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Chubb H, Bulic A, Mah D, Moore JP, Janousek J, Fumanelli J, Asaki SY, Pflaumer A, Hill AC, Escudero C, Kwok SY, Mangat J, Ochoa Nunez LA, Balaji S, Rosenthal E, Regan W, Horndasch M, Asakai H, Tanel R, Czosek RJ, Young ML, Bradley DJ, Paul T, Fischbach P, Malloy-Walton L, McElhinney DB, Dubin AM. Impact and Modifiers of Ventricular Pacing in Patients With Single Ventricle Circulation. J Am Coll Cardiol 2022; 80:902-914. [PMID: 36007989 DOI: 10.1016/j.jacc.2022.05.053] [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] [Received: 02/10/2022] [Revised: 05/04/2022] [Accepted: 05/23/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Palliation of the single ventricle (SV) circulation is associated with a burden of lifelong complications. Previous studies have identified that the need for a permanent ventricular pacing system (PPMv) may be associated with additional adverse long-term outcomes. OBJECTIVES The goal of this study was to quantify the attributable risk of PPMv in patients with SV, and to identify modifiable risk factors. METHODS This international study was sponsored by the Pediatric and Congenital Electrophysiology Society. Centers contributed baseline and longitudinal data for functionally SV patients with PPMv. Enrollment was at implantation. Controls were matched 1:1 to PPMv subjects by ventricular morphology and sex, identified within center, and enrolled at matched age. Primary outcome was transplantation or death. RESULTS In total, 236 PPMv subjects and 213 matched controls were identified (22 centers, 9 countries). Median age at enrollment was 5.3 years (quartiles: 1.5-13.2 years), follow-up 6.9 years (3.4-11.6 years). Median percent ventricular pacing (Vp) was 90.8% (25th-75th percentile: 4.3%-100%) in the PPMv cohort. Across 213 matched pairs, multivariable HR for death/transplant associated with PPMv was 3.8 (95% CI 1.9-7.6; P < 0.001). Within the PPMv population, higher Vp (HR: 1.009 per %; P = 0.009), higher QRS z-score (HR: 1.19; P = 0.009) and nonapical lead position (HR: 2.17; P = 0.042) were all associated with death/transplantation. CONCLUSIONS PPMv in patients with SV is associated with increased risk of heart transplantation and death, despite controlling for increased associated morbidity of the PPMv cohort. Increased Vp, higher QRS z-score, and nonapical ventricular lead position are all associated with higher risk of adverse outcome and may be modifiable risk factors.
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Affiliation(s)
- Henry Chubb
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA.
| | - Anica Bulic
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Douglas Mah
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy P Moore
- Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California, USA
| | - Jan Janousek
- Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Jennifer Fumanelli
- Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic; Pediatric Cardiology Unit, Department of Women's and Child's Health, University of Padova, Padova, Italy
| | - S Yukiko Asaki
- Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | - Andreas Pflaumer
- The Royal Children's Hospital, MCRI and University of Melbourne, Melbourne, Victoria, Australia
| | - Allison C Hill
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, USA; Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolina Escudero
- Department of Pediatrics, Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Sit Yee Kwok
- Cardiology Centre, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Jasveer Mangat
- Paediatric Cardiology, Great Ormond Street, London, United Kingdom
| | | | - Seshadri Balaji
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric Rosenthal
- Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - William Regan
- Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - Michaela Horndasch
- Department of Congenital Heart Diseases and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Hiroko Asakai
- Department of Paediatrics, University of Tokyo Hospital, Tokyo, Japan
| | - Ronn Tanel
- Division of Pediatric Cardiology, Department of Pediatrics, UCSF School of Medicine, San Francisco, California, USA
| | - Richard J Czosek
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio, USA
| | - Ming-Lon Young
- Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - David J Bradley
- University of Michigan, CS Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Thomas Paul
- Department of Pediatric Cardiology, Georg-August-University Medical Center, Göttingen, Germany
| | | | | | - Doff B McElhinney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA
| | - Anne M Dubin
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA
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Previtali G, Alessio M, Seaman A, Wahl E, Mangat J, Nibecker J, Springfield O, Bentow C, Mahler M. T205 Clinical study of Aptiva anti-transglutaminase IgA reagent on patients with biopsy results. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.689] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ware J, Boughton CK, Allen JM, Wilinska ME, Tauschmann M, Denvir L, Thankamony A, Campbell FM, Wadwa RP, Buckingham BA, Davis N, DiMeglio LA, Mauras N, Besser REJ, Ghatak A, Weinzimer SA, Hood KK, Fox DS, Kanapka L, Kollman C, Sibayan J, Beck RW, Hovorka R, Hovorka R, Acerini CL, Thankamony A, Allen JM, Boughton CK, Dovc K, Dunger DB, Ware J, Musolino G, Tauschmann M, Wilinska ME, Hayes JF, Hartnell S, Slegtenhorst S, Ruan Y, Haydock M, Mangat J, Denvir L, Kanthagnany SK, Law J, Randell T, Sachdev P, Saxton M, Coupe A, Stafford S, Ball A, Keeton R, Cresswell R, Crate L, Cripps H, Fazackerley H, Looby L, Navarra H, Saddington C, Smith V, Verhoeven V, Bratt S, Khan N, Moyes L, Sandhu K, West C, Wadwa RP, Alonso G, Forlenza G, Slover R, Towers L, Berget C, Coakley A, Escobar E, Jost E, Lange S, Messer L, Thivener K, Campbell FM, Yong J, Metcalfe E, Allen M, Ambler S, Waheed S, Exall J, Tulip J, Buckingham BA, Ekhlaspour L, Maahs D, Norlander L, Jacobson T, Twon M, Weir C, Leverenz B, Keller J, Davis N, Kumaran A, Trevelyan N, Dewar H, Price G, Crouch G, Ensom R, Haskell L, Lueddeke LM, Mauras N, Benson M, Bird K, Englert K, Permuy J, Ponthieux K, Marrero-Hernandez J, DiMeglio LA, Ismail H, Jolivette H, Sanchez J, Woerner S, Kirchner M, Mullen M, Tebbe M, Besser REJ, Basu S, London R, Makaya T, Ryan F, Megson C, Bowen-Morris J, Haest J, Law R, Stamford I, Ghatak A, Deakin M, Phelan K, Thornborough K, Shakeshaft J, Weinzimer SA, Cengiz E, Sherr JL, Van Name M, Weyman K, Carria L, Steffen A, Zgorski M, Sibayan J, Beck RW, Borgman S, Davis J, Rusnak J, Hellman A, Cheng P, Kanapka L, Kollman C, McCarthy C, Chalasani S, Hood KK, Hanes S, Viana J, Lanning M, Fox DS, Arreaza-Rubin G, Eggerman T, Green N, Janicek R, Gabrielson D, Belle SH, Castle J, Green J, Legault L, Willi SM, Wysham C. Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial. Lancet Digit Health 2022; 4:e245-e255. [PMID: 35272971 DOI: 10.1016/s2589-7500(22)00020-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/10/2021] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population. METHODS In a multicentre, multinational, parallel randomised controlled trial, participants aged 6-18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbA1c levels between 53 and 86 mmol/mol (7·0-10·0%). Using block randomisation and central randomisation software, we randomly assigned participants to either closed-loop insulin delivery (closed-loop group) or to usual care with insulin pump therapy (control group) for 6 months. Randomisation was stratified at each centre by local baseline HbA1c. The Cambridge closed-loop algorithm running on a smartphone was used with either (1) a modified Medtronic 640G pump, Medtronic Guardian 3 sensor, and Medtronic prototype phone enclosure (FlorenceM configuration), or (2) a Sooil Dana RS pump and Dexcom G6 sensor (CamAPS FX configuration). The primary endpoint was change in HbA1c at 6 months combining data from both configurations. The primary analysis was done in all randomised patients (intention to treat). Trial registration ClinicalTrials.gov, NCT02925299. FINDINGS Of 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbA1c was 8·2% (SD 0·7) in the closed-loop group and 8·3% (0·7) in the control group. At 6 months, HbA1c was lower in the closed-loop group than in the control group (between-group difference -3·5 mmol/mol (95% CI -6·5 to -0·5 [-0·32 percentage points, -0·59 to -0·04]; p=0·023). Closed-loop usage was low with FlorenceM due to failing phone enclosures (median 40% [IQR 26-53]), but consistently high with CamAPS FX (93% [88-96]), impacting efficacy. A total of 155 adverse events occurred after randomisation (67 in the closed-loop group, 88 in the control group), including seven severe hypoglycaemia events (four in the closed-loop group, three in the control group), two diabetic ketoacidosis events (both in the closed-loop group), and two non-treatment-related serious adverse events. There were 23 reportable hyperglycaemia events (11 in the closed-loop group, 12 in the control group), which did not meet criteria for diabetic ketoacidosis. INTERPRETATION The Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX. FUNDING National Institute of Diabetes and Digestive and Kidney Diseases.
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Norrish G, Chubb H, Field E, McLeod K, Ilina M, Spentzou G, Till J, Daubeney PEF, Stuart AG, Matthews J, Hares D, Brown E, Linter K, Bhole V, Pillai K, Bowes M, Jones CB, Uzun O, Wong A, Yue A, Sadagopan S, Bharucha T, Yap N, Rosenthal E, Mathur S, Adwani S, Reinhardt Z, Mangat J, Kaski JP. Clinical outcomes and programming strategies of implantable cardioverter-defibrillator devices in paediatric hypertrophic cardiomyopathy: a UK National Cohort Study. Europace 2021; 23:400-408. [PMID: 33221861 DOI: 10.1093/europace/euaa307] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/28/2020] [Accepted: 09/18/2020] [Indexed: 01/23/2023] Open
Abstract
AIMS Sudden cardiac death (SCD) is the most common mode of death in paediatric hypertrophic cardiomyopathy (HCM). This study describes the implant and programming strategies with clinical outcomes following implantable cardioverter-defibrillator (ICD) insertion in a well-characterized national paediatric HCM cohort. METHODS AND RESULTS Data from 90 patients undergoing ICD insertion at a median age 13 (±3.5) for primary (n = 67, 74%) or secondary prevention (n = 23, 26%) were collected from a retrospective, longitudinal multi-centre cohort of children (<16 years) with HCM from the UK. Seventy-six (84%) had an endovascular system [14 (18%) dual coil], 3 (3%) epicardial, and 11 (12%) subcutaneous system. Defibrillation threshold (DFT) testing was performed at implant in 68 (76%). Inadequate DFT in four led to implant adjustment in three patients. Over a median follow-up of 54 months (interquartile range 28-111), 25 (28%) patients had 53 appropriate therapies [ICD shock n = 45, anti-tachycardia pacing (ATP) n = 8], incidence rate 4.7 per 100 patient years (95% CI 2.9-7.6). Eight inappropriate therapies occurred in 7 (8%) patients (ICD shock n = 4, ATP n = 4), incidence rate 1.1/100 patient years (95% CI 0.4-2.5). Three patients (3%) died following arrhythmic events, despite a functioning device. Other device complications were seen in 28 patients (31%), including lead-related complications (n = 15) and infection (n = 10). No clinical, device, or programming characteristics predicted time to inappropriate therapy or lead complication. CONCLUSION In a large national cohort of paediatric HCM patients with an ICD, device and programming strategies varied widely. No particular strategy was associated with inappropriate therapies, missed/delayed therapies, or lead complications.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Henry Chubb
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Lucile Packard Children's Hospital, Stanford University, CA, USA
| | - Ella Field
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | | | | | | | - Jan Till
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Harefield, UK
| | - Piers E F Daubeney
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Harefield, UK
| | | | - Jane Matthews
- University Hospitals Bristol NHS Foundation Trust, UK
| | | | | | | | - Vinay Bhole
- Birmingham Women and Children's NHS Foundation Trust, UK
| | | | | | | | - Orhan Uzun
- University Hospital of Wales, Cardiff, UK
| | - Amos Wong
- University Hospital of Wales, Cardiff, UK
| | - Arthur Yue
- University Hospital Southampton NHS Foundation Trust, UK
| | | | - Tara Bharucha
- University Hospital Southampton NHS Foundation Trust, UK
| | - Norah Yap
- University Hospital Southampton NHS Foundation Trust, UK
| | - Eric Rosenthal
- Evelina London Children's Hospital, Guys and St Thomas', NHS Foundation Trust, UK
| | - Sujeev Mathur
- Evelina London Children's Hospital, Guys and St Thomas', NHS Foundation Trust, UK
| | | | | | - Jasveer Mangat
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
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Mahmood A, Andrews R, Fenton M, Morrison A, Mangat J, Davies B, Burch M, Simmonds J. Permanent pacemaker implantation after pediatric heart transplantation: Risk factors, indications, and outcomes. Clin Transplant 2019; 33:e13503. [DOI: 10.1111/ctr.13503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/18/2019] [Accepted: 01/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Adil Mahmood
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Rachel Andrews
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Alanna Morrison
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Jasveer Mangat
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Ben Davies
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Michael Burch
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Jacob Simmonds
- Great Ormond Street Hospital for Children Foundation Trust London UK
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Mangat J, Morgan J, Benson E, Båth M, Lewis M, Reilly A. A STUDY OF THE IMAGE QUALITY OF COMPUTED TOMOGRAPHY ADAPTIVE STATISTICAL ITERATIVE RECONSTRUCTED BRAIN IMAGES USING SUBJECTIVE AND OBJECTIVE METHODS. Radiat Prot Dosimetry 2016; 169:92-99. [PMID: 27103646 DOI: 10.1093/rpd/ncw084] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Abstract
The recent reintroduction of iterative reconstruction in computed tomography has facilitated the realisation of major dose saving. The aim of this article was to investigate the possibility of achieving further savings at a site with well-established Adaptive Statistical iterative Reconstruction (ASiR™) (GE Healthcare) brain protocols. An adult patient study was conducted with observers making visual grading assessments using image quality criteria, which were compared with the frequency domain metrics, noise power spectrum and modulation transfer function. Subjective image quality equivalency was found in the 40-70% ASiR™ range, leading to the proposal of ranges for the objective metrics defining acceptable image quality. Based on the findings of both the patient-based and objective studies of the ASiR™/tube-current combinations tested, 60%/305 mA was found to fall within all, but one, of these ranges. Therefore, it is recommended that an ASiR™ level of 60%, with a noise index of 12.20, is a viable alternative to the currently used protocol featuring a 40% ASiR™ level and a noise index of 11.20, potentially representing a 16% dose saving.
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Affiliation(s)
- J Mangat
- Cardiac CT Department, Barts Heart Centre, Bartshealth NHS Trust, London, UK
| | - J Morgan
- Radiography Department, School of Health Sciences, City University, London, UK
| | - E Benson
- Medical Engineering and Physics Department, Kings College Hospital, London, UK
| | - M Båth
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Lewis
- Medical Physics Department, Guy's and St. Thomas' Hospital, London, UK
| | - A Reilly
- Department of Radiotherapy Physics, Altnagelvin Hospital, Londonderry, UK
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McMillan MR, Day TG, Bartsota M, Mead-Regan S, Bryant R, Mangat J, Abrams D, Lowe M, Kaski JP. Feasibility and outcomes of ajmaline provocation testing for Brugada syndrome in children in a specialist paediatric inherited cardiovascular diseases centre. Open Heart 2014; 1:e000023. [PMID: 25332787 PMCID: PMC4195922 DOI: 10.1136/openhrt-2013-000023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/08/2014] [Accepted: 01/17/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives Brugada syndrome (BrS) is an inherited arrhythmia syndrome that causes sudden cardiac death in the young. The class Ia antiarrhythmic ajmaline can be used to provoke the diagnostic ECG pattern. Its use has been established in adults, but little data exist on the ajmaline provocation test in children. This study aims to determine the safety and feasibility of ajmaline provocation testing in a large paediatric cohort in a specialist paediatric inherited cardiac diseases centre. Methods 98 consecutive ajmaline tests were performed in 95 children between September 2004 and July 2012 for family history of BrS (n=46 (48%)); family history of unexplained sudden cardiac death (n=39 (41%); symptoms with suspicious ECG abnormalities (n=9 (10%)). Three patients were retested with age, due to the possibility of age-related penetrance. ECG parameters were measured at baseline and during maximal ajmaline effect. Results The mean patient age was 12.55 years, 43% were female. Nineteen patients (20%) had a positive ajmaline test. There were no arrhythmias or adverse events during testing. Ajmaline provoked significant prolongation of the PR, QRS and QTc in all patients. Mean follow-up was 3.62 years with no adverse outcomes reported in any patients with BrS. There were no predictors of a positive ajmaline provocation test on multivariable analysis. One patient who tested negative at 12 years of age, subsequently tested positive at 15 years of age. Conclusions Ajmaline testing appears safe and feasible in children when performed in an appropriate setting by an experienced team. Test positivity may change with age in individuals, suggesting that the test should be repeated in the late teenage years or early adulthood.
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Affiliation(s)
- Merlin Ranald McMillan
- Inherited Cardiovascular Diseases Unit, Department of Cardiology , Great Ormond Street Hospital for Children , London , UK
| | - Thomas George Day
- Inherited Cardiovascular Diseases Unit, Department of Cardiology , Great Ormond Street Hospital for Children , London , UK
| | - Margarita Bartsota
- Inherited Cardiovascular Diseases Unit, Department of Cardiology , Great Ormond Street Hospital for Children , London , UK
| | - Sarah Mead-Regan
- Inherited Cardiovascular Diseases Unit, Department of Cardiology , Great Ormond Street Hospital for Children , London , UK
| | - Rory Bryant
- Inherited Cardiovascular Diseases Unit, Department of Cardiology , Great Ormond Street Hospital for Children , London , UK
| | - Jasveer Mangat
- Inherited Cardiovascular Diseases Unit, Department of Cardiology , Great Ormond Street Hospital for Children , London , UK
| | - Dominic Abrams
- Department of Cardiology , Boston Children's Hospital , Boston, Massachusetts , USA
| | - Martin Lowe
- Inherited Cardiovascular Diseases Unit, Department of Cardiology , Great Ormond Street Hospital for Children , London , UK
| | - Juan Pablo Kaski
- Inherited Cardiovascular Diseases Unit, Department of Cardiology , Great Ormond Street Hospital for Children , London , UK ; Institute of Cardiovascular Science, University College London , London , UK
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Day TG, Bartsota M, Mead-Reagan S, Bryant R, Abrams D, Lowe M, Mangat J, Kaski JP. 077 AJMALINE PROVOCATION TESTING FOR BRUGADA SYNDROME IN CHILDREN: THE GREAT ORMOND STREET EXPERIENCE. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Leelarathna L, English S, Thabit H, Caldwell K, Allen J, Kumareswaran K, Wilinska M, Nodale M, Mangat J, Evans M, Burnstein R, Hovorka R. Continuous glucose monitoring in critically ill adults: comparison of two different calibration protocols. Crit Care 2013. [PMCID: PMC3642847 DOI: 10.1186/cc12397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Day TG, Bartsota M, Mead-Reagan S, Bryant R, Abrams D, Lowe M, Mangat J, Kaski JP. AJMALINE PROVOCATION TESTING FOR BRUGADA SYNDROME IN CHILDREN: THE GREAT ORMOND STREET EXPERIENCE. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60293-4] [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: 10/27/2022]
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Axell R, Lynch C, Chudleigh T, Bradshaw L, Mangat J, White P, Lees C. Clinical implications of machine-probe combinations on obstetric ultrasound measurements used in pregnancy dating. Ultrasound Obstet Gynecol 2012; 40:194-9. [PMID: 22190416 DOI: 10.1002/uog.11081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2011] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To investigate the effect of use of different machine-probe combinations on measurement variability and to assess how this variability impacts on accuracy of pregnancy dating. METHODS Sixteen different ultrasound machine-probe combinations were used for lateral measurement of targets spaced 10 and 40 mm apart and axial measurement of targets spaced 10 and 50 mm apart in an ultrasound phantom, and differences between the measured and true values were determined. The mean of the 40-mm lateral measurements was used to estimate gestational age using standard obstetric dating tables for crown-rump length (CRL) and femur length (FL) and the mean of the 50-mm axial measurements was used to estimate gestational age using the obstetric dating tables for biparietal diameter (BPD). RESULTS As absolute measurements became larger, differences observed using different machine-probe combinations exceeded those due to intraobserver variability. Maximum dating differences for first-trimester CRL of 2 days (based on a measured CRL range of 39-42 mm), second-trimester BPD of 4 days (based on a measured BPD range of 49-52 mm) and FL of 9 days (based on a measured FL range of 39-42 mm) were observed when measurements were transposed to the equivalent gestational age using standard charts. CONCLUSION Differences between measured and true values of biometric measurements reflect both machine-probe and intraobserver variability. Incremental first-trimester CRL growth with time is rapid, but second-trimester FL growth is much less so, leaving this lateral measurement more prone to both observer and machine-probe errors. The only axial growth measurement commonly performed is BPD where the measurement differences were intermediate between those of CRL and FL. The differences that can be ascribed to different equipment combinations are in many cases greater than those expected in clinical practice and are of potential importance in determining how fetal biometry is used for dating pregnancies.
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Affiliation(s)
- R Axell
- Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Abstract
Flecainide is a class IC antiarrhythmic agent, used frequently in all age groups for the treatment of tachyarrhythmias. Flecainide blocks the voltage-gated sodium channel in the myocardium, leading to prolongation of depolarisation resulting in slowed conduction velocity. Within a paediatric population, flecainide is indicated primarily for supraventricular tachycardia resulting from atrioventricular nodal re-entry and accessory pathway mediated re-entry. It can be considered for use in patients with atrial tachycardia, fascicular ventricular tachycardia, benign right ventricular outflow tract tachycardia and paroxysmal atrial fibrillation. It is well documented to cause paradoxical proarryhthmia in children, with evidence that milk can reduce absorption in infants. The authors present the case of an older child whose flecainide levels were persistently subtherapeutic until he reduced his milk intake. At this time he developed symptoms of severe flecainide toxicity associated with increased levels.
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Affiliation(s)
- Ben Thompson
- Institute of Child Health, University of Liverpool/Alder Hey Children's Hospital, Liverpool, Merseyside, UK
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Clark A, Mangat J, King Y, Islam S, Anagnostou K, Foley L, Deighton J, Ewan P. Thermographic imaging during nasal peanut challenge may be useful in the diagnosis of peanut allergy. Allergy 2012; 67:574-6. [PMID: 22309457 DOI: 10.1111/j.1398-9995.2012.02788.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Double-blinded challenges are widely used for diagnosing food allergy but are time-consuming and cause severe reactions. Outcome relies on subjective interpretation of symptoms, which leads to variations in outcome between observers. Facial thermography combined with nasal peanut challenge was evaluated as a novel objective indicator of clinical allergy. METHODS Sixteen children with positive blinded peanut challenge underwent nasal challenge with 10 μg peanut protein or placebo. Mean skin temperatures were recorded from the mouth and nose using infrared thermography over 18 min. RESULTS The area under curve of nasal skin temperature was significantly elevated after peanut vs placebo (18.2 vs 4.8°Cmin). The maximum increase in temperature was also significantly greater after peanut: mean difference +0.9°C. CONCLUSION This feasibility study shows thermography can detect inflammation caused by nasal challenges whilst employing one thousand-fold less peanut than an oral challenge. This novel technique could be developed to provide a rapid, safe and objective clinical allergy test.
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Affiliation(s)
- A. Clark
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - J. Mangat
- Department of Clinical Engineering/Medical Physics; Cambridge University Hospitals; Cambridge; UK
| | - Y. King
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - S. Islam
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - K. Anagnostou
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - L. Foley
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - J. Deighton
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - P. Ewan
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
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Affiliation(s)
| | | | | | - Ying Foo
- Great Ormond Street Hospital; London WC1 3NJH UK
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Abstract
We describe four patients with Barth syndrome who have undergone successful orthotopic heart transplantation. Patients are one, seven, 12.5 and 14.7 yr post-transplantation. One episode of severe infection occurred. Renal dysfunction and coronary allograft vasculopathy do not appear accelerated over non-Barth patients. Despite withholding purine synthesis inhibitors, these patients have not demonstrated an increased rate of rejection.
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Affiliation(s)
- Jasveer Mangat
- Cardiac Transplant, Great Ormond Street Hospital, London, UK
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Rachbauer F, Mangat J, Bodner G, Eichberger P, Krismer M. Heat distribution and heat transport in bone during radiofrequency catheter ablation. Arch Orthop Trauma Surg 2003; 123:86-90. [PMID: 12721686 DOI: 10.1007/s00402-003-0478-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [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: 09/04/2002] [Indexed: 01/08/2023]
Abstract
BACKGROUND To assess the feasibility of percutaneous radiofrequency ablation in large bone tumours, the heat distribution in cortical bone and marrow around inserted electrodes was measured. METHODS Fresh bovine cadaver tibial bones were locally heated through drill holes for a maximum of half an hour using water-cooled single radiofrequency electrodes (Radionics Instruments Inc) by pulsed energy. Temperatures were measured in the marrow canal as well as in cortical bone by thermocouples at various distances from the inserted probes. RESULTS Perpendicular to the probe, hyperthermia of more than 50 degrees C could be created in bone marrow in a sphere of approximately 3 cm, and of approximately 1 cm in cortical bone. CONCLUSION As irreversible cellular damage can be expected when increasing the temperature to 50 degrees C for a duration of 6 min, this method may be effective for the minimal invasive ablation of neoplasms within human bone in cigar-shaped regions of approximately 3-cm diameter.
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Affiliation(s)
- F Rachbauer
- Universitaetsklinik fuer Orthopaedie, Anichstrasse 35, 6020 Innsbruck, Austria.
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