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El Assaad I, Hammond B, Janson CM, Sherwin ED, Stephenson EA, Johnsrude CL, Niu MC, Shetty I, Lawrence DK, McCanta AC, Balaji S, Sanatani S, Fish FA, Webster G, Aziz PF. PO-674-04 ANTICOAGULATION MANAGEMENT AND RISK OF THROMBOEMBOLISM IN HEALTHY YOUTH WITH ATRIAL FIBRILLATION: DATA FROM A MULTI-INSTITUTIONAL PACES COLLABORATIVE REGISTRY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.444] [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: 11/30/2022]
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El Assaad I, Hammond BH, Kost LD, Worley S, Janson CM, Sherwin ED, Stephenson EA, Johnsrude CL, Niu M, Shetty I, Lawrence D, McCanta AC, Balaji S, Sanatani S, Fish F, Webster G, Aziz PF. Management and outcomes of atrial fibrillation in 241 healthy children and young adults: Revisiting "lone" atrial fibrillation-A multi-institutional PACES collaborative study. Heart Rhythm 2021; 18:1815-1822. [PMID: 34343691 DOI: 10.1016/j.hrthm.2021.07.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/08/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) in healthy children and young adults is rare. Risk of recurrence and treatment efficacy are not well defined. OBJECTIVE The purpose of this study was to assess recurrence patterns and treatment efficacy in AF. METHODS A retrospective multicenter cohort study including 13 congenital heart centers was facilitated by the Pediatric & Congenital Electrophysiology Society (PACES). Patients ≤21 years of age with documented AF from January 2004 to December 2018 were included. Demographics, family and clinical history, medications, electrophysiological study parameters, and outcomes related to the treatment of AF were recorded and analyzed. Patients with contributory diseases were excluded. RESULTS In 241 subjects (83% male; mean age at onset 16 years), AF recurred in 94 patients (39%) during 2.1 ± 2.6 years of follow-up. In multivariable analysis, predictors of AF recurrence were family history in a first-degree relative <50 years of age (odds ratio [OR] 1.9; P = .047) and longer PR interval in sinus rhythm (OR 1.1 per 10 ms; P = .037). AF recurrence was similar whether patients began no treatment (39/125 [31%]), began daily antiarrhythmic therapy (24/63 [38%]), or had an ablation at any time (14/53 [26%]; P = .39). Ablating non-AF substrate with supraventricular tachycardia improved freedom from AF recurrence (P = .013). CONCLUSION Recurrence of AF in the pediatric population is common, and the incidence of recurrence was not impacted by "no treatment," "medication only," or "ablation" treatment strategy. Ablation of pathways and other reentrant targets was the only intervention that decreased AF recurrence in children and young adults.
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Affiliation(s)
- Iqbal El Assaad
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Benjamin H Hammond
- Division of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Lukas D Kost
- Division of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Sarah Worley
- Division of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Christopher M Janson
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Mary Niu
- Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah
| | - Ira Shetty
- Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - David Lawrence
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, Michigan
| | - Anthony C McCanta
- Department of Pediatric Cardiology, University of California-Irvine and Children's Hospital of Orange County, Orange, California
| | - Seshadri Balaji
- Division of Pediatric Cardiology, Oregon Health and Science University, Portland, Oregon
| | - Shubhayan Sanatani
- Children's Heart Centre, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Frank Fish
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory Webster
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Peter F Aziz
- Division of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
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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]
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Zimmerman FJ, Bharati S, Freter A, Kanjanauthai S, Russo L, Shetty I. SUCCESSFUL MID-TERM OUTCOMES OF CRYOABLATION WITH AN 8-MM TIP CATHETER FOR PEDIATRIC AVNRT. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30910-x] [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: 10/22/2022]
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Yousef N, Philips M, Shetty I, Cui VW, Zimmerman F, Roberson DA. Transesophageal echocardiography of intracardiac thrombus in congenital heart disease and atrial flutter: the importance of thorough examination of the Fontan. Pediatr Cardiol 2014; 35:1099-107. [PMID: 24748037 DOI: 10.1007/s00246-014-0902-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 11/27/2013] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
Transesophageal echocardiography (TEE) is used in atrial flutter or fibrillation (AFF) before electric cardioversion to detect intracardiac thrombi. Previous studies have described the use of TEE to diagnose intracardiac thrombi in the left atrium and left atrial appendage, which has an incidence of 8 % among patients without congenital heart disease (CHD). In their practice the authors have noted a significant incidence of intracardiac thrombi in other structures of patients with CHD and AFF. This study aimed to determine the incidence and location of intracardiac thrombi using TEE in patients with CHD requiring electric cardioversion of AFF and to compare the use of TEE and transthoracic echo (TTE) to detect intracardiac thrombus in this population. A retrospective chart review of TEE and TTE findings for all patients with CHD who had electric cardioversion of AFF at our institution from 2005 to 2013 was conducted. The diagnosis, presence, and location of intracardiac thrombus were determined. The TEE and TTE results were compared. The study identified 27 patients with CHD who met the study entry criteria at our institution between 2005 and 2013. Seven of these patients had a single ventricle with Fontan palliation. All the patients presented with AFF and had TEE before electric cardioversion. No patients were excluded from the study. The patients ranged in age from 2 to 72 years (median, 21 years) and weighed 17-100 kg (median, 65 kg). The duration of AFF before TEE and attempted cardioversion ranged from 1 day to 3 weeks (median, 3.5 days). Intracardiac thrombus was present in 18 % (5/27) of the patients and in 57 % (4/7) of the Fontan patients with AFF. No embolic events were reported acutely or during a 6-month follow-up period. Among patients with CHD who present with AFF, a particularly high incidence of intracardiac thrombi is present in the Fontan patients that may be difficult to detect by TTE. Thorough TEE examination of the Fontan and related structures is indicated before electric cardioversion of AFF. The incidence of intracardiac thrombus in CHD patients is more than double that reported in non-CHD patients.
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Affiliation(s)
- Nida Yousef
- Advocate Children's Hospital Heart Institute, 4440 West 95th Street, Oak Lawn, IL, 60453, USA,
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Al-Ahdab MK, Roberson D, Shetty I, Freter A, Cui V, Dennis J, Zimmerman F. MID-TERM RESULTS FOLLOWING CARDIAC RESYNCHRONIZATION THERAPY FOR PATIENTS WITH COMPLEX CONGENITAL HEART DISEASE. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60527-1] [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: 11/26/2022]
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Shetty I, Silver ES, Hordof AJ, Goldberg PH, Liberman L. Ablation of supraventricular tachycardia allows more liberal therapy in some children with attention-deficit-hyperactivity disorder. Pediatr Int 2011; 53:715-717. [PMID: 21261787 DOI: 10.1111/j.1442-200x.2011.03326.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/28/2022]
Abstract
BACKGROUND First-line therapy for children with attention-deficit-hyperactivity disorder (ADHD) is stimulant medication, which may have potential cardiovascular side-effects. In patients with supraventricular tachycardia or Wolf-Parkinson-White syndrome (WPW), therapy for ADHD could become challenging. The purpose of the present study was to review the authors' experience of performing electrophysiologic study (EPS) with or without ablation to determine how it affected ADHD therapy. METHODS Retrospective chart review of patients who underwent EPS between 2002 and 2009 was carried out. All patients under 21 years of age who had prior diagnosis of ADHD were included. RESULTS Twenty patients met the inclusion criteria. The mean age was 12.1 ± 2.7 years (range: 5.6-16.8 years). The patients were diagnosed with ADHD on average 3.9 ± 2.7 years (range: 6 months-9 years) prior to the EPS. All patients had a structurally normal heart. Sixteen patients had cardiac symptoms. Seventeen patients underwent ablation of the arrhythmia substrate (16/17, 94% successful). Three patients with asymptomatic WPW were at low risk for life-threatening arrhythmias and did not have ablation. After the EPS, two patients had increased doses of their ADHD medications, and two patients whose health-care providers stopped the stimulant medication prior to EPS because of recurrent tachycardia were restarted on medications. All other patients on ADHD medications continued therapy. CONCLUSIONS EPS for risk stratification and ablation of arrhythmia substrate is safe and effective, allowing more liberal therapy in patients with ADHD and supraventricular tachycardia or WPW.
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Affiliation(s)
- Ira Shetty
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Eric S Silver
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Allan J Hordof
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Pablo H Goldberg
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Leonardo Liberman
- Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA
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Kean AC, Gelehrter SK, Shetty I, Dick M, Bradley DJ. Experience with CartoSound for arrhythmia ablation in pediatric and congenital heart disease patients. J Interv Card Electrophysiol 2010; 29:139-45. [PMID: 20878221 DOI: 10.1007/s10840-010-9512-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 08/26/2010] [Indexed: 12/19/2022]
Abstract
PURPOSE Electro-anatomic mapping (EAM) has been used for more than a decade to assist in defining arrhythmia propagation for transcatheter ablation. Intra-cardiac echocardiography (ICE) has also gained acceptance as an adjunct to further define intracardiac anatomy. The integration of these two technologies (CartoSound, Biosense-Webster, Diamond Bar, CA, USA) is a recent development. In this report, we describe our early experience in the young, with and without congenital heart defects (CHD). METHODS The clinical and electrophysiologic records of the first 17 patients to undergo procedures with the CartoSound (EAM-ICE) system were reviewed. In all 17, the 3-dimensional shape of the chamber(s) of interest was created using serial tracing of ICE images. The ICE catheter was placed in the esophagus in three and through the femoral vein in 14. Descriptive analysis was performed on demographic data as well as procedural characteristics including procedure time, fluoroscopy time, geometry acquisition time, EAM duration, ablation time, procedure success, and complications. RESULTS Arrhythmias comprised intra-atrial re-entry tachycardia (13 patients, 76%), Wolff-Parkinson-White syndrome (1; 6%), ventricular ectopic tachycardia (2; 12%), and atrioventricular node re-entrant tachycardia (1; 6%). Thirteen had CHD, with a median two palliative operations; six had single-ventricle anatomy. Procedure duration was 266 ± 134 min (median ± SD), and fluoroscopy time was 29 ± 28.3 min. Geometry acquisition took 41 ± 35.4 min, or 16% of the total case duration. Ablation lesions were placed in 16 cases, (cooled tip in 12) of which 15 (94%) were successful. One patient experienced mild hypotension. ICE image quality in three patients with the probe placed in the esophagus was suboptimal. CONCLUSIONS Advantages of CartoSound appear to be (1) anatomy modeling in the shape imposed by the arrhythmia, (2) more accurate geometry than EAM alone, and (3) demonstration of catheter position and lesions on echo during the study. Perceived disadvantages are (1) the large sheath required for ICE (11F), and (2) significant procedure time devoted to creation of anatomy. Optimal use may be to focus on key structures required for ablation, obtaining additional views as needed.
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Affiliation(s)
- Adam C Kean
- Michigan Congenital Heart Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5204, USA
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