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1.
J Electrocardiol ; 76: 14-16, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36372012

RESUMO

We describe a case of a previously healthy adolescent who presented with junctional tachycardia and complete atrioventricular (AV) block due to Lyme carditis. The simultaneous presence of these findings suggested significant inflammation of the AV junction. Junctional tachycardia, particularly if seen in a patient with conduction abnormalities and potential tick exposure, should increase suspicion for Lyme carditis.


Assuntos
Bloqueio Atrioventricular , Doença de Lyme , Miocardite , Taquicardia Ectópica de Junção , Taquicardia Ventricular , Humanos , Adolescente , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Miocardite/complicações , Miocardite/diagnóstico , Eletrocardiografia , Doença de Lyme/complicações , Doença de Lyme/diagnóstico , Taquicardia Ectópica de Junção/diagnóstico
2.
Am J Emerg Med ; 59: 49-53, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35779288

RESUMO

BACKGROUND: It is traditionally taught that pediatric patients with myocarditis almost always have an abnormal electrocardiogram (ECG) at presentation. However, there has never been a study to objectively evaluate ECG changes in pediatric myocarditis patients compared to healthy controls or explore if specific ECG changes correlate with clinical outcomes. METHODS: Pediatric patients diagnosed with acute myocarditis were age and sex matched 1:2 with healthy controls in this retrospective case-control study spanning a seven-year period. ECGs from presentation through discharge were interpreted by electrophysiologists blinded to the patients' diagnoses. RESULTS: Thirty-nine patients with myocarditis were identified. Twenty-eight (72%) had an abnormal ECG at presentation, 11 (28%) had a completely normal ECG. In this second group, six patients had an abnormal ECG at some point during their hospital course for a total of 34 (88%). Myocarditis patients who had an abnormal ECG at presentation spent more time in the hospital, 5 (2-19) versus 2 ((1-3) days (p < 0.01), and in the ICU, 1 (0-6) versus 0 (0-1) days (p < 0.01). Myocarditis patients were more likely to have ST elevation on their ECG compared to control patients (41% versus 17%, p < 0.01). Patients with ST elevation at presentation had a higher peak troponin level, 18.4 (5.8-31.0) versus 7.7 (0-19.1) ng/ml, (p < 0.01). CONCLUSIONS: Over a quarter of patients with myocarditis had a normal ECG at presentation to the emergency department. Patients with an abnormal ECG at presentation spent more time in the hospital. The presenting ECG, particularly the presence of ST elevation, may correlate with other clinical markers and help direct early management decisions.


Assuntos
Miocardite , Infarto do Miocárdio com Supradesnível do Segmento ST , Arritmias Cardíacas/diagnóstico , Estudos de Casos e Controles , Criança , Eletrocardiografia , Humanos , Miocardite/diagnóstico , Estudos Retrospectivos
3.
J Cardiovasc Electrophysiol ; 30(7): 1036-1041, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30938913

RESUMO

INTRODUCTION: Adenosine challenge (AC) can be used to evaluate possible Wolff-Parkinson-White (WPW) pattern on an electrocardiogram (ECG). Despite the use of this technique, there is a paucity of studies in the pediatric population evaluating the efficacy, safety, and outcomes of this testing modality. METHODS AND RESULTS: All ACs performed from January 2009 to June 2017 were retrospectively reviewed. Patient demographics, adenosine dosing, results, adverse effects, and outcomes including results of electrophysiology studies (EPS) were reviewed. Analysis was conducted between AC positive and negative cohorts. ECG criteria of shortest PR interval, longest QRS duration, and the number of suspected pre-excited leads were evaluated for inter-rater reliability and correlation to positive AC. Fifty-six AC (n = 51) were performed (median age, 13.8; range, 0.3-20 years). Forty-one AC were pre-EPS and 15 post-EPS due to concern for recurrent WPW. Thirty-one (76%) pre-EPS AC were negative, 9 (22%) positive, and 1 (2%) equivocal. EPS was performed following seven positive AC revealing 5 (71%) left posterior and 2 (29%) right posteroseptal AP. The 15 post-EPS AC were all found to be negative. Mean effective adenosine dose was 0.2 ± 0.11 mg/kg. No adverse events were reported. Mean follow up duration after AC was 314 ± 482 days with no documented arrhythmias. CONCLUSION: Adenosine challenge is an effective and safe testing modality for subtle WPW in the pediatric population. In our population, there were no adverse events or documented arrhythmias in patients following a negative study.


Assuntos
Adenosina/administração & dosagem , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Síndrome de Wolff-Parkinson-White/diagnóstico , Potenciais de Ação , Adenosina/efeitos adversos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Síndrome de Wolff-Parkinson-White/fisiopatologia , Adulto Jovem
4.
Pediatr Transplant ; 22(5): e13206, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29744993

RESUMO

Late-onset paroxysmal AVB has been described as a rare complication after HT and has been associated with AR or CAV. We describe 4 pediatric HT recipients who developed paroxysmal AVB hours after routine cardiac catheterization in the absence of AR, CAV, or underlying conduction system disease. Four pediatric HT recipients who were >1 year post-transplant had episodes of paroxysmal AVB hours after surveillance cardiac catheterization with EMB. Telemetry demonstrated high-grade block, ranging from 2:1 AVB to complete AVB without ventricular escape for several seconds. None of the patients had significant AR or rapidly progressive CAV. Supplemental testing did not reveal underlying conduction system disease. Three of the 4 patients received permanent pacemakers, although subsequent interrogations showed minimal ventricular pacing. These pediatric HT recipients had paroxysmal AVB hours after cardiac catheterization in the absence of significant AR, CAV, or underlying conduction system disease. Subsequent pacemaker interrogations showed minimal ventricular pacing, suggesting these were isolated episodes. These cases suggest that mechanisms in addition to AR and CAV may cause paroxysmal AVB in pediatric HT recipients, warranting further investigation.


Assuntos
Bloqueio Atrioventricular/etiologia , Cateterismo Cardíaco/efeitos adversos , Transplante de Coração , Complicações Pós-Operatórias/etiologia , Adolescente , Bloqueio Atrioventricular/diagnóstico , Criança , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Adulto Jovem
5.
Pacing Clin Electrophysiol ; 41(1): 50-56, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29219203

RESUMO

BACKGROUND: Borderline QTc is a common referral to the pediatric cardiology clinic. Evaluation is challenging due to significant overlap of normal and abnormal QTc ranges. We hypothesized that automated QT analysis on Holter could differentiate between patients with long QT syndrome (LQTS) and healthy controls. METHODS: We conducted a retrospective review of 39 patients with known genotype-positive, phenotype-positive LQTS who underwent Holter monitoring between January 2010 and January 2016. They were compared 2:1 to age- and sex-matched controls. Automated QT analysis data were analyzed. RESULTS: Significant differences were found in all automated QT and QTc fields, except minimum QTc interval (P = 0.57). Mean QTc interval (LQTS 479 ± 28 ms vs controls 429 ± 16 ms; P ≤ 0.001) and percent QTc intervals (%QTc) >450 ms (LQTS 80 ± 28% vs controls 14 ± 16%; P ≤ 0.001) were selected for further analysis. A receiver operating characteristic curve was generated for each variable demonstrating high area under the curve values of 0.9494 and 0.9540, respectively. Threshold values of ≥461 ms for mean QTc (sensitivity 79.49%, specificity 98.72%) and ≥65% of %QTc >450 ms (sensitivity 79.49%, specificity 98.72%) allowed highly specific discrimination between cohorts (false positive rate 1.09%). Similarly, thresholds of <434 ms (sensitivity 97.44, specificity 61.54) for mean QTc and <32% (sensitivity 89.74, specificity 87.18) for %QTc >450 ms resulted in highly sensitive discrimination (false negative rates 2.17% and 8.7%). CONCLUSION: Holter monitor testing with automated QT analysis may be a useful tool to differentiate LQTS and control patients.


Assuntos
Eletrocardiografia Ambulatorial , Síndrome do QT Longo/diagnóstico , Estudos de Casos e Controles , Criança , Diagnóstico Diferencial , Feminino , Humanos , Síndrome do QT Longo/fisiopatologia , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade
6.
Pacing Clin Electrophysiol ; 41(1): 35-41, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29222860

RESUMO

BACKGROUND: Successful ablation sites in Wolff-Parkinson-White syndrome (WPW) are characterized by short atrioventricular (AV) intervals. Approximately 15% of patients with WPW have adenosine-sensitive accessory pathways (APs). We sought to determine if local AV intervals of adenosine-sensitive APs are different from those of adenosine-insensitive APs in patients with WPW. METHODS: Patients ≤21 years with WPW and adenosine-sensitive APs who underwent successful ablation over a 9-year period were included. Patients with WPW and adenosine-insensitive APs were matched by age and weight in a 1:2 case-control design. AP location, antegrade and retrograde conduction properties, supraventricular tachycardia (SVT) inducibility, local AV interval, interval from delta wave onset to local ventricular activation (del-V), and time to loss of preexcitation were reviewed. RESULTS: Fourteen patients with adenosine-sensitive APs and 28 with adenosine-insensitive APs were included. Patients with adenosine-sensitive APs had minimum 1:1 antegrade AP conduction at a longer median paced cycle length (380, interquartile range [IQR] 295 to 585 ms vs 290, IQR 250 to 330 ms, P = 0.046), were less likely to have inducible SVT (35.7% vs 75.0%, P = 0.035), and had a longer median local AV interval (40.5, IQR 30.8 to 58.3 ms vs 32.0, IQR 29.3 to 37.8 ms, P = 0.029) when compared to those with adenosine-insensitive APs. CONCLUSION: Patients with WPW and adenosine-sensitive APs have 1:1 antegrade AP conduction at longer cycle lengths, lower likelihood of SVT induction, and longer local AV intervals when compared to those with adenosine-insensitive APs. In patients with WPW, it may be important to consider adenosine response when selecting appropriate ablation targets.


Assuntos
Nó Atrioventricular/fisiopatologia , Nó Atrioventricular/cirurgia , Ablação por Cateter , Síndrome de Wolff-Parkinson-White/fisiopatologia , Síndrome de Wolff-Parkinson-White/cirurgia , Adenosina , Adolescente , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Síndromes de Pré-Excitação/fisiopatologia , Taquicardia Supraventricular/fisiopatologia
7.
Pediatr Cardiol ; 39(3): 637-639, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29435607

RESUMO

We describe a 17-year-old female who presented with 3 weeks of abdominal pain, exercise intolerance, and an episode of altered mental status found to have marked first-degree atrioventricular block. Exercise stress test and cardiac catheterization demonstrated pseudo-pacemaker syndrome, and a permanent pacemaker was placed. Following placement, she has resolution of symptoms and markedly improved exercise tolerance.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/cirurgia , Cateterismo Cardíaco , Marca-Passo Artificial , Adolescente , Eletrocardiografia , Teste de Esforço , Tolerância ao Exercício , Feminino , Humanos , Complicações Pós-Operatórias
8.
Circulation ; 131(20): 1806-18, 2015 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-25908771

RESUMO

BACKGROUND: Acute rheumatic fever remains a serious healthcare concern for the majority of the world's population despite its decline in incidence in Europe and North America. The goal of this statement was to review the historic Jones criteria used to diagnose acute rheumatic fever in the context of the current epidemiology of the disease and to update those criteria to also take into account recent evidence supporting the use of Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute rheumatic fever. METHODS AND RESULTS: To achieve this goal, the American Heart Association's Council on Cardiovascular Disease in the Young and its Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee organized a writing group to comprehensively review and evaluate the impact of population-specific differences in acute rheumatic fever presentation and changes in presentation that can result from the now worldwide availability of nonsteroidal anti-inflammatory drugs. In addition, a methodological assessment of the numerous published studies that support the use of Doppler echocardiography as a means to diagnose cardiac involvement in acute rheumatic fever, even when overt clinical findings are not apparent, was undertaken to determine the evidence basis for defining subclinical carditis and including it as a major criterion of the Jones criteria. This effort has resulted in the first substantial revision to the Jones criteria by the American Heart Association since 1992 and the first application of the Classification of Recommendations and Levels of Evidence categories developed by the American College of Cardiology/American Heart Association to the Jones criteria. CONCLUSIONS: This revision of the Jones criteria now brings them into closer alignment with other international guidelines for the diagnosis of acute rheumatic fever by defining high-risk populations, recognizing variability in clinical presentation in these high-risk populations, and including Doppler echocardiography as a tool to diagnose cardiac involvement.


Assuntos
Ecocardiografia Doppler , Febre Reumática/diagnóstico por imagem , Doença Aguda , American Heart Association , Artrite Reativa/etiologia , Coreia/etiologia , Diagnóstico Diferencial , Saúde Global , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Miocardite/diagnóstico por imagem , Miocardite/epidemiologia , Recidiva , Febre Reumática/diagnóstico , Febre Reumática/epidemiologia , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/epidemiologia , Risco , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Avaliação de Sintomas , Estados Unidos , Populações Vulneráveis
9.
Cardiol Young ; 26(1): 206-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26446852

RESUMO

Ventricular tachycardia is uncommon in children without CHD. We present the case of a 15-year-old boy who presented with severe diabetic ketoacidosis and ventricular tachycardia and was not responsive to traditional anti-arrhythmic therapy. This case highlights the importance of identification of the underlying metabolic derangement causing the arrhythmia to provide appropriate management.


Assuntos
Cetoacidose Diabética/complicações , Taquicardia Ventricular/etiologia , Adolescente , Cardiopatias , Humanos , Masculino
10.
Cardiol Young ; 26(7): 1297-302, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26507259

RESUMO

At present, three-dimensional mapping is often used during cardiac ablations with an explicit goal of decreasing radiation exposure; three-dimensional mapping was introduced in our institution in 2007, but not specifically to decrease fluoroscopy time. We document fluoroscopy use and catheterisation times in this setting. Data were obtained retrospectively from patients who underwent ablation for atrioventricular nodal re-entrant tachycardia from January, 2004 to December, 2011. A total of 93 patients were included in the study. Among them, 18 patients who underwent radiofrequency ablation without three-dimensional mapping were included in Group 1, 13 patients who underwent cryoablation without three-dimensional mapping were included in Group 2, and 62 patients who underwent cryoablation with three-dimensional mapping were included in Group 3. Mean fluoroscopy times differed significantly (34.3, 23.4, and 20.3 minutes, p<0.001) when all the groups were compared. Group 3 had a shorter average fluoroscopy time that did not reach significance when compared directly with Group 2 (p=0.29). An unadjusted linear regression model showed a progressive decrease in fluoroscopy time (p=0.002). Mean total catheterisation times differed significantly (180, 211, and 210 minutes, p=0.02) and were related to increased ablation times inherent to cryoablation techniques. Acute success was achieved in 89, 100, and 97% of patients (p=0.25), and chronic success was achieved in 80, 92, and 93% of patients (p=0.38). Complication rates were similar (17, 23, and 7%, p=0.14). In conclusion, three-dimensional mapping systems decrease fluoroscopy times even without an explicit goal of zero fluoroscopy. Efficacy and safety of the procedure have not changed.


Assuntos
Ablação por Cateter/efeitos adversos , Fluoroscopia/efeitos adversos , Exposição à Radiação/estatística & dados numéricos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Adolescente , Mapeamento Potencial de Superfície Corporal , Criança , Criocirurgia , Feminino , Objetivos , Humanos , Imageamento Tridimensional , Modelos Lineares , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
11.
J Pediatr ; 166(2): 338-42.e1, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25477160

RESUMO

OBJECTIVE: To describe the presentation and clinical course of patients with ventricular ectopy (VE) without known heart disease seen at a single institution. STUDY DESIGN: Patients with VE were identified from the cardiology database. Patients with known hemodynamically significant heart disease or systemic diseases were excluded. RESULTS: A total of 219 patients constitute the study population, with 59% male and median age of diagnosis 11.3 years. A total of 138 patients had follow-up data. Median duration of follow-up was 3.1 years (n = 138, range 0-21 years) for a total of 587 patient-years. Simple VE was found in 83%, and 17% had ventricular tachycardia. Most patients were asymptomatic at presentation (77%) At presentation, echocardiograms were performed in 164 patients, with 98% normal. Of the 36 patients with sequential echocardiograms, 32 (88%) remained normal, 3 (9%) had abnormal echocardiograms which normalized, and 1 (3%) had progressive left ventricular dysfunction. On sequential Holter data (n = 48), 54% showed stable or decreased VE, 40% showed resolution, and 6% showed worsening. No cases of death or resuscitated sudden death occurred. CONCLUSIONS: Most patients were asymptomatic. There were rare cases of progression of VE and development of left ventricular dysfunction but the majority had stable findings. No deaths occurred.


Assuntos
Complexos Ventriculares Prematuros/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Cardiopatias , Humanos , Masculino , Estudos Retrospectivos , Complexos Ventriculares Prematuros/fisiopatologia
13.
Pediatr Cardiol ; 36(3): 625-32, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25381624

RESUMO

The aim of the study is to explore the indications for cardiac catheterization while on extracorporeal membrane oxygenation (ECMO) and the various catheter interventions performed as well as assess the safety profile and determine the short- and intermediate-term survival. ECMO is a lifesaving intervention for pediatric patients with respiratory and/or cardiovascular failure. There is limited recent literature discussing the survival and outcomes of patients undergoing cardiac catheterization while on ECMO. A retrospective review of consecutive patients undergoing catheterization while on ECMO from 2004 to 2013 was performed. Thirty-six patients who underwent 40 cardiac catheterizations were identified. Indications for catheterization included hemodynamic/anatomic assessment of postoperative (16) and non-operative patients (7), planned catheter interventions (CI) (12), and cardiomyopathy assessment (5). CI were performed during 18 (45 %) catheterizations, including stenting of vessels/surgical shunts (9), balloon atrial septostomy (4), device closure of septal defects/vessels (3), thrombolysis of vessels (2), endomyocardial biopsy (2), and temporary pacer wire placement (1). Unexpected diagnostic information was found in 21 (52 %), and 13 patients were referred for surgical intervention. Successful decannulation was achieved in 86 % of patients. Survival to discharge was 72 % and intermediate survival was 69 % (median = 29 months). Survival was 88 % (15/17) among patients who underwent CI. There were six procedural complications (15 %); five vascular and one non-vascular. There were no complications related to patient transport. Cardiac catheterization and interventions while on ECMO are safe, with a survival to discharge of 72 %. Diagnostic information obtained from catheterization leads to management decisions which may impact survival.


Assuntos
Cateterismo Cardíaco/métodos , Oxigenação por Membrana Extracorpórea/métodos , Hemodinâmica , Alta do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Taxa de Sobrevida , Cateterismo Cardíaco/mortalidade , Pré-Escolar , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Resultado do Tratamento
14.
Cardiol Young ; 25(7): 1379-81, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25599662

RESUMO

An 8-year-old girl with supraventricular tachycardia and an implanted vagus nerve stimulator underwent radiofrequency ablation of her supraventricular tachycardia substrate. No known literature exists addressing the potential interaction of these two technologies, although there are reported cases of interaction between radiofrequency and other implanted stimulating devices such as pacemakers. The procedure was performed successfully without observed interaction, and the patient's family reported no significant change in frequency of seizure control.


Assuntos
Ablação por Cateter/métodos , Marca-Passo Artificial/efeitos adversos , Taquicardia Supraventricular/cirurgia , Nervo Vago/fisiopatologia , Criança , Feminino , Humanos
15.
Cardiol Young ; 25(2): 398-9, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24820647

RESUMO

We present a case of a previously healthy adolescent male for outpatient evaluation of prolonged QT interval. He was ultimately found to have acquired QT interval prolongation secondary to hypocalcaemia related to undiagnosed hypoparathyroidism. This case report highlights the importance of routine electrolyte analysis, even in the outpatient setting, during initial diagnostic workup for QT interval prolongation.


Assuntos
Hiperfosfatemia/etiologia , Hipocalcemia/complicações , Hipoparatireoidismo/complicações , Síndrome do QT Longo/etiologia , Adolescente , Humanos , Hiperfosfatemia/sangue , Hiperfosfatemia/diagnóstico , Hipocalcemia/sangue , Hipocalcemia/diagnóstico , Hipoparatireoidismo/sangue , Hipoparatireoidismo/diagnóstico , Síndrome do QT Longo/sangue , Síndrome do QT Longo/diagnóstico , Masculino , Programas de Rastreamento
16.
J Pediatr ; 164(5): 1133-5, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24655535

RESUMO

OBJECTIVES: To use smartphone applications (apps) to measure heart rates during supraventricular tachycardia (SVT) in pediatric patients and compare them with heart rates measured by standard electrocardiogram (ECG). STUDY DESIGN: Patients <18 years of age (n = 26) undergoing an electrophysiology study were enrolled. During the study, heart rates were measured at baseline and during SVT by the use of 2 smartphone apps. The obtained heart rates were compared with a simultaneous standard ECG. Pearson correlation coefficient (r) was used to compare the accuracy of the apps with ECG. RESULTS: At baseline, 33 heart rates were obtained with apps and all were within ±4 beats per minute (bpm) of the ECG heart rate. During SVT, 38 heart rate measurements were attempted during 21 SVT events in 18 patients. App 1 failed to provide a measured heart rate in 11 of 21 attempts. The 10 heart rates obtained had an r of 0.56. When tachycardia rates were <210 bpm, accuracy increased (r = 0.86) and when tachycardia rates were <200 bpm, the accuracy increased further (r = 0.99). App 2 failed to provide a measured heart rate in 12 of 17 attempts. The 5 heart rates obtained had an r of -0.43. CONCLUSIONS: During tachycardia, neither of the 2 apps consistently determined an accurate heart rate at rates >200 bpm. The apps tested should not be considered an accurate tool for assessment of heart rates during SVT in pediatric patients. Select apps may have utility detecting slower SVT or confirming normal heart rates with further validation.


Assuntos
Telefone Celular , Aplicativos Móveis , Taquicardia Supraventricular/diagnóstico , Adolescente , Criança , Pré-Escolar , Eletrocardiografia , Feminino , Humanos , Masculino , Fotopletismografia/métodos , Reprodutibilidade dos Testes
17.
World J Pediatr Congenit Heart Surg ; 15(4): 525-527, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38646725

RESUMO

Persistent junctional reciprocating tachycardia is a rare form of refractory atrioventricular reentrant tachycardia that accounts for <1% of supraventricular tachycardia in pediatrics. The accessory pathways are generally isolated with few reported underlying structural heart defects. We present a case of a five-month-old male with refractory tachyarrhythmia found to have cor triatriatum sinister, which to our knowledge, is the first reported case of these two rare anomalies coexisting.


Assuntos
Coração Triatriado , Humanos , Coração Triatriado/complicações , Coração Triatriado/cirurgia , Masculino , Lactente , Eletrocardiografia , Taquicardia Reciprocante/cirurgia , Taquicardia Reciprocante/complicações , Taquicardia Reciprocante/fisiopatologia , Taquicardia Ectópica de Junção/complicações
18.
Pacing Clin Electrophysiol ; 36(4): 491-6, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23379990

RESUMO

BACKGROUND: Adenosine administration to patients with Wolff-Parkinson-White (WPW) usually increases preexcitation and therefore may be diagnostic for WPW syndrome when the electrocardiogram (ECG) is questionable. We aimed to determine the adenosine response in pediatric patients with WPW pattern on ECG and whether blocked accessory pathway (AP) conduction with adenosine correlated with nonrapid AP conduction measured by invasive electrophysiology study (EPS). METHODS: All patients with WPW ≤ 18 years of age who underwent EPS over a 5-year period were identified. The adenosine response during atrial pacing was characterized as blocked or continued AP conduction. Invasive data were obtained during atrial pacing and atrial fibrillation. Conduction through the AP to a cycle length ≤ 250 ms was considered rapid; otherwise patients were nonrapid. The sensitivity, specificity, and positive (PPV) and negative predictive value were calculated for blocked AP conduction to identify nonrapid baseline AP conduction during EPS. RESULTS: There were 59 patients included and nine (15%) had blocked AP conduction with adenosine. Five of these nine had WPW syndrome and four had fasciculoventricular APs. All nine patients had nonrapid conduction on baseline EPS. Blocked AP conduction with adenosine as a marker of nonrapid baseline AP conduction had a specificity of 100%, a PPV of 100%. CONCLUSIONS: In these pediatric patients with WPW pattern on ECG, a significant minority blocked AP conduction with adenosine and this finding had 100% specificity and PPV for nonrapid baseline antegrade AP conduction. The finding of blocked AP conduction with adenosine may aid in risk stratification.


Assuntos
Adenosina , Síndrome de Wolff-Parkinson-White/diagnóstico , Adolescente , Criança , Eletrocardiografia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Síndrome de Wolff-Parkinson-White/fisiopatologia , Adulto Jovem
19.
Pacing Clin Electrophysiol ; 35(4): e87-90, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21401653

RESUMO

This report describes a fetus presenting with intrauterine tachycardia and hydrops fetalis. Soon after birth the neonate was noted to be in torsades de pointes that responded dramatically to medical management. Long QT syndrome (LQTS) was diagnosed on electrocardiogram obtained soon after birth. The prognosis is poor when LQTS presents in utero or during the first week of life. However, our infant did well with medical management and has remained free of arrhythmias at follow-up.


Assuntos
Doenças Fetais/diagnóstico , Feto/fisiopatologia , Síndrome do QT Longo/diagnóstico , Antagonistas Adrenérgicos beta/uso terapêutico , Antiarrítmicos/uso terapêutico , Canal de Potássio ERG1 , Eletrocardiografia , Canais de Potássio Éter-A-Go-Go/genética , Feminino , Doenças Fetais/tratamento farmacológico , Doenças Fetais/genética , Doenças Fetais/fisiopatologia , Humanos , Hidropisia Fetal/diagnóstico , Hidropisia Fetal/fisiopatologia , Recém-Nascido , Isoproterenol/uso terapêutico , Lidocaína/uso terapêutico , Síndrome do QT Longo/tratamento farmacológico , Síndrome do QT Longo/genética , Síndrome do QT Longo/fisiopatologia , Masculino , Torsades de Pointes/diagnóstico , Torsades de Pointes/tratamento farmacológico , Torsades de Pointes/genética , Torsades de Pointes/fisiopatologia , Resultado do Tratamento
20.
Pacing Clin Electrophysiol ; 35(12): 1451-7, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22978820

RESUMO

BACKGROUND: In Wolff-Parkinson-White (WPW) syndrome, rapid antegrade conduction of atrial tachyarrhythmias can result in ventricular fibrillation and sudden death. Antegrade conduction can be assessed through noninvasive testing or invasive electrophysiology study (EPS). We aimed to determine the correlation between noninvasive testing and EPS in a pediatric WPW population. METHODS: All WPW patients <21 years who underwent EPS over a 10-year period were identified. Noninvasive testing reviewed included electrocardiogram, Holter, and exercise stress test (EST). Patients were classified as low-risk if preexcitation was lost during any test. EPS data reviewed included antegrade conduction during atrial pacing and atrial fibrillation. Conduction through the accessory pathway (AP) to a cycle length ≤ 250 ms was considered rapid, otherwise patients were nonrapid. Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) of noninvasive testing to correctly identify nonrapid conduction was calculated. RESULTS: There were 135 EPS. Twenty-four patients (18%) were classified low-risk noninvasively. Two of the 24 (8%) had rapid conduction at baseline EPS. The sensitivity, specificity, PPV, and NPV of low-risk noninvasive testing to predict nonrapid conduction was 22%, 94%, 92%, and 31%, respectively. Sixteen of the 24 had low-risk EST and none had rapid conduction at baseline EPS. The specificity and PPV of low-risk EST were 100%. CONCLUSION: Loss of preexcitation during noninvasive testing had high specificity and PPV for nonrapid antegrade conduction during baseline EPS. Abrupt loss of preexcitation during EST was a highly reliable noninvasive marker of nonrapid AP conduction at baseline in our pediatric WPW patients.


Assuntos
Eletrocardiografia/métodos , Teste de Esforço , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologia , Adolescente , Distribuição de Qui-Quadrado , Criança , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Medição de Risco , Sensibilidade e Especificidade , Adulto Jovem
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