of moderate or severe TR at 5-year follow-up, conditional on having severe preoperative TR, was 74.4% for the repair and 10.7% for the replacement group. Five-year cumulative risk of TV reintervention was comparable for valve repair and replacement. CONCLUSIONS Despite the need for concomitant cardiac procedures in most of the patients, early mortality was low after TV surgery. Survival and rate of TV reintervention were comparable for the repair and replacement groups. However, TV repair was associated with progressive TR during intermediate follow-up, especially in patients with severe preoperative TR.
Collapse
Affiliation(s)
- Ying Huang
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Brian D Lahr
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | | | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Bryan C Cannon
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | | |
Collapse
|
16
|
Bains S, Lador A, Neves R, Bos JM, Giudicessi JR, Cannon BC, Ackerman MJ. Role of chronic continuous intravenous lidocaine in the clinical management of patients with malignant type 3 long QT syndrome. Heart Rhythm 2021; 19:81-87. [PMID: 34537410 DOI: 10.1016/j.hrthm.2021.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/17/2021] [Accepted: 09/10/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Type 3 long QT syndrome (LQT3) is caused by pathogenic, gain-of-function variants in SCN5A leading to a prolonged action potential, ventricular ectopy, and torsades de pointes. Treatment options include pharmacotherapy, cardiac denervation, and/or device therapy. Rarely, patients with malignant LQT3 require cardiac transplantation. OBJECTIVE The purpose of this study was to evaluate the role of chronic continuous intravenous (IV) lidocaine as a therapeutic option for select patients with LQT3 refractory to standard therapy. METHODS We performed a retrospective review of patients evaluated and treated at Mayo Clinic and identified 4 of 161 patients with LQT3 (2.5%) who were refractory to standard therapies and therefore treated with IV lidocaine. RESULTS There were 4 patients (2 female [50%]). The median age at first IV lidocaine infusion was 2 months (interquartile range 1.5-4.8 months), and the median cumulative duration on IV lidocaine was 11.5 months (interquartile range 8.7-17.8 months). The main indication for IV lidocaine in all patients was persistent ventricular arrhythmias. Before IV lidocaine, all patients received an implantable cardioverter-defibrillator, and while on intermittent IV lidocaine, all patients underwent bilateral cardiac sympathetic denervation. Additionally, 2 (50%) patients had cardiac ablation for premature ventricular complexes. In all patients, lidocaine infusion resulted in a significant reduction of LQT3-triggered cardiac events. The main side effects of IV lidocaine observed were dizziness (n = 2, 50%) and seizures (n = 2, 50%). During follow-up, 3 of 4 (75%) patients underwent orthotopic cardiac transplantation. The remaining patient continues to receive IV lidocaine bolus for rescue as needed. CONCLUSION For patients with LQT3 who are refractory to standard treatment, chronic IV lidocaine infusion can be used as a potential "bridge to transplant."
Collapse
Affiliation(s)
- Sahej Bains
- Medical Scientist Training Program, Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Adi Lador
- Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Raquel Neves
- Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - J Martijn Bos
- Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - John R Giudicessi
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota
| | - Bryan C Cannon
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael J Ackerman
- Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
17
|
Holst KA, Dearani JA, Qureshi MY, Wackel P, Cannon BC, O'Leary PW, Olson TM, Seisler DK, Nelson TJ. From Safety to Benefit in Cell Delivery During Surgical Repair of Ebstein Anomaly: Initial Results. Ann Thorac Surg 2021; 113:890-895. [PMID: 33539782 DOI: 10.1016/j.athoracsur.2020.11.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The objective of this study is to assess the safety and early impact of intramyocardial delivery of autologous bone marrow-derived mononuclear cells (BM-MNC) at time of surgical Ebstein repair. METHODS Patients with Ebstein anomaly (ages 6 months to 30 years) scheduled to undergo repair of the tricuspid valve were eligible to participate in this open-label, non-randomized phase I clinical trial. BM-MNC target dose was 1-3 million cells/kg. Ten patients have undergone surgical intervention and cell delivery to the right ventricle (RV) and completed 6-month follow-up. RESULTS All patients underwent surgical tricuspid valve repair and uneventful BM-MNC delivery; there were no ventricular arrhythmias and no adverse events related to study product or delivery. Echocardiographic RV myocardial performance index improved and RV fractional area change showed an initial decline and then through study follow-up. There was no evidence of delayed myocardial enhancement or regional wall motion abnormalities at injection sites on 6-month follow-up magnetic resonance imaging. CONCLUSIONS Intramyocardial delivery of BM-MNC after surgical repair in Ebstein anomaly can be performed safely. Echocardiography variables suggest a positive impact of cell delivery on the RV myocardium with improvements in both RV size and wall motion over time. Additional follow-up and comparison to control groups are required to better characterize the impact of cell therapy on the myopathic RV in Ebstein anomaly.
Collapse
Affiliation(s)
- Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - M Yasir Qureshi
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
| | - Philip Wackel
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | | | - Timothy M Olson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Drew K Seisler
- Wanek HLHS Consortium Clinical Pipeline, Mayo Clinic, Rochester, Minnesota
| | - Timothy J Nelson
- Wanek HLHS Consortium Clinical Pipeline, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
18
|
Escudero CA, Ceresnak SR, Collins KK, Pass RH, Aziz PF, Blaufox AD, Ortega MC, Cannon BC, Cohen MI, Dechert BE, Dubin AM, Motonaga KS, Epstein MR, Erickson CC, Fishberger SB, Gates GJ, Capone CA, Nappo L, Kertesz NJ, Kim JJ, Valdes SO, Kubuš P, Law IH, Maldonado J, Moore JP, Perry JC, Sanatani S, Seslar SP, Shetty I, Zimmerman FJ, Skinner JR, Marcondes L, Stephenson EA, Asakai H, Tanel RE, Uzun O, Etheridge SP, Janson CM. Loss of ventricular preexcitation during noninvasive testing does not exclude high-risk accessory pathways: A multicenter study of WPW in children. Heart Rhythm 2020; 17:1729-1737. [DOI: 10.1016/j.hrthm.2020.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
|
19
|
Dubin AM, Cannon BC, Saarel EV, Triedman JK, Berul CI, Bar-Cohen Y, Shah MJ, Paulsen J, Patel H, Reich J, Carlson MD, Stein K, Gilkerson JO, Kowal RC, Peiris V. Pediatric and congenital electrophysiology society initiative on device needs in pediatric electrophysiology. Heart Rhythm 2019; 16:e39-e46. [DOI: 10.1016/j.hrthm.2018.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Indexed: 11/16/2022]
|
20
|
Cundiff NM, Robinson JA, Cannon BC, Snyder CS. Atrioventricular junctional tachycardia with exit block in an adolescent. HeartRhythm Case Rep 2018; 4:594-597. [PMID: 30581740 PMCID: PMC6301910 DOI: 10.1016/j.hrcr.2018.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nicholas M Cundiff
- Centers for Osteopathic Research and Education, Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Jeffrey A Robinson
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Christopher S Snyder
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| |
Collapse
|
21
|
Gist KM, Marino BS, Palmer C, Fish FA, Moore JP, Czosek RJ, Cassedy A, LaPage MJ, Law IH, Garnreiter J, Cannon BC, Collins KK. Cosmetic outcomes and quality of life in children with cardiac implantable electronic devices. Pacing Clin Electrophysiol 2018; 42:46-57. [PMID: 30334588 DOI: 10.1111/pace.13522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 09/05/2018] [Accepted: 09/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Axillary implant location is an alternative implant location in patients for cardiac implantable electronic devices (CIEDs) for the purposes of improved cosmetic outcome. The impact from the patient's perspective is unknown. The purpose of this study was to compare scar perception scores and quality of life (QOL) in pediatric patients with axillary CIED implant location versus the standard infraclavicular approach. METHODS This is a multicenter prospective study conducted at eight pediatric centers and it includes patients aged from 8 to 18 years with a CIED. Patients with prior sternotomy were excluded. Scar perception and QOL outcomes were compared between the infraclavicular and axillary implant locations. RESULTS A total of 141 patients (83 implantable cardioverter defibrillator [ICD]/58 pacemakers) were included, 55 with an axillary device and 86 with an infraclavicular device. Patients with an ICD in the axillary position had better perception of scar appearance and consciousness. Patients in the axillary group reported, on average, a total Pediatric QOL Inventory score that was 6 (1, 11) units higher than the infraclavicular group, after adjusting for sex and race (P = 0.02). CONCLUSIONS QOL is significantly improved in axillary in comparison to the infraclavicular CIED position, regardless of device type. Scar perception is improved in patients with ICD in the axillary position.
Collapse
Affiliation(s)
- Katja M Gist
- Heart Institute, Children's Hospital Colorado, University of Colorado Denver: Anschutz Medical Campus, Aurora, CO, USA
| | - Bradley S Marino
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Claire Palmer
- Children's Hospital Colorado Child Health Research Biostatistical Core, University of Colorado Denver: Anschutz Medical Campus, Aurora, CO, USA
| | - Frank A Fish
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeremy P Moore
- UCLA Medical Center, University of California at Los Angeles, Los Angeles, CA, USA
| | - Richard J Czosek
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Martin J LaPage
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Ian H Law
- University of Iowa Stead Family Children's Hospital, University of Iowa, Iowa City, IA, USA
| | - Jason Garnreiter
- Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, St. Louis, MO, USA
| | | | - Kathryn K Collins
- Heart Institute, Children's Hospital Colorado, University of Colorado Denver: Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
22
|
Abstract
BACKGROUND A thyroid storm (TS) is a rare, but life-threatening condition in hyperthyroid patients. Mortality in adult TS patients may be as high as 10%. Typically, a trigger precipitates the storm in hyperthyroid patients. CASE PRESENTATION We report the case of an adolescent girl with untreated hyperthyroidism who developed fulminant TS after a significant choking episode. Initially, she was found to have neck swelling and tachycardia leading providers to suspect infection. She deteriorated after a CAT Scan (CT) was performed with iodine contrast, potentially worsening storm symptoms. Here, we describe the case, the treatment strategy and propose a treatment modification for pediatric patients. CONCLUSIONS While many children are found to have minor abnormalities in thyroid studies, this case highlights the critical importance of prompt medical attention for any child with significantly elevated free thyroxine (FT4) levels as morbidity can occur when left untreated.
Collapse
Affiliation(s)
- Ana L Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
23
|
Podliesna S, Delanne J, Miller L, Tester DJ, Uzunyan M, Yano S, Klerk M, Cannon BC, Khongphatthanayothin A, Laurent G, Bertaux G, Falcon-Eicher S, Wu S, Yen HY, Gao H, Wilde AAM, Faivre L, Ackerman MJ, Lodder EM, Bezzina CR. Supraventricular tachycardias, conduction disease, and cardiomyopathy in 3 families with the same rare variant in TNNI3K (p.Glu768Lys). Heart Rhythm 2018; 16:98-105. [PMID: 30010057 DOI: 10.1016/j.hrthm.2018.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rare genetic variants in TNNI3K encoding troponin-I interacting kinase have been linked to a distinct syndrome consisting primarily of supraventricular tachycardias and variably expressed conduction disturbance and dilated cardiomyopathy in 2 families. OBJECTIVE The purpose of this study was to identify new genetic variants associated with inherited supraventricular tachycardias, cardiac conduction disease, and cardiomyopathy. METHODS We conducted next generation sequencing in 3 independent multigenerational families with atrial/junctional tachycardia with or without conduction disturbance, dilated cardiomyopathy, and sudden death. We also assessed the effect of identified variant on protein autophosphorylation. RESULTS In this study, we uncovered the same ultra-rare genetic variant in TNNI3K (c.2302G>A, p.Glu768Lys), which co-segregated with disease features in all affected individuals (n = 23) from all 3 families. TNNI3K harboring the TNNI3K-p.Glu768Lys variant displayed enhanced kinase activity, in line with expectations from previous mouse studies that demonstrated increased conduction indices and procardiomyopathic effects with increased levels of Tnni3k. CONCLUSION This study corroborates further the causal link between rare genetic variation in TNNI3K and this distinct complex phenotype, and points to enhanced kinase activity of TNNI3K as the underlying pathobiological mechanism.
Collapse
Affiliation(s)
- Svitlana Podliesna
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Lindsey Miller
- USC Keck School of Medicine, LAC+USC Medical Center, Los Angeles, California
| | - David J Tester
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota
| | - Merujan Uzunyan
- USC Keck School of Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Shoji Yano
- USC Keck School of Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Mischa Klerk
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Bryan C Cannon
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota
| | - Apichai Khongphatthanayothin
- USC Keck School of Medicine, LAC+USC Medical Center, Los Angeles, California; Bangkok General Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Gabriel Laurent
- Centre de compétence pour les troubles du rythme cardiaque d'origine génétique, CHU Dijon-Bourgogne, Dijon, France; Service de rythmologie Centre Hospitalier Universitaire Le Bocage 2, Dijon, France
| | - Geraldine Bertaux
- Centre de compétence pour les troubles du rythme cardiaque d'origine génétique, CHU Dijon-Bourgogne, Dijon, France
| | - Sylvie Falcon-Eicher
- Centre de compétence pour les troubles du rythme cardiaque d'origine génétique, CHU Dijon-Bourgogne, Dijon, France
| | | | | | - Hanlin Gao
- Fulgent Genetics, Temple City, California
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
| | - Laurence Faivre
- Centre de Génétique, Hôpital d'Enfants, Dijon, France; Equipe GAD, UMR1231, FHU TRANSLAD et Institut GIMI, CHU Dijon-Bourgogne et Université de Bourgogne-Franche Comté, Dijon, France
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota
| | - Elisabeth M Lodder
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
24
|
Bogush N, Espinosa RE, Cannon BC, Wackel PL, Okamura H, Friedman PA, McLeod CJ. Erratum to “Selecting the right defibrillator in the younger patient: Transvenous, epicardial or subcutaneous?” [Int. J. Cardiol. 250 (2018) 133–138]. Int J Cardiol 2018. [DOI: 10.1016/j.ijcard.2018.02.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
25
|
Etheridge SP, Escudero CA, Blaufox AD, Law IH, Dechert-Crooks BE, Stephenson EA, Dubin AM, Ceresnak SR, Motonaga KS, Skinner JR, Marcondes LD, Perry JC, Collins KK, Seslar SP, Cabrera M, Uzun O, Cannon BC, Aziz PF, Kubuš P, Tanel RE, Valdes SO, Sami S, Kertesz NJ, Maldonado J, Erickson C, Moore JP, Asakai H, Mill L, Abcede M, Spector ZZ, Menon S, Shwayder M, Bradley DJ, Cohen MI, Sanatani S. Life-Threatening Event Risk in Children With Wolff-Parkinson-White Syndrome. JACC Clin Electrophysiol 2018; 4:433-444. [DOI: 10.1016/j.jacep.2017.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
|
26
|
Schneider AE, Cannon BC, Johnson JN, Ackerman MJ, Wackel PL. Left Axis Deviation in Children Without Previously Known Heart Disease. Pediatrics 2018; 141:peds.2017-1970. [PMID: 29437138 DOI: 10.1542/peds.2017-1970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Left axis deviation (LAD) discovered in children via electrocardiogram (ECG) is uncommon but can be associated with heart disease (HD). The optimal diagnostic approach in a seemingly healthy child with LAD is unclear. We sought to better stratify which patients with LAD but without previously known HD may warrant additional workup. METHODS A retrospective chart review was performed to identify patients ≥1 to <18 years of age with LAD (QRS frontal plane axis 0 to -90) on an ECG between January 2002 and December 2014. Patients with known HD before their initial ECG were excluded. RESULTS Overall, 296 patients were identified (n = 181 [61%] male; mean age: 10.8 ± 4.6 years; mean QRS axis: -24 ± 22°). An echocardiogram was performed in 158 (53%) patients, with 24 (15%) having HD. Compared with those with an echocardiogram but without HD (n = 134), patients with HD had a more negative mean QRS axis (-42 vs -27°; P = .002) and were more likely to have a QRS axis ≤-42° (58% vs 26%; P = .003), ECG chamber enlargement or hypertrophy (38% vs 5%; P < .0001), and abnormal cardiac physical examination findings (75% vs 8%; P < .0001). CONCLUSIONS LAD discovered in isolation in the asymptomatic pediatric patient may not necessitate further cardiovascular investigation. Clinicians should consider obtaining an echocardiogram in patients with LAD and ECG cardiac chamber enlargement or hypertrophy, a QRS axis ≤-42°, and/or the presence of abnormal cardiac physical examination findings.
Collapse
Affiliation(s)
- Andrew E Schneider
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine
| | - Michael J Ackerman
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine.,Division of Heart Rhythm Services, Department of Cardiovascular Diseases, and.,Department of Molecular Pharmacology and Experimental Therapeutics and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Philip L Wackel
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine,
| |
Collapse
|
27
|
Bogush N, Espinosa RE, Cannon BC, Wackel PL, Okamura H, Friedman PA, McLeod CJ. Selecting the right defibrillator in the younger patient: Transvenous, epicardial or subcutaneous? Int J Cardiol 2018; 250:133-138. [DOI: 10.1016/j.ijcard.2017.09.213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 09/16/2017] [Accepted: 09/29/2017] [Indexed: 01/22/2023]
|
28
|
Holst KA, Dearani JA, Said S, Pike RB, Connolly HM, Cannon BC, Sessions KL, O'Byrne MM, O'Leary PW. Improving Results of Surgery for Ebstein Anomaly: Where Are We After 235 Cone Repairs? Ann Thorac Surg 2017; 105:160-168. [PMID: 29174783 DOI: 10.1016/j.athoracsur.2017.09.058] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ebstein anomaly has heterogeneous anatomy and numerous operative techniques are described. Cone repair provides a near anatomic tricuspid valve repair. The purpose of this study was to examine our experience with cone repair. METHODS Cone repair was performed in 235 consecutive patients with Ebstein anomaly, 134 children (57%) and 101 adults (43%), from June 2007 to October 2015. Median age was 15.6 years (range, 6 months to 73 years). Cone repair was the first operation in 192 patients (82%), the second in 41 (17%), and the third in 2 (1%). Previous tricuspid valve repair had been performed in 27 (12%). Echocardiograms were obtained preoperatively and at hospital dismissal for all patients and for a subgroup of patients at least 6 months after cone repair (n = 81). RESULTS Leaflet augmentation was done in 67 patients (28%), Sebening stitch in 57 (24.2%), neochordae in 49 (21%), and annuloplasty band in 158 (67%). Bidirectional cavopulmonary shunt was performed in 46 patients (20%). There was 1 early death (0.4%). Early reoperation was required in 14 patients (5.9%); re-repair was possible in 7 (50%). The majority of early reoperations (11 of 14; 79%) occurred in the first third of the series. Mean follow-up was 3.5 ± 2.5 years. There was sustained reduction in tricuspid regurgitation (p < 0.0001), a progressive decline in right ventricle size (p < 0.0001), and late increase in right ventricle fractional area change after initial decline (p < 0.0001). Freedom from late reoperation was 97.9% at 6 years. CONCLUSIONS Cone repair is safe, and the learning curve is significant. Sustained reduction in tricuspid regurgitation and favorable changes in the right ventricle at follow-up suggest that cone repair has an advantageous impact on right ventricular remodeling.
Collapse
Affiliation(s)
- Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Sameh Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Roxann B Pike
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | | | - Megan M O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
29
|
Fender EA, Killu AM, Cannon BC, Friedman PA, Mcleod CJ, Hodge DO, Broberg CS, Henrikson CA, Cha YM. Lead extraction outcomes in patients with congenital heart disease. Europace 2017; 19:441-446. [PMID: 27738059 DOI: 10.1093/europace/euw049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/06/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Patients with congenital heart disease (CHD) are at increased risk for intracardiac device malfunction and infection that may necessitate extraction; however, the risk of extraction is poorly understood. This study addresses the safety of extraction in patients with structural heart disease and previous cardiac surgery. Methods and results This retrospective study included 40 CHD and 80 matched control patients, who underwent transvenous lead extractions between 2001 and 2014. Only leads >12 months were included. There were 77 leads in CHD patients and 146 in controls. The mean age was 38 ± 16 years in CHD patients. Ninety per cent of CHD patients had ≥1 cardiac surgeries when compared with 21% of controls (P < 0.001). The number of abandoned leads was significantly different (17 vs. 3, P < 0.001). Lead age was similar with an average duration of 83 ± 87 months in CHD patients and 62 ± 65 months in controls (P = 0.24). There was no significant difference in extraction techniques. Manual traction was successful in 40% of CHD patients and 47% of controls, and advanced techniques were used in 60 and 53% of CHD patients and controls, respectively. Complete extraction was achieved in 94% of the patients in both groups. There was no significant difference in complications. Conclusion Lead extraction can be safely performed in patients with CHD. Despite anatomic abnormalities and longer implantation times, the difficulty of lead extraction in patients with CHD is comparable with controls.
Collapse
Affiliation(s)
- Erin A Fender
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Ammar M Killu
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Bryan C Cannon
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Paul A Friedman
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Christopher J Mcleod
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - David O Hodge
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Craig S Broberg
- Oregon Health and Science University, Knight Cardiovascular Institute, Mail Code UHN-62 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Charles A Henrikson
- Oregon Health and Science University, Knight Cardiovascular Institute, Mail Code UHN-62 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Yong-Mei Cha
- Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA
| |
Collapse
|
30
|
Qureshi MY, Cabalka AK, Khan SP, Hagler DJ, Haile DT, Cannon BC, Olson TM, Cantero-Peral S, Dietz AB, Radel DJ, Taggart NW, Kelle AM, Rodriguez V, Dearani JA, O'Leary PW. Cell-Based Therapy for Myocardial Dysfunction After Fontan Operation in Hypoplastic Left Heart Syndrome. Mayo Clin Proc Innov Qual Outcomes 2017; 1:185-191. [PMID: 30225415 PMCID: PMC6134900 DOI: 10.1016/j.mayocpiqo.2017.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Myocardial dysfunction after Fontan palliation for univentricular congenital heart disease is a challenging clinical problem. The medical treatment has a limited impact, with cardiac transplant being the ultimate management step. Cell-based therapies are evolving as a new treatment for heart failure. Phase 1 clinical trials using regenerative therapeutic strategies in congenital heart disease are ongoing. We report the first case of autologous bone marrow-derived mononuclear cell administration for ventricular dysfunction, 23 years after Fontan operation in a patient with hypoplastic left heart syndrome. The cells were delivered into the coronary circulation by cardiac catheterization. Ventricular size decreased and several parameters reflecting ventricular function improved, with maximum change noted 3 months after cell delivery. Such regenerative therapeutic options may help in delaying and preventing cardiac transplant.
Collapse
Affiliation(s)
| | | | - Shakila P Khan
- Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN
| | - Donald J Hagler
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | - Dawit T Haile
- Division of Pediatric Anesthesia, Mayo Clinic, Rochester, MN
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | - Timothy M Olson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | | | - Allan B Dietz
- Division of Transfusion Medicine, Mayo Clinic, Rochester, MN
| | - Darcie J Radel
- Division of Transfusion Medicine, Mayo Clinic, Rochester, MN
| | | | - Angela M Kelle
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN
| | | | | | | |
Collapse
|
31
|
Rohatgi RK, Sugrue A, Bos JM, Cannon BC, Asirvatham SJ, Moir C, Owen HJ, Bos KM, Kruisselbrink T, Ackerman MJ. Contemporary Outcomes in Patients With Long QT Syndrome. J Am Coll Cardiol 2017; 70:453-462. [DOI: 10.1016/j.jacc.2017.05.046] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 11/15/2022]
|
32
|
Holst KA, Said SM, Nelson TJ, Cannon BC, Dearani JA. Current Interventional and Surgical Management of Congenital Heart Disease: Specific Focus on Valvular Disease and Cardiac Arrhythmias. Circ Res 2017; 120:1027-1044. [PMID: 28302746 DOI: 10.1161/circresaha.117.309186] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 01/15/2023]
Abstract
Successful outcome in the care of patients with congenital heart disease depends on a comprehensive multidisciplinary team. Surgery is offered for almost every heart defect, despite complexity. Early mortality for cardiac surgery in the neonatal period is ≈10% and beyond infancy is <5%, with 90% to 95% of patients surviving with a good quality of life into the adult years. Advances in imaging have facilitated accurate diagnosis and planning of interventions and surgical procedures. Similarly, advances in the perioperative medical management of patients, particularly with intensive care, has also contributed to improving outcomes. Arrhythmias and heart failure are the most common late complications for the majority of defects, and reoperation for valvar problems is common. Lifelong surveillance for monitoring of recurrent or residual structural heart defects, as well as periodic assessment of cardiac function and arrhythmia monitoring, is essential for all patients. The field of congenital heart surgery is poised to incorporate new innovations such as bioengineered cells and scaffolds that will iteratively move toward bioengineered patches, conduits, valves, and even whole organs.
Collapse
Affiliation(s)
- Kimberly A Holst
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Sameh M Said
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Timothy J Nelson
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Bryan C Cannon
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN.
| |
Collapse
|
33
|
Hassan A, Tan NY, Aung H, Connolly HM, Hodge DO, Vargas ER, Cannon BC, Packer DL, Asirvatham SJ, McLeod CJ. Outcomes of atrial arrhythmia radiofrequency catheter ablation in patients with Ebstein’s anomaly. Europace 2017; 20:535-540. [DOI: 10.1093/europace/euw396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/07/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Abdalla Hassan
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave, Chicago, IL 60657, USA
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St, Rochester, MN 55905, USA
| | - Nicholas Y Tan
- Department of Internal Medicine, Mayo Clinic, 200 First St, Rochester, MN 55905, USA
| | - Htin Aung
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St, Rochester, MN 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St, Rochester, MN 55905, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Emily R Vargas
- Department of Health Sciences Research, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Bryan C Cannon
- Department of Pediatric Cardiology, Mayo Clinic, 200 First St, Rochester, MN 55905, USA
| | - Douglas L Packer
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St, Rochester, MN 55905, USA
| | - Christopher J McLeod
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St, Rochester, MN 55905, USA
| |
Collapse
|
34
|
Wackel PL, McCrary AW, Idriss SF, Asirvatham SJ, Cannon BC. Radiofrequency Ablation in the Sinus of Valsalva for Ventricular Arrhythmia in Pediatric Patients. Pediatr Cardiol 2016; 37:1534-1538. [PMID: 27562131 DOI: 10.1007/s00246-016-1467-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
The need to perform catheter ablation of ventricular arrhythmia from within the sinuses of Valsalva in a pediatric patient is uncommon. This has been reported in adults, but there are little data about the feasibility, safety or efficacy of catheter ablation in the sinuses of Valsalva in the pediatric patients. This is a retrospective review of all patients aged 18 years or less, at two separate institutions with no structural heart disease that underwent an ablation procedure for ventricular arrhythmia mapped to the sinus of Valsalva from 2010 to 2015. We identified 8 total patients meeting inclusion criteria. Median age was 16 years and the median weight was 61 kg. All patients were symptomatic or had developed arrhythmia-induced ventricular dysfunction. Ablation was performed in the left sinus in 4 patients and the right sinus in 4 patients. No ablations were required in the non-coronary sinus. All 8 patients had an acutely successful ablation using radiofrequency energy. There were no complications. At a mean follow-up of 7 months (4-15 months), all patients were known to be living. Follow-up data regarding arrhythmia were available in 6 of the 8 patients, and none had recurrence of their ventricular arrhythmia off of all antiarrhythmic medications. Radiofrequency catheter ablation of ventricular arrhythmia in the sinus of Valsalva can be done safely and effectively in pediatric patients.
Collapse
|
35
|
Poterucha JT, Taggart NW, Johnson JN, Cannon BC, Cabalka AK, Hagler DJ, Dearani JA, Cetta F. Intravascular and hybrid intraoperative stent placement for baffle obstruction in transposition of the great arteries after atrial switch. Catheter Cardiovasc Interv 2016; 89:306-314. [DOI: 10.1002/ccd.26783] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Joseph T. Poterucha
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Rochester Minnesota
| | - Nathaniel W. Taggart
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Rochester Minnesota
| | - Jonathan N. Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Rochester Minnesota
| | - Bryan C. Cannon
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Rochester Minnesota
| | - Allison K. Cabalka
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Rochester Minnesota
| | - Donald J. Hagler
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Rochester Minnesota
- Division of Cardiovascular Diseases, Department of Medicine; Rochester Minnesota
| | - Joseph A. Dearani
- Division of Cardiovascular Surgery, Mayo Clinic College of Medicine; Rochester Minnesota
| | - Frank Cetta
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Rochester Minnesota
- Division of Cardiovascular Diseases, Department of Medicine; Rochester Minnesota
| |
Collapse
|
36
|
Thompson AJ, Cannon BC, Wackel PL, Horner JM, Ackerman MJ, O'Leary PW, Eidem BW, Johnson JN. Electrocardiographic abnormalities in elite high school athletes: comparison to adolescent hypertrophic cardiomyopathy. Br J Sports Med 2016; 50:105-10. [PMID: 26729893 DOI: 10.1136/bjsports-2015-094880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In athletes, ECG changes from physiological cardiac remodelling are common but can overlap with findings from a pathological disorder. We compared ECG findings in a group of elite high school athletes to a cohort of adolescents with hypertrophic cardiomyopathy (HCM). METHODS/RESULTS We prospectively performed 15-lead ECGs and echocardiograms in 147 elite high school athletes. Student-athlete ECGs were compared in blinded fashion to ECGs of 148 adolescents with HCM of similar age and ethnicity. Standard ECG hypertrophy criteria and established expert opinion guidelines (European Society of Cardiology, ESC and Seattle criteria) were analysed. All student-athletes had normal echocardiograms. Overall, 77/147 (52%) of student-athletes met standard ECG criteria for ventricular hypertrophy compared to 126/148 (85%) adolescents with HCM (p<0.0001). There were 112/148 (76%) adolescents with HCM who had pathological Q-waves, T-wave inversion and/or ST-segment depression compared to 1/147 (1%) athletes (p<0.0001). Most patients with HCM (84%, 124/148) had ≥1 abnormal ECG finding(s) according to Seattle criteria, compared to 1% of student-athletes (2/147). Similarly, 130/148 (88%) patients with HCM met group-2 ESC criteria (abnormal), compared to 36/147 (24%) student-athletes (p<0.0001). CONCLUSIONS Over 50% of elite high school athletes with echocardiographically confirmed normal hearts satisfied standard voltage criteria for ventricular hypertrophy. Pathological Q-waves, T-wave inversion or ST-segment depression were most helpful in distinguishing adolescents with HCM from normals. Both ESC and Seattle criteria successfully stratified the student-athlete and HCM cohorts, however each had a false-negative rate >10% for the HCM cohort. The Seattle criteria demonstrated a significantly lower false-positive rate (1%) than the ESC criteria (24%).
Collapse
Affiliation(s)
- Alex J Thompson
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan C Cannon
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip L Wackel
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Justin M Horner
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Ackerman
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick W O'Leary
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin W Eidem
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
37
|
Schneider AE, Burkhart HM, Ackerman MJ, Dearani JA, Wackel P, Cannon BC. Minimally invasive epicardial implantable cardioverter-defibrillator placement for infants and children: An effective alternative to the transvenous approach. Heart Rhythm 2016; 13:1905-12. [DOI: 10.1016/j.hrthm.2016.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Indexed: 11/16/2022]
|
38
|
Syed FF, Ackerman MJ, McLeod CJ, Kapa S, Mulpuru SK, Sriram CS, Cannon BC, Asirvatham SJ, Noseworthy PA. Sites of Successful Ventricular Fibrillation Ablation in Bileaflet Mitral Valve Prolapse Syndrome. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004005. [PMID: 27103091 DOI: 10.1161/circep.116.004005] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 03/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although the vast majority of mitral valve prolapse (MVP) is benign, a small subset of patients, predominantly women, with bileaflet prolapse, complex ventricular ectopy (VE), and abnormal T waves comprise the recently described bileaflet MVP syndrome. We compared findings on electrophysiological study in bileaflet MVP syndrome patients with and without cardiac arrest to identify factors that may predispose to malignant ventricular arrhythmia. METHODS AND RESULTS Fourteen consecutive bileaflet MVP syndrome patients (n=13 women; median [limits], age at index ablation, 33.8 [21.0-58.7] years; ejection fraction, 60% [45%-67%]; all ≤ moderate mitral regurgitation; n=6 with previous cardiac arrest and implantable cardioverter defibrillator shocks for ventricular fibrillation; and n=8 without implantable cardioverter defibrillator although with symptomatic complex VE) were included. The 2 groups had similar baseline echocardiographic and electrocardiographic characteristics. All patients had at least 1 left ventricular papillary or fascicular VE focus. Purkinje origin VE was identified as the ventricular fibrillation trigger in 6 of 6 cardiac arrest patients (4 from papillary muscle) and Purkinje origin of dominant VE was seen in 5 of 8 (3 from papillary muscle) nonarrest patients. Acute success was seen in 17 of 19 procedures, and a ventricular fibrillation storm occurred within 24 hours of ablation in a single patient. Repeat ablation for recurrent symptomatic arrhythmia was performed in 6 patients. At 478 (39-2099) days of follow-up, 2 cardiac arrest patients received appropriate shocks. Symptoms from VE were reduced in 12 of 14. CONCLUSIONS Bileaflet MVP syndrome is characterized by fascicular and papillary muscle VE that triggers ventricular fibrillation. Ablation of clinically dominant VE foci improves symptoms and reduces appropriate implantable cardioverter defibrillator shocks.
Collapse
Affiliation(s)
- Faisal F Syed
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Michael J Ackerman
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN.
| | - Christopher J McLeod
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Suraj Kapa
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Siva K Mulpuru
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Chenni S Sriram
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Bryan C Cannon
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Samuel J Asirvatham
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| |
Collapse
|
39
|
Pundi KN, Pundi KN, Johnson JN, Dearani JA, Li Z, Driscoll DJ, Wackel PL, McLeod CJ, Cetta F, Cannon BC. Sudden cardiac death and late arrhythmias after the Fontan operation. CONGENIT HEART DIS 2016; 12:17-23. [DOI: 10.1111/chd.12401] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/22/2016] [Accepted: 07/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Kavitha N. Pundi
- Division of Pediatric Cardiology; Mayo Clinic; Rochester Minnesota
| | - Krishna N. Pundi
- Mayo Clinic College of Medicine; Mayo Clinic; Rochester Minnesota
| | - Jonathan N. Johnson
- Division of Pediatric Cardiology; Mayo Clinic; Rochester Minnesota
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Joseph A. Dearani
- Division of Cardiovascular Surgery; Mayo Clinic; Rochester Minnesota
| | - Zhuo Li
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | | | - Philip L. Wackel
- Division of Pediatric Cardiology; Mayo Clinic; Rochester Minnesota
| | | | - Frank Cetta
- Division of Pediatric Cardiology; Mayo Clinic; Rochester Minnesota
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Bryan C. Cannon
- Division of Pediatric Cardiology; Mayo Clinic; Rochester Minnesota
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| |
Collapse
|
40
|
Gaba P, Bos JM, Cannon BC, Cha YM, Friedman PA, Asirvatham SJ, Ackerman MJ. Implantable cardioverter-defibrillator explantation for overdiagnosed or overtreated congenital long QT syndrome. Heart Rhythm 2016; 13:879-85. [DOI: 10.1016/j.hrthm.2015.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Indexed: 11/15/2022]
|
41
|
Poterucha JT, Egbe AC, Johnson JN, Niaz T, Wackel PL, Cannon BC, Eidem BW, Cetta F. Improved Ventricular Function after TEE-guided Cardioversion of Atrial Arrhythmias in Patients after the Fontan Operation. CONGENIT HEART DIS 2016; 11:578-583. [DOI: 10.1111/chd.12339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph T. Poterucha
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Mayo Clinic College of Medicine; Rochester MN USA
| | - Alexander C. Egbe
- Division of Cardiovascular Diseases, Department of Medicine; Mayo Clinic College of Medicine; Rochester Minn USA
| | - Jonathan N. Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Mayo Clinic College of Medicine; Rochester MN USA
- Division of Cardiovascular Diseases, Department of Medicine; Mayo Clinic College of Medicine; Rochester Minn USA
| | - Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Mayo Clinic College of Medicine; Rochester MN USA
| | - Phillip L. Wackel
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Mayo Clinic College of Medicine; Rochester MN USA
| | - Bryan C. Cannon
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Mayo Clinic College of Medicine; Rochester MN USA
| | - Benjamin W. Eidem
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Mayo Clinic College of Medicine; Rochester MN USA
- Division of Cardiovascular Diseases, Department of Medicine; Mayo Clinic College of Medicine; Rochester Minn USA
| | - Frank Cetta
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; Mayo Clinic College of Medicine; Rochester MN USA
- Division of Cardiovascular Diseases, Department of Medicine; Mayo Clinic College of Medicine; Rochester Minn USA
| |
Collapse
|
42
|
Pundi KN, Johnson JN, Dearani JA, Pundi KN, Li Z, Hinck CA, Dahl SH, Cannon BC, O’Leary PW, Driscoll DJ, Cetta F. 40-Year Follow-Up After the Fontan Operation. J Am Coll Cardiol 2015; 66:1700-10. [DOI: 10.1016/j.jacc.2015.07.065] [Citation(s) in RCA: 306] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/26/2015] [Accepted: 07/24/2015] [Indexed: 12/21/2022]
|
43
|
Abstract
BACKGROUND Hypoglycemia is a potential side effect of beta-blockers; however, no cases have been reported in children with long QT syndrome (LQTS). OBJECTIVE The purpose of this study was to determine the frequency and severity of hypoglycemia among children with beta-blocker-treated LQTS. METHODS A retrospective study was performed to identify children with LQTS evaluated from 2000 to 2014 who developed symptomatic hypoglycemia while being treated with a beta-blocker. RESULTS Nine children (3%; 7 boys; average corrected QT interval 486 ± 35 ms) developed 13 episodes (0.005 events per 100 treatment years) of beta-blocker-associated hypoglycemia (mean initial glucose 21 ± 7 mg/dL), including 3 of 157 patients with LQTS type 1 (LQT1; 1.9%) and 6 of 105 with LQTS type 2 (LQT2; 5.7%). The mean age at hypoglycemic event was 3.5 ± 2 years (range 7 months to 9 years), involving nadolol in 6 cases (mean dose 1.4 ± 0.2 mg/kg/d) and propranolol in 3 (mean dose 2.7±1 mg/kg/d). Hypoglycemic events were more frequent in patients with LQT2 than in those with LQT1 (10 vs. 3 events; P = .02). Hypoglycemia-triggered seizures were observed in 6 patients, fasting ketoacidosis in 5, and 7 patients required hospitalization (mean of 3 ± 2 days). Decreased caloric intake before the event was identified in all patients and a concomitant viral infection in 3. CONCLUSION This is the largest single-center case series of beta-blocker-induced hypoglycemia. Clinicians should be cognizant of hypoglycemia symptoms in younger children during periods of poor appetite and during viral illness, and parents of these children should be educated about the signs and symptoms of hypoglycemia. A potential LQT2-hypoglycemia genotype-phenotype relationship warrants further investigation.
Collapse
Affiliation(s)
- Joseph T Poterucha
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - J Martijn Bos
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J Ackerman
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
44
|
Stulak JM, Sharma V, Cannon BC, Ammash N, Schaff HV, Dearani JA. Optimal surgical ablation of atrial tachyarrhythmias during correction of Ebstein anomaly. Ann Thorac Surg 2015; 99:1700-5; discussion 1705. [PMID: 25825196 DOI: 10.1016/j.athoracsur.2015.01.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 12/29/2014] [Accepted: 01/13/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Ebstein anomaly (EA) is commonly associated with atrial flutter or fibrillation (AFl/F), which adversely affects outcome. Surgical ablation of AFl/F during surgery for EA has been shown to be effective, but the optimal lesion set remains unknown. METHODS Between 1995 and 2010, 86 patients had corrective surgery for EA and concomitant maze procedure for associated AFl/F. Median age at operation was 40 years (range, 1 to 72 years), and 49 patients (60%) were male. Preoperative AFl/F was paroxysmal in 43 patients (50%). All patients who had diagnosis of or treatment for accessory pathways and reentrant tachycardia were excluded from this analysis. RESULTS All patients underwent tricuspid valve surgery for EA and concomitant maze procedure, including right-sided maze (RSM) in 62 patients (72%) and biatrial maze (BAM) in 24 patients (28%). Early mortality occurred in 3 patients (3.5%). During median follow-up of 52 months (range, 3 months to 17 years), overall freedom from AFl/F without antiarrhythmic medications was 79% (RSM, 80% versus BAM, 76%; p = 0.97). Although there was no difference in rhythm outcome between RSM and BAM for patients with paroxysmal AFl/F (p = 0.08), there was a trend toward higher freedom from AF without antiarrhythmic medications in patients with persistent AFl/F for BAM (86%) versus RSM (71%; p = 0.053). Overall, there were no late strokes, and 84% were free from sodium warfarin anticoagulation. CONCLUSIONS Overall, surgical ablation of preoperative AFl/F is effective in patients undergoing surgery for EA. Although rhythm outcome of RSM and BAM did not differ in patients with preoperative paroxysmal AFl/F, those with persistent or permanent AFl/F may benefit from a biatrial lesion set.
Collapse
Affiliation(s)
- John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Vikas Sharma
- Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Bryan C Cannon
- Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Naser Ammash
- Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Hartzell V Schaff
- Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota.
| |
Collapse
|
45
|
Cantero Peral S, Burkhart HM, Oommen S, Yamada S, Nyberg SL, Li X, O'Leary PW, Terzic A, Cannon BC, Nelson TJ. Safety and feasibility for pediatric cardiac regeneration using epicardial delivery of autologous umbilical cord blood-derived mononuclear cells established in a porcine model system. Stem Cells Transl Med 2015; 4:195-206. [PMID: 25561683 DOI: 10.5966/sctm.2014-0195] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Congenital heart diseases (CHDs) requiring surgical palliation mandate new treatment strategies to optimize long-term outcomes. Despite the mounting evidence of cardiac regeneration, there are no long-term safety studies of autologous cell-based transplantation in the pediatric setting. We aimed to establish a porcine pipeline to evaluate the feasibility and long-term safety of autologous umbilical cord blood mononuclear cells (UCB-MNCs) transplanted into the right ventricle (RV) of juvenile porcine hearts. Piglets were born by caesarean section to enable UCB collection. Upon meeting release criteria, 12 animals were randomized in a double-blinded fashion prior to surgical delivery of test article (n=6) or placebo (n=6). The UCB-MNC (3×10(6) cells per kilogram) or control (dimethyl sulfoxide, 10%) products were injected intramyocardially into the RV under direct visualization. The cohorts were monitored for 3 months after product delivery with assessments of cardiac performance, rhythm, and serial cardiac biochemical markers, followed by terminal necropsy. No mortalities were associated with intramyocardial delivery of UCB-MNCs or placebo. Two animals from the placebo group developed local skin infection after surgery that responded to antibiotic treatment. Electrophysiological assessments revealed no arrhythmias in either group throughout the 3-month study. Two animals in the cell-therapy group had transient, subclinical dysrhythmia in the perioperative period, likely because of an exaggerated response to anesthesia. Overall, this study demonstrated that autologous UCB-MNCs can be safely collected and surgically delivered in a pediatric setting. The safety profile establishes the foundation for cell-based therapy directed at the RV of juvenile hearts and aims to accelerate cell-based therapies toward clinical trials for CHD.
Collapse
Affiliation(s)
- Susana Cantero Peral
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Harold M Burkhart
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Saji Oommen
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Satsuki Yamada
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Scott L Nyberg
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Xing Li
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Patrick W O'Leary
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Andre Terzic
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Bryan C Cannon
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Timothy J Nelson
- Division of General Internal Medicine, Center for Regenerative Medicine, Pediatric Cardiothoracic Surgery, Division of Cardiovascular Diseases, Transplant Center, Division of Biomedical Statistics and Informatics, Division of Pediatric Cardiology, Department of Molecular Pharmacology and Experimental Therapeutics, and Mayo Clinic, Rochester, Minnesota, USA; Program of Doctorate of Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| |
Collapse
|
46
|
Abstract
OBJECTIVE T-wave inversion in lateral electrocardiogram (ECG) leads (II, III, aVF, V4 -V6 ) is suspicious of cardiac pathology in pediatric patients, though many are found to have structurally normal hearts. The purpose of this study is to evaluate T-wave response during exercise stress testing (EST) in pediatric patients with structurally normal hearts and lateral-lead T-wave inversion on resting ECG. DESIGN An IRB-approved, retrospective review of EST databases at two centers identified patients with lateral-lead T-wave inversion on resting ECG. Inclusion criteria were normal exam and echocardiogram, absence of anginal chest pain, and age <18 years. All patients underwent treadmill or cycle ergometer EST. Data recorded included demographics, echocardiogram results, baseline ECG, EST method, peak heart rate and metabolic equivalents (METs), and heart rate and METs at T-wave reversion. T-wave reversion was considered complete if T-waves reverted in all leads, partial if reversion occurred in only some leads, and none if no reversion occurred. RESULTS The search identified 14 patients: nine females and five males (10 Caucasians and four African Americans) and an average age of 16 (range 12-18) years. Complete T-wave reversion occurred in 11 (79%) patients, partial in two (14%), and none in one (7%). Reversion occurred in both genders, ethnicities, and EST methods. No complications occurred during EST; no adverse outcomes occurred during 2-year follow-up. CONCLUSIONS EST in pediatric patients with lateral-lead T-wave inversion on resting ECG and structurally and functionally normal hearts resulted in either complete or partial T-wave reversion in the vast majority of patients.
Collapse
Affiliation(s)
- Walter J Hoyt
- Department of Pediatrics, Division of Pediatric Cardiology, University of Virginia, Charlottesville, Va, USA
| | | | | | | |
Collapse
|
47
|
Kang KT, Etheridge SP, Kantoch MJ, Tisma-Dupanovic S, Bradley DJ, Balaji S, Hamilton RM, Singh AK, Cannon BC, Schaffer MS, Potts JE, Sanatani S. Current Management of Focal Atrial Tachycardia in Children. Circ Arrhythm Electrophysiol 2014; 7:664-70. [DOI: 10.1161/circep.113.001423] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Focal atrial tachycardia (FAT) is an uncommon cause of supraventricular tachycardia in children. Incessant FAT can lead to tachycardia-induced cardiomyopathy. There is limited information regarding the clinical course and management of FAT. This study characterizes current management strategies for FAT in children including the prevalence of spontaneous resolution and the role of catheter ablation.
Methods and Results—
This is a retrospective chart review of pediatric patients with FAT managed between January 2000 and November 2010 at 10 pediatric centers. There were 249 patients with a median age at diagnosis of 7.2 (95% confidence interval, 5.8–10.4) years. Cardiomyopathy was observed in 28%. Resolution of FAT occurred in 89%, including spontaneous resolution without catheter ablation in 34%. Antiarrhythmic medications were used for initial therapy in 154 patients with control of FAT in 72%. Among first-line medications, β-blockers were the most common (53%) and effective (42%). Catheter ablation was successful in 80% of patients. FAT recurrence was less common with electroanatomic mapping compared with conventional mapping techniques (16% versus 35%;
P
=0.02). Patients were followed for a median of 2.1 (95% confidence interval, 1.8–2.6) years.
Conclusions—
FAT is managed successfully in most children. Current approaches are variable. Many patients have control of FAT with medications; however, catheter ablation is used for most patients. Spontaneous resolution is common for young children, emphasizing the role for delayed ablation in this group. Ablation is successful for all ages. Lower recurrence occurs when electroanatomic mapping techniques are used.
Collapse
Affiliation(s)
- Kristopher T. Kang
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Susan P. Etheridge
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Michal J. Kantoch
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Svjetlana Tisma-Dupanovic
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - David J. Bradley
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Seshadri Balaji
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Robert M. Hamilton
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Anoop K. Singh
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Bryan C. Cannon
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Michael S. Schaffer
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - James E. Potts
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| | - Shubhayan Sanatani
- From the Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children’s Hospital, Salt Lake City, UT (S.P.E.); Stollery Children’s Hospital, Edmonton, AB, Canada (M.J.K.); Children’s Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin,
| |
Collapse
|
48
|
Atallah J, Erickson CC, Cecchin F, Dubin AM, Law IH, Cohen MI, LaPage MJ, Cannon BC, Chun TU, Freedenberg V, Gierdalski M, Berul CI. Multi-Institutional Study of Implantable Defibrillator Lead Performance in Children and Young Adults. Circulation 2013; 127:2393-402. [DOI: 10.1161/circulationaha.112.001120] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart disease patients is hampered by poor long-term lead survival. Lead extraction is technically difficult and carries substantial morbidity. We sought to determine the outcomes of ICD leads in pediatric and congenital heart disease patients.
Methods and Results—
The Pediatric Lead Extractability and Survival Evaluation (PLEASE) is a 24-center international registry. Pediatric and congenital heart disease patients with ICD lead implantations from 2005 to 2010 were eligible. Study subjects comprised 878 ICD patients (44% congenital heart disease). Mean±SD age at implantation was 18.6±9.8 years. Of the 965 total leads, 54% were thin (≤7F), of which 57% were Fidelis, and 23% were coated with expanded polytetrafluoroethylene. There were 139 ICD lead failures (14%) in 132 patients (15%) at a mean lead age of 2.0±1.4 years, causing shocks in 53 patients (40%). Independent predictors of lead failure included younger implantation age and Fidelis leads. Actuarial analysis showed an incremental risk of lead failure with younger age at implantation: <8 years compared with >18 years (
P
=0.015). The actuarial yearly failure rate was 2.3% for non-Fidelis and 9.1% for Fidelis leads. Extraction was performed on 143 leads (80% thin, 7% expanded polytetrafluoroethylene coated), with lead age as the only independent predictor for advanced extraction techniques. There were 6 major extraction complications (4%) but no procedural mortality.
Conclusions—
This study demonstrates that ICD leads in children and congenital heart disease patients have an age-related suboptimal performance, further compounded by a high failure rate of Fidelis leads. Advanced extraction techniques were common and correlated with older lead age.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00335036.
Collapse
Affiliation(s)
- Joseph Atallah
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Christopher C. Erickson
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Frank Cecchin
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Anne M. Dubin
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Ian H. Law
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Mitchell I. Cohen
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Martin J. LaPage
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Bryan C. Cannon
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Terrence U.H. Chun
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Vicki Freedenberg
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Marcin Gierdalski
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| | - Charles I. Berul
- From the Stollery Children’s Hospital, Edmonton, AB, Canada (J.A.); UNMC/Children’s Hospital and Medical Center, Omaha, NE (C.E.C.); Children’s Hospital Boston, Boston, MA (F.C.); Packard Children’s Hospital at Stanford, Palo Alto, CA (A.M.D.); University of Iowa Children’s Hospital, Iowa City (I.H.L.); Phoenix Children’s Hospital, Phoenix, AZ (M.I.C.); University of Michigan, Ann Arbor (M.J.L.); Mayo Clinic, Rochester, MN (B.C.C.); Seattle Children’s Hospital, Seattle, WA (T.U.H.C.); and Children’s
| |
Collapse
|
49
|
Triedman JK, Pfeiffer P, Berman A, Blaufox AD, Cannon BC, Fish FA, Perry J, Pflaumer A, Seslar SP. COMPASS: a novel risk-adjustment model for catheter ablation in pediatric and congenital heart disease patients. CONGENIT HEART DIS 2013; 8:393-405. [PMID: 23489580 DOI: 10.1111/chd.12050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Robust risk-adjustment algorithms are often necessary if data from clinical registries is to be used to compare rates of important clinical outcomes between participating centers. Although such algorithms have been successfully developed for surgical and catheter-based cardiac interventions in children, outcomes of pediatric and congenital catheter ablation have not been modeled with respect to case mix. METHODS A working group was appointed by the Pediatric and Congenital Electrophysiology Society to develop a risk-adjustment algorithm for use in conjunction with a modernized, multicenter registry database. Expert consensus was used to develop relevant outcome measures, an inclusive list of possible predictors, and estimates of associated incremental risk. Historical data from the Pediatric Radiofrequency Ablation Registry was reanalyzed using multivariate regression to create statistical models of ablation outcomes. RESULTS Acute ablation failure and serious adverse event rates were modeled as outcomes. Statistical modeling was performed on 4486 cases performed in 19 centers. For ablation failure rate, a simple model including general category of arrhythmia mechanism and presence of structural congenital heart disease accounted for ∼71% of outcome variance. The model was useful for identification of between-center variability in the historical data set. Although expert consensus predicted the need for a more complex model, predicted univariate effects were similar to those generated by statistical modeling. Serious adverse events were too infrequent to permit statistical association with any predictive variable, but could be compared with the mean rate observed among all centers. CONCLUSION A substantial component of the intercenter variability of acute ablation outcomes in a historical database of pediatric and congenital ablation patients may be accounted for by a simple statistical model, exposing variations in outcome specific to centers. This will be a useful initial model for use a modern registry for pediatric catheter ablation outcomes.
Collapse
|
50
|
Drezner JA, Fischbach P, Froelicher V, Marek J, Pelliccia A, Prutkin JM, Schmied CM, Sharma S, Wilson MG, Ackerman MJ, Anderson J, Ashley E, Asplund CA, Baggish AL, Börjesson M, Cannon BC, Corrado D, DiFiori JP, Harmon KG, Heidbuchel H, Owens DS, Paul S, Salerno JC, Stein R, Vetter VL. Normal electrocardiographic findings: recognising physiological adaptations in athletes. Br J Sports Med 2013; 47:125-36. [DOI: 10.1136/bjsports-2012-092068] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|