Congenital EP Featured Articles of February 2017

Utility and Safety of Combined Interventional Catheterization and Electrophysiology Procedures in a Children’s Hospital.

Asaki SY, Orcutt JW, Miyake CY, Justino H, DE LA Uz CM, Kim JJ, Valdes SO, Qureshi AM.

Pacing Clin Electrophysiol. 2017 Feb 13. doi: 10.1111/pace.13047. [Epub ahead of print]

PMID: 28191656

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Take Home Points:

  • Patients with congenital heart disease often require both structural and electrophysiological interventions as part of their clinical management
  • Combining the two types of interventions into one procedure may be beneficial, but potentially challenging due to limitations in physician availability and the perception of increased procedural risk
  • Such combined procedures, as demonstrated in the present study, may be performed at high volume centers effectively and without elevated risk

 

J MooreCommentary from Dr. Jeremy Moore (Los Angeles), section editor of Pediatric Cardiac EP Journal Watch:  Patients with congenital heart disease are frequently exposed to both structural and electrophysiological procedures as a result of residual surgical lesions, collateral vessel formation, and either congenital or acquired rhythm abnormalities. These procedures are usually performed separately, which at least in theory, could have negative consequences in terms of repeated anesthetic exposures, exhaustion of patient and physician resources, and increases in health care costs (as compared to a single combined procedure). Investigators from Texas Children’s Hospital reported their experience with combining these two types of interventions into a single procedure over a study period from 2001 through 2014.

 

In total, the investigators identified 61 pediatric and adult patients that underwent a planned combination of structural and electrophysiologic intervention during this period. The most important subgroups included 1) ACHD (26%), 2) single ventricle (34%), and 3) heterotaxy patients (19%). Overall, structural interventions were successful in all but 2 cases and electrophysiological interventions were successful in all but 1 case. There were 3 adverse events (~5%), but none of these were felt to be secondary to the combined nature of the procedure and there were no prolonged hospital admissions as a result of this approach. Details of the procedures are shown in the table below.

EP media 1

 

Overall, the authors concluded that a combined approach could be attained in large volume centers without increased risk. There was a presumed benefit in terms of the single hospital encounter, lower overall anesthetic exposure, and potential reduction in health care costs. The major limitations of the study were the significant heterogeneity of the study population and the lack of a control arm. Future study to address these limitations was recommended.

 

Appearance of QRS fragmentation late after Mustard/Senning repair is associated with adverse outcome.

Helsen F, Vandenberk B, De Meester P, Van De Bruaene A, Gabriels C, Troost E, Gewillig M, Meyns B, Willems R, Budts W; FH and BV contributed equally to this study..

Heart. 2017 Feb 9. pii: heartjnl-2016-310512. doi: 10.1136/heartjnl-2016-310512. [Epub ahead of print]

PMID: 28183791

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Take Home Points:

  • Patients with D-TGA after the atrial switch operation are at elevated risk for heart failure and cardiovascular mortality
  • Robust risk stratification models in this population are limited
  • The appearance of a fractionated QRS complex is independently associated with the composite end-point of cardiovascular mortality, heart transplantation, or the need for ventricular assist device support for D-TGA patients after the atrial switch operation

 

Commentary from Dr. Jeremy Moore (Los Angeles), section editor of Pediatric Cardiac EP Journal Watch: The Mustard/Senning operations for physiologic repair of D-TGA was the primary surgical approach spanning a 20-year period from the early 1960’s through the mid 1980’s. Such patients are known to be at increased risk for heart failure and sudden cardiac death. Since existing risk stratification models are limited, these investigators from Belgium sought to evaluate the contribution of a novel non-invasive marker for the composite end-point of cardiovascular mortality, heart transplantation, or the need for ventricular assist device support.

 

From a cohort of 133 patients, all 12 lead ECGs were assessed for new-onset QRS fragmentation, which was defined as a previously normal ECG followed by an ECG with a fragmented QRS complex in the same patient, occurring in at least 2 contiguous right precordial, inferior, or left lateral leads (see examples below).

 

EP media 2

During the follow up period of nearly 17 years, approximately one-third of patients developed a fragmented QRS complex, most commonly in the inferior leads (suggesting myocardial involvement in the territory of the right coronary). Overall, 10% of patients experienced the composite outcome of cardiovascular mortality, heart transplantation, or the need for ventricular assist device support. In the multivariate analysis, both fractionated QRS and severe RV dysfunction independently predicted this composite outcome (HR 18.4, p=0.022 and HR 16.7, p=0.007; respectively).

 

The authors concluded that this electrocardiographic finding can be easily implemented and could be useful for clinical decision-making for the D-TGA population after the atrial switch operation.

 

CHD EP Feb 2017 

  1. Acute Cardiac MRI Assessment of Radiofrequency Ablation Lesions for Pediatric Ventricular Arrhythmia: Feasibility and Clinical Correlation.

Grant EK, Berul CI, Cross RR, Moak JP, Hamann KS, Sumihara K, Cronin I, O’Brien KJ, Ratnayaka K, Hansen MS, Kellman P, Olivieri LJ.

J Cardiovasc Electrophysiol. 2017 Feb 28. doi: 10.1111/jce.13197. [Epub ahead of print]

PMID: 28245348

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  1. Tilt table testing to diagnose pseudosyncope in the pediatric population.

Robinson JA, Shivapour JK, Snyder CS.

Congenit Heart Dis. 2017 Feb 27. doi: 10.1111/chd.12458. [Epub ahead of print]

PMID: 28240408

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  1. Avoiding sports-related sudden cardiac death in children with congenital channelopathy : Recommendations for sports activities.

Lang CN, Steinfurt J, Odening KE.

Herz. 2017 Feb 23. doi: 10.1007/s00059-017-4549-2. [Epub ahead of print]

PMID: 28233036

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  1. A Mutation in the G-Protein Gene GNB2 Causes Familial Sinus Node and Atrioventricular Conduction Dysfunction.

Stallmeyer B, Kuß J, Kotthoff S, Zumhagen S, Vowinkel KS, Rinne S, Matschke LA, Friedrich C, Schulze-Bahr E, Rust S, Seebohm G, Decher N, Schulze-Bahr E.

Circ Res. 2017 Feb 20. pii: CIRCRESAHA.116.310112. doi: 10.1161/CIRCRESAHA.116.310112. [Epub ahead of print]

PMID: 28219978

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  1. Outcomes of lead extraction in young adults.

El-Chami MF, Sayegh MN, Patel A, El-Khalil J, Desai Y, Leon AR, Merchant FM.

Heart Rhythm. 2017 Feb 14. pii: S1547-5271(17)30080-2. doi: 10.1016/j.hrthm.2017.01.030. [Epub ahead of print]

PMID: 28189822

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  1. Utility and Safety of Combined Interventional Catheterization and Electrophysiology Procedures in a Children’s Hospital.

Asaki SY, Orcutt JW, Miyake CY, Justino H, DE LA Uz CM, Kim JJ, Valdes SO, Qureshi AM.

Pacing Clin Electrophysiol. 2017 Feb 13. doi: 10.1111/pace.13047. [Epub ahead of print]

PMID: 28191656

Similar articles

Select item 28190295

 

  1. Appearance of QRS fragmentation late after Mustard/Senning repair is associated with adverse outcome.

Helsen F, Vandenberk B, De Meester P, Van De Bruaene A, Gabriels C, Troost E, Gewillig M, Meyns B, Willems R, Budts W; FH and BV contributed equally to this study..

Heart. 2017 Feb 9. pii: heartjnl-2016-310512. doi: 10.1136/heartjnl-2016-310512. [Epub ahead of print]

PMID: 28183791

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Select item 28181926

 

  1. Autonomic Nervous System Function After a Skin-to-Skin Contact Intervention in Infants With Congenital Heart Disease.

Harrison TM, Brown R.

J Cardiovasc Nurs. 2017 Feb 9. doi: 10.1097/JCN.0000000000000397. [Epub ahead of print]

PMID: 28181926

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  1. Application of pediatric appropriate use criteria for initial outpatient evaluation of syncope.

Phelps HM, Kelleman MS, McCracken CE, Benavidez OJ, Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Stern KW, Welch E, Sachdeva R.

Echocardiography. 2017 Feb 8. doi: 10.1111/echo.13475. [Epub ahead of print]

PMID: 28177138

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  1. Measures of and changes in heart rate variability in pediatric heart transplant recipients.

Williams T, Tang X, Gilmore G, Gossett J, Knecht KR.

Pediatr Transplant. 2017 Feb 8. doi: 10.1111/petr.12894. [Epub ahead of print]

PMID: 28181355

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  1. Increased risk of thromboembolic events in adult congenital heart disease patients with atrial tachyarrhythmias.

Masuda K, Ishizu T, Niwa K, Takechi F, Tateno S, Horigome H, Aonuma K.

Int J Cardiol. 2017 Feb 5. pii: S0167-5273(17)30680-0. doi: 10.1016/j.ijcard.2017.02.004. [Epub ahead of print]

PMID: 28209388

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  1. A congenital diverticulum of the left ventricular apex manifested by stroke and recurrent ventricular tachycardia.

Dostálová G, Paleček T, Kuchynka P, Havránek Š, Mašek M, Hlubocká Z, Karetová D, Wichterle D, Dušková J, Lindner J, Linhart A.

Cardiovasc Pathol. 2017 Feb 4;28:3-6. doi: 10.1016/j.carpath.2017.01.009. [Epub ahead of print]

PMID: 28219755

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  1. Evaluation of Prolonged QT interval: Structural Heart Disease Mimicking Long QT Syndrome.

Weissler-Snir A, Gollob MH, Chauhan V, Care M, Spears DA.

Pacing Clin Electrophysiol. 2017 Feb 3. doi: 10.1111/pace.13040. [Epub ahead of print]

PMID: 28155223

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  1. Hemodynamic effects of sustained postoperative cardiac resynchronization therapy in infants after repair of congenital heart disease: Results of a randomized clinical trial.

Friedberg MK, Schwartz SM, Zhang H, Chiu-Man C, Manlhiot C, Ilina MV, Arsdell GV, Kirsh JA, McCrindle BW, Stephenson EA.

Heart Rhythm. 2017 Feb;14(2):240-247. doi: 10.1016/j.hrthm.2016.09.025.

PMID: 27687644

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  1. Interventricular dyssynchrony in a patient with a biventricular physiology and a systemic right ventricle.

Miyazaki A, Sakaguchi H, Noritake K, Hayama Y, Negishi J, Kagisaki K, Yasuda K, Ichikawa H, Ohuchi H.

Heart Vessels. 2017 Feb;32(2):234-239. doi: 10.1007/s00380-016-0876-0.

PMID: 27385023

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  1. Biventricular Paced QRS Area Predicts Acute Hemodynamic CRT Response Better Than QRS Duration or QRS Amplitudes.

DE Pooter J, El Haddad M, DE Buyzere M, Aranda HA, Cornelussen R, Stegemann B, Rinaldi CA, Sterlinski M, Sokal A, Francis DP, Jordaens L, Stroobandt RX, VAN Heuverswyn F, Timmermans F.

J Cardiovasc Electrophysiol. 2017 Feb;28(2):192-200. doi: 10.1111/jce.13132.

PMID: 27885752

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  1. Acute Management of Refractory and Unstable Pediatric Supraventricular Tachycardia.

Lewis J, Arora G, Tudorascu DL, Hickey RW, Saladino RA, Manole MD.

J Pediatr. 2017 Feb;181:177-182.e2. doi: 10.1016/j.jpeds.2016.10.051.

PMID: 27912926

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  1. Implantation of VVI pacemaker in a patient with dextrocardia, persistent left superior vena cava, and sick sinus syndrome: A case report.

Guo G, Yang L, Wu J, Sun L.

Medicine (Baltimore). 2017 Feb;96(5):e6028. doi: 10.1097/MD.0000000000006028.

PMID: 28151908 Free PMC Article

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  1. The Role of Conventional and Right-Sided ECG Screening for Subcutaneous ICD in a Tetralogy of Fallot Population.

Alonso P, Osca J, Cano O, Pimenta P, Andrés A, Yagüe J, Millet J, Rueda J, Sancho-Tello MJ.

Pacing Clin Electrophysiol. 2017 Feb;40(2):145-153. doi: 10.1111/pace.13017.

PMID: 28070890

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  1. Selective use of the electrocardiogram in pediatric preparticipation athletic examinations among pediatric primary care providers.

Clark BC, Hayman JM, Berul CI, Burns KM, Kaltman JR.

Ann Noninvasive Electrocardiol. 2017 Feb 21. doi: 10.1111/anec.12446. [Epub ahead of print]

PMID: 28220574

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  1. A Mutation in the G-Protein Gene GNB2 Causes Familial Sinus Node and Atrioventricular Conduction Dysfunction.

Stallmeyer B, Kuß J, Kotthoff S, Zumhagen S, Vowinkel KS, Rinne S, Matschke LA, Friedrich C, Schulze-Bahr E, Rust S, Seebohm G, Decher N, Schulze-Bahr E.

Circ Res. 2017 Feb 20. pii: CIRCRESAHA.116.310112. doi: 10.1161/CIRCRESAHA.116.310112. [Epub ahead of print]

PMID: 28219978

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  1. High School Cardiac Emergency Response Plans and Sudden Cardiac Death in the Young.

White MJ, Loccoh EC, Goble MM, Yu S, Odetola FO, Russell MW.

Prehosp Disaster Med. 2017 Feb 20:1-4. doi: 10.1017/S1049023X17000048. [Epub ahead of print]

PMID: 28215188

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  1. Successful use of sirolimus for refractory atrial ectopic tachycardia in a child with cardiac rhabdomyoma.

Ninic S, Kalaba M, Jovicic B, Vukomanovic V, Prijic S, Vucetic B, Kravljanac R, Vujic A, Kosutic J.

Ann Noninvasive Electrocardiol. 2017 Feb 19. doi: 10.1111/anec.12435. [Epub ahead of print]

PMID: 28217909

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  1. Mid-Term Follow-up of School-Aged Children With Borderline Long QT Interval.

Miyazaki A, Sakaguchi H, Matsumura Y, Hayama Y, Noritake K, Negishi J, Tsuda E, Miyamoto Y, Aiba T, Shimizu W, Kusano K, Shiraishi I, Ohuchi H.

Circ J. 2017 Feb 18. doi: 10.1253/circj.CJ-16-0991. [Epub ahead of print]

PMID: 28216547 Free Article

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  1. Radiofrequency catheter ablation of left-sided accessory pathways in children using a new fluoroscopy integrated 3D-mapping system.

Drago F, Grifoni G, Remoli R, Russo MS, Righi D, Pazzano V, Palmieri R, Placidi S, Saputo FA, Silvetti MS.

Europace. 2017 Feb 15. doi: 10.1093/europace/euw220. [Epub ahead of print] No abstract available.

PMID: 28201731

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  1. Commentary: Clinical Phenotype of HCN4-related Sick Sinus Syndrome.

Raucci FJ Jr, Shoemaker MB, Knollmann BC.

Heart Rhythm. 2017 Feb 14. pii: S1547-5271(17)30164-9. doi: 10.1016/j.hrthm.2017.02.006. [Epub ahead of print] No abstract available.

PMID: 28213054

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  1. Pilot Study Analyzing Automated ECG Screening of Hypertrophic Cardiomyopathy.

Campbell M, Zhou X, Han C, Abrishami H, Webster G, Miyake CY, Sower CT, Anderson JB, Knilans TK, Czosek RJ.

Heart Rhythm. 2017 Feb 10. pii: S1547-5271(17)30169-8. doi: 10.1016/j.hrthm.2017.02.011. [Epub ahead of print]

PMID: 28193509

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  1. Prenatal exposure to snus alters heart rate variability in the infant.

Nordenstam F, Lundell B, Cohen G, Tessma MK, Raaschou P, Wickström R.

Nicotine Tob Res. 2017 Feb 10. doi: 10.1093/ntr/ntx035. [Epub ahead of print] No abstract available.

PMID: 28186551

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  1. Lateral Atrial Tunnel Fontan Operation Predisposes to the Junctional Rhythm.

Januszewska K, Schuh A, Lehner A, Dalla-Pozza R, Malec E.

Pediatr Cardiol. 2017 Feb 10. doi: 10.1007/s00246-017-1571-3. [Epub ahead of print]

PMID: 28184977

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  1. Incidence of Idiopathic Ventricular Arrhythmias: A Population-Based Study.

Sirichand S, Killu AM, Padmanabhan D, Hodge DO, Chamberlain AM, Brady PA, Kapa S, Noseworthy PA, Packer DL, Munger TM, Gersh BJ, McLeod CJ, Shen WK, Cha YM, Asirvatham SJ, Friedman PA, Mulpuru SK.

Circ Arrhythm Electrophysiol. 2017 Feb;10(2). pii: e004662. doi: 10.1161/CIRCEP.116.004662.

PMID: 28183845

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  1. Prominent QTc prolongation in a patient with a rare variant in the cardiac ryanodine receptor gene.

Taniguchi Y, Miyazaki A, Sakaguchi H, Hayama Y, Ebishima N, Negishi J, Noritake K, Miyamoto Y, Shimizu W, Aiba T, Ohuchi H.

Heart Vessels. 2017 Feb;32(2):229-233. doi: 10.1007/s00380-016-0869-z.

PMID: 27401738

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  1. Prevalence and Risk Factors of Prolonged Corrected QT Interval Among Children and Adolescents Treated With Antipsychotic Medications: A Long-Term Follow-Up in a Real-World Population.

Palanca-Maresca I, Ruiz-Antorán B, Centeno-Soto GA, Forti-Buratti MA, Siles A, Usano A, Avendaño-Solá C.

J Clin Psychopharmacol. 2017 Feb;37(1):78-83. doi: 10.1097/JCP.0000000000000639.

PMID: 27930499

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  1. Junctional ectopic tachycardia in late period after early postoperative complete atrioventricular block: Messenger of return to normal sinus rhythm? : Explanation with four case series.

Ozyilmaz I, Ergul Y, Ozyilmaz S, Guzeltas A.

J Electrocardiol. 2017 Feb 1. pii: S0022-0736(17)30018-3. doi: 10.1016/j.jelectrocard.2017.01.015. [Epub ahead of print]

PMID: 28189280

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  1. Characterizing cardiac arrest in children undergoing cardiac surgery: A single-center study.

Gupta P, Wilcox A, Noel TR, Gossett JM, Rockett SR, Eble BK, Rettiganti M.

J Thorac Cardiovasc Surg. 2017 Feb;153(2):450-458.e1. doi: 10.1016/j.jtcvs.2016.10.013.

PMID: 27866783

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  1. Key Role of Pacing Site as Determinant Factor of Exercise Testing Performance in Pediatric Patients with Chronic Ventricular Pacing.

Cabrera Ortega M, Duamy HT, Benítez Ramos DB.

Pediatr Cardiol. 2017 Feb;38(2):368-374. doi: 10.1007/s00246-016-1523-3.

PMID: 27913834

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  1. Predictors of Pharmacological Therapy of Ectopic Atrial Tachycardia in Children.

Ge H, Li X, Liu H, Jiang H.

Pediatr Cardiol. 2017 Feb;38(2):289-295. doi: 10.1007/s00246-016-1511-7.

PMID: 27882422

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  1. Rate Control by Transoesophageal Atrial Overdrive Pacing for Refractory Supraventricular Tachycardia with Severe Ventricular Dysfunction: A Bridge to Recovery.

Paech C, Janousek J, Wagner F, Gebauer RA.

Pediatr Cardiol. 2017 Feb;38(2):228-233. doi: 10.1007/s00246-016-1503-7.

PMID: 27837305

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