Pulmonary haemorrhage in neonates: Systematic review of management.

AIM: Pulmonary haemorrhage (PH) is an acute catastrophic event with low incidence yet high mortality among neonates. We aimed to systematically review the management of PH. METHODS: A search was carried out of the PubMed, EMBASE and Cochrane databases according to the PRISMA guidelines. Data were extracted on study design and size, patient demographics, primary and adjunctive treatment methods, and treatment outcomes. RESULTS: Sixteen studies with 385 newborn infants were included and were significantly heterogeneous regarding treatment methods. Primary treatments included surfactant, high-frequency oscillatory ventilation (HFOV), epinephrine, coagulopathy management, intermittent positive pressure ventilation, cocaine and tolazoline. Adjunctive treatment methods included blood products, HFOV, increased positive end-expiratory pressure, vitamin K, surfactant, adrenaline, vasopressors and inotropes. All five studies using surfactant as primary treatment were effective in improving oxygenation index measures and preventing recurrence of PH, and three studies found no association between surfactant and death or long-term disability. Ventilatory support, epinephrine, management of coagulopathy and tolazoline were all found to be effective primary treatments for PH. CONCLUSION: There are several effective methods of managing PH in neonates. Further understanding of the aetiology of PH and ongoing research will allow future prevention and improvements in management of PH.

Indications of Cardiac Resynchronization in Non-Left Bundle Branch Block: Clinical Review of Available Evidence.

Cardiac resynchronization therapy (CRT) benefits have been firmly established in patients with heart failure and reduced left ventricular ejection fraction (HFrEF), who remain in New York Heart Association (NYHA) functional classes II and III, despite optimal medical therapy, and have a wide QRS complex. An important and consistent finding in published systematic reviews and in subgroup analyses is that the benefits of CRT are maximum for patients with a broader QRS durations, typically described as QRS duration > 150 ms, and for patients with a typical left bundle branch block (LBBB) QRS morphology. It remains uncertain whether patients with non-LBBB QRS complex morphology clearly benefit from CRT or only modestly respond.

Ventricular Tachycardia Storm After Standard Radiofrequency Pulmonary Vein Isolation.

BACKGROUND The occurrence of ventricular arrhythmias (VAs), particularly premature ventricular complexes, following pulmonary vein isolation (PVI) is a documented phenomenon, but monomorphic scar-related ventricular tachycardia (VT) following PVI is an unusual phenomenon. In this case report, we present a case of new-onset VA after radiofrequency PVI in a patient with no prior history of sustained VTs. CASE REPORT Our patient was a 69-year-old man with a history of symptomatic persistent atrial fibrillation, with an apparently structurally normal heart with subtle regional wall motion abnormalities. He underwent radiofrequency directed pulmonary vein isolation ablation. On the night of an uneventful procedure, the patient for the first time experienced a sustained ventricular tachycardia that exacerbated into a VT storm. Each arrhythmia was terminated by cardioversion due to hemodynamic instability. Antiarrhythmic treatment with lidocaine was initiated immediately. The patient settled from sustained ventricular arrhythmia and received further ablation to monomorphic ventricular tachycardia. CONCLUSIONS The incidence of ventricular ectopics after PVI ablation has been previously described, but a sustained monomorphic ventricular storm has not been reported before with RF ablation. We attribute the pathophysiology to an increase in myocardial excitability and/or ventricular autonomic modulation. This is a very rare phenomenon, but any subtle imaging abnormality before planning RF-PVI should be taken into consideration.