Heart rate variability and atria function in children at late follow-up evaluation after atrioventricular node slow-pathway radiofrequency ablation.

This study was designed to assess the changes in the conductive system, autonomic dysfunction, and global and regional function of the atria and ventricles in children late after slow-pathway radiofrequency ablation (RFA). The study enrolled 22 children, who has successfully undergone RFA 2 to 5 years previously (RFA group) and 20 healthy children (control group). Electrophysiologic study was performed for the RFA group. Holter monitoring and echocardiography were performed for all the children. At a late follow-up assessment, the RFA children were free of paroxysms, whereas 8 of the 22 children (36%) reported transient palpitations. Both mean and maximal heart rates (HR) were significantly increased, whereas indices of HR variability (% of successive normal sinus RR intervals exceeding 50 ms [pNN50], root mean square of the successive normal sinus RR interval difference [rMSSD], high-frequency component [HFC]) were significantly decreased in the RFA group compared with preablation and control data. Left atrial (LA) and right atrial (RA) volumes were significantly higher, and atria deformation indices were significantly lower in the RFA group. Correlations were found between the mean HR and the volumes of LA (r = 0.477; p < 0.001) and RA (r = 0.512; p < 0.001). A negative correlation between the maximal LA volume and the longitudinal strain rate (SR) during relaxation (r = -0.476; p = 0.03) and a positive correlation between the minimal LA volume and both longitudinal SR (r = 0.361; p = 0.03) and strain (ε) (r = 0.375; p = 0.024) during contraction were shown. These data suggest a possible link between atrial dysfunction and the hyperadrenergic state after RFA.

Changes in electrophysiologic properties of the conductive system of the heart in children with atrioventricular nodal reentrant tachycardia after 2-8 years following radiofrequency catheter ablation of the slow pathway.

UNLABELLED: Radiofrequency ablation of the slow pathway is an effective method of treatment in children with atrioventricular nodal reentrant tachycardia. The aim of our study was to evaluate anterograde conduction properties in children before and after radiofrequency ablation of the slow pathway and to determine the efficacy and safety of this method. MATERIAL AND METHODS: Noninvasive transesophageal electrophysiological examination was performed in 30 patients at the follow-up period (mean duration, 3.24 years) after radiofrequency ablation of the slow pathway. RESULTS: The slow pathway function was observed in 13 patients one day after ablation, in 26 patients during the follow-up period, and in 28 patients after administration of atropine sulfate. Atrioventricular node conduction was significantly decreased the following day after ablation and at the follow-up versus the preablation (165.2 [30.2] bmp and 146.3 [28.5] bpm versus 190.9 [31.4] bpm; P<0.001). The atrioventricular node effective refractory period prolonged significantly the following day after ablation and at the follow-up versus the preablation (319.3 [55.3] ms and 351.0 [82.1] ms versus 248.3 [36.6] ms; P<0.001). Effective refractory period of the fast pathway prolonged significantly as compared with the preablation (from 408.0 [60.4] ms to 481.2 [132.9] ms; P=0.005). The prolongation of effective refractory period of the slow pathway was more significant than effective refractory period of the fast pathway at the follow-up (P<0.001). Two late recurrences occurred; one patient had atrial tachycardia. CONCLUSION: Children with atrioventricular nodal reentrant tachycardia can be effectively and safety cured by ablative therapy. The end-point during slow pathway ablation should be the abolition of tachycardia with preservation of dual atrioventricular nodal physiology.

Idiopathic ventricular tachycardia in children: curative therapy with radiofrequency ablation.

UNLABELLED: Idiopathic ventricular tachycardia is a rare condition, and there is a lack of clear guidelines for the necessity and indications for prophylactic antiarrhythmic or curative treatment. The aim of this study was to review the clinical picture of idiopathic ventricular tachycardia and evaluate the efficacy and safety of radiofrequency ablation therapy in children. MATERIAL AND METHODS: The subjects of this study were 16 children with idiopathic ventricular tachycardia. The mean age at onset of idiopathic ventricular tachycardia was 12 years. All patients underwent electrophysiological examination. Nonfluoroscopic mapping technology (Carto) was used in one case. Radiofrequency ablation was performed in all children (mean duration of follow-up was 46 months). RESULTS: Six children with idiopathic ventricular tachycardia were free of symptoms. Palpitation was the only complain in four patients, and six patients presented with symptoms of circulatory disorder (the tendency of the higher rate of ventricular tachycardia and more premature contractions and episodes of ventricular tachycardia in one day were noticed in five of them). All children after radiofrequency ablation were alive, and only one complication (complete right bundle branch block) occurred. Success at last follow-up included five children with left and six with right idiopathic ventricular tachycardia. CONCLUSIONS: Catheter ablation seems a promising therapeutic option with the outlook possible of the idiopathic ventricular tachycardia in children. It is safe enough and should be considered as the therapy of choice even in children without of symptoms if they wish to live active social and physical life.

[Heart fibroma: an unusual cause of ventricular tachycardia in a child]. / Sirdies fibroma--reta vaiko skilvelines tachikardijos priezastis.

Ventricular tachycardia with underlying structural heart disease is a potential dangerous pathology in children. In most cases, ventricular tachycardia occurs after ventricular surgery for congenital anomalies. Ventricular tachycardia associated with primary heart tumors is extremely rare. A 4-year-boy presented with primary heart tumor, fibroma, manifesting as ventricular tachycardia. Manifestation of the disease was ventricular tachycardia. The complete resection of the tumor was performed successfully. The diagnosis was confirmed histologically.

[Changes in morphometric parameters and function of left ventricle in child and adolescent athletes]. / Sportuojanciu vaiku ir paaugliu sirdies morfometriniu parametru pokyciai ir kairiojo skilvelio funkcija.

UNLABELLED: The aim of the study was to assess the impact of physical load on left ventricular morphometric parameters and function in child and adolescent athletes. MATERIAL AND METHODS: A total of 143 trained athletes aged 7-17 years and 54 healthy nonathletic children and adolescents aged 8-17 years were involved in this study. The participants were divided into four groups according to the duration of physical activity (training hours per week). Two-dimensional, M-mode, and Doppler echocardiography were used to evaluate cardiac dimensions and function. Absolute parameters and parameters corrected for body surface area were calculated. Left ventricular fractional shortening was calculated as an index of systolic function, and E/A ratio was calculated for evaluation of left ventricular diastolic function. RESULTS: In 69.9% of athletes, septal and posterior wall thickness, end-diastolic diameter, left ventricular mass, and mass index were statistically significantly higher than in controls. There were no differences in left ventricular end-diastolic diameter and posterior wall thickness corrected for body surface area as well as diastolic E/A ratio between the groups. The fractional shortening in athletes was significantly higher (P<0.01). Interventricular septum thickness, end-diastolic diameter, and left ventricular mass were significantly higher in athletes whose training exceeded 8 hours per week compared to the controls. Left ventricular fractional shortening was significantly higher in athletes training more than 10 hours per week than in controls. Diastolic function index--E/A ratio--did not differ between the groups. CONCLUSION: Our study demonstrated that echocardiographic parameters of child and adolescent athletes statistically significantly exceeded the parameters of untrained controls. These parameters were dependent on the anthropometric data and physical activity (the duration of training expressed in hours per week).

[Height, weight and body mass index of preterm very low birth weight infants at the preschool age]. / Neisnesiotu labai mazo gimimo svorio vaiku ugis, svoris ir kuno mases indeksas sulaukus ikimokyklinio amziaus.

UNLABELLED: THE AIM of this study was to reveal trends in height, weight, and body mass index of preterm very low birth weight children from birth up to 5 years of age. MATERIAL AND METHODS: The present study is based on cross-sectional growth study carried out in the Clinic of Neonatology of Kaunas University of Medicine. Total sample consisted of 735 children from birth up to 5 years of age: 379 preterm children with very low birth weight; and 356 term children with normal (appropriate for gestation age) birth weight. Height, weight, body mass index were measured. In order to verify if normal birth weight group corresponds to Lithuanian standards, the data of normal birth weight group children were compared with Lithuanian standard measures. Then data of very low birth weight group and normal birth weight group were compared. RESULTS: We found that height and weight of very low birth weight girls and boys were significantly lower than height and weight of term normal birth weight infant from birth up to 5 years of age (p<0.01). The body mass index of very low birth weight girls was significantly lower than that of term normal birth weight girls at birth (p<0.01) and at age of 4 years (p<0.05). The body mass index of very low birth weight boys was significantly lower than that of term normal birth weight boys at birth and from age of 2 up to the age of 5 years (p<0.01). These data show that very low birth weight boys differently from girls were more slender than term normal birth weight infant of the same age. CONCLUSIONS: It has been shown that preterm very low birth weight infants have different patterns of growth than term normal birth weight infants. The very low birth weight infants have not caught up on their retardation at the age of 5 years.

[Juvenile idiopathic systemic arthritis]. / Sisteminis jaunatvinis idiopatinis artritas.

UNLABELLED: THE PURPOSE OF THE STUDY was to evaluate the peculiarities of the clinical features, laboratory parameters and tactics of treatment in juvenile idiopatic systematic arthritis. METHODS: A retrospective data review of 41 children (26 boys and 15 girls) who underwent treatment for systemic arthritis (according to ILAR criteria) in our institution between 1992 and 2002 was performed. RESULTS: The disease started with fever of unknown origin in all cases. In 73% of patients it lasted longer than one month, in 54% fever was with twice daily spikers in the morning and in the evening. The rash during the rise of temperature appeared in 49%, in most cases (70%) there was a maculo-papular rash. Lymphadenopathy and serositis were observed in 32%, hepatomegaly in 29%, and splenomegaly in 24%. Arthritis coincided with the fever in 29% of patients, in majority of cases it was progressing to a severe persistent arthritis after the systematic phase. There was no specific laboratory findings: neutrophilic leucocytosis was found in 73%, anemia - in 80.5%, trombocytosis - in 36.6%, elevated CRP - in 63.4%, dysproteinemia - in 79% of patients. Antinuclear factors were absent in all examined children. For all patients intravenous methylprednisolone pulses have been administered (10-22 mg/kg/infusion). Prednisolone was also continued orally (1-2 mg/kg/day). 24.4% of patients required in addition immunosupressive agents such as methotrexate, azathioprine and cyclophosphamide. CONCLUSION: Puls-therapy of methylprednisolone is a safe and sufficiently effective method of treatment in most cases of the systematic juvenile arthritis.

[Henoch-Schönlein purpura - one of the most common types of systemic vasculitis in childhood]. / Henoch-Schönlein purpura - dazniausias vaiku sisteminis vaskulitas.

UNLABELLED: The aim of our study was to estimate etiology, most common clinical findings, the course and peculiarities of treatment in children to whom Henoch-Schönlein purpura was diagnosed during 1996-2002 at Clinic of Children's Diseases of Kaunas University of Medicine Hospital. METHODS: The Henoch-Schönlein purpura diagnosis was based on the association of non-trombocytopenic purpura, arthritis and abdominal pain in 45 children, mostly at preschool age. Routine laboratory blood tests usually were normal. Serum level of imunoglobulin A (Ig A), complement 3, 4 (C(3), C(4)), antineutrophil cytoplasm antibodies were measured for some patients. Urinary analyses were performed for all patients in order to assess nephritis. RESULTS: In 1/3 (33.3%) of children Henoch-Schönlein purpura was preceded by an upper respiratory tract infection. The most common clinical signs were: non-trombocytopenic purpura -100%, subcutaneous edema - 53%, arthritis of large joints - 64%, gastrointestinal symptoms (pain, diarrhea with bleeding) - 37.5%. The incidence of renal involvement was 13.3%, but usually not at the onset of the disease. Relapses were often, and they had tendency to repeat in 1-2 week periods. Late relapses were absent. Treatment of Henoch-Schönlein purpura was symptomic. Nonsteroidal anti-inflammatory drugs which are helpful in joint pain, were prescribed for 33.3% patients. Steroids which reduce abdominal pain, melena, massive hemorrhage, nephritic symptoms, were given for 28.8% patients. CONCLUSIONS: Non-trombocytopenic purpura, arthritis and colic abdominal pain, classic triad of Henoch-Schönlein purpura that occurs in early stage of the disease, were most common. Renal involvement had tendency occur later. Nonsteroidal anti-inflammatory drugs were prescribed for patients with arthritis; prednisone reduced gastrointestinal, nephritic symptoms. Relapses were often.