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1.
J Am Heart Assoc ; 6(5)2017 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-28515113

RESUMEN

BACKGROUND: Based on data from studies of atrial fibrillation ablations, optimal parameters for the TactiCath (TC; St. Jude Medical, Inc) force-sensing ablation catheter are a contact force of 20 g and a force-time integral of 400 g·s for the creation of transmural lesions. We aimed to evaluate TC in pediatric and congenital heart disease patients undergoing ablation. METHODS AND RESULTS: Comprehensive chart and case reviews were performed from June 2015 to March 2016. Of the 102 patients undergoing electrophysiology study plus ablation, 58 (57%) underwent ablation initially with a force-sensing catheter. Patients had an average age of 14 (2.4-23) years and weight of 58 (18-195) kg with 15 patients having abnormal cardiac anatomy. Electrophysiology diagnoses for the +TC group included 30 accessory pathway-mediated tachycardia, 24 atrioventricular nodal reentrant tachycardia, and 7 other. Baseline generator settings included a power of 20 W, temperature of 40°, and 6 cc/min flow during lesion creation with 11 patients (19%) having alterations to parameters. Seventeen patients (30%) converted to an alternate ablation source. A total of 516 lesions were performed using the TC with a median contact force of 6 g, force-time integral of 149 g·s, and lesion size index of 3.3. Median-term follow-up demonstrated 5 (10%) recurrences with no acute or median-term complications. CONCLUSIONS: TactiCath can be effectively employed in the treatment of pediatric patients with congenital heart disease with lower forces than previously described in the atrial fibrillation literature. Patients with atrioventricular nodal reentrant tachycardia or atrioventricular reciprocating tachycardia may not require transmural lesions and the TC may provide surrogate markers for success during slow pathway ablation.


Asunto(s)
Arritmias Cardíacas/cirugía , Catéteres Cardíacos , Ablación por Catéter/instrumentación , Cardiopatías Congénitas/complicaciones , Transductores de Presión , Adolescente , Factores de Edad , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , Ablación por Catéter/efectos adversos , Niño , Preescolar , Técnicas Electrofisiológicas Cardíacas , Diseño de Equipo , Femenino , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/fisiopatología , Humanos , Masculino , Presión , Recurrencia , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
2.
Can J Cardiol ; 30(10): e1-e63, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25262867
3.
Circ Arrhythm Electrophysiol ; 7(4): 658-63, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24987047

RESUMEN

BACKGROUND: Pediatric patients with persistent arrhythmias may require mechanical cardiopulmonary support. We sought to classify the population, spectrum, and success of current treatment strategies. METHODS AND RESULTS: A multicenter retrospective chart review was undertaken at 11 sites. Inclusion criteria were (1) patients <21 years, (2) initiation of mechanical support for a primary diagnosis of arrhythmias, and (3) actively treated on mechanical support. A total of 39 patients were identified with a median age of 5.5 months and median weight of 6 kg. A total of 69% of patients were cannulated for supraventricular tachycardia with a median rate of 230 beats per minute. A total of 90% of patients were supported with extracorporeal membrane oxygenation for an average of 5 days. The remaining 10% were supported with ventricular assist devices for an average of 38 (20-60) days. A total of 95% of patients were treated with antiarrhythmics, with 43% requiring >1 antiarrhythmic. Amiodarone was the most frequently used medication alone or in combination. A total of 33% patients underwent electrophysiology study/transcatheter ablation. Radiofrequency ablation was successful in 9 patients on full flow extracorporeal membrane oxygenation with 3 radiofrequency-failures/conversion to cryoablation. One patient underwent primary cryoablation. A total of 15% of complications were related to electrophysiology study/ablation. At follow-up, 23 patients were alive, 8 expired, and 8 transplanted. CONCLUSIONS: Younger patients were more likely to require support in the presented population. Most patients were treated with antiarrhythmics and one third required electrophysiology study/ablation. Radiofrequency ablation is feasible without altering extracorporeal membrane oxygenation flows. There was a low frequency of acute adverse events in patients undergoing electrophysiology study/ablation, while on extracorporeal membrane oxygenation.


Asunto(s)
Antiarrítmicos/uso terapéutico , Arritmias Cardíacas/terapia , Ablación por Catéter , Criocirugía , Oxigenación por Membrana Extracorpórea , Corazón Auxiliar , Choque Cardiogénico/terapia , Factores de Edad , Antiarrítmicos/efectos adversos , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/fisiopatología , Canadá , Ablación por Catéter/efectos adversos , Ablación por Catéter/mortalidad , Criocirugía/efectos adversos , Criocirugía/mortalidad , Técnicas Electrofisiológicas Cardíacas , Oxigenación por Membrana Extracorpórea/efectos adversos , Oxigenación por Membrana Extracorpórea/mortalidad , Corazón Auxiliar/efectos adversos , Humanos , Lactante , Estudios Retrospectivos , Factores de Riesgo , Choque Cardiogénico/etiología , Choque Cardiogénico/mortalidad , Choque Cardiogénico/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos
4.
Heart Rhythm ; 11(10): e102-65, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24814377
5.
Congenit Heart Dis ; 4(5): 356-61, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19740190

RESUMEN

OBJECTIVE: We studied, as a physiological benchmark, acute effects of right ventricular (RV) apical, RV outflow, and left ventricular (LV) pacing in children with normal cardiac function on LV and RV function and ventricular-ventricular interactions. DESIGN: The design of the study was a prospective, acute intervention. SETTING: The study was conducted in a tertiary care electrophysiology laboratory. Population and Methods. Seven children (mean +/- SD, 12 +/- 4 years) were paced after accessory pathway ablation, at baseline (AOO), and with atrioventricular pacing (DOO) from the RV apex, RV outflow, and left ventricle. OUTCOME MEASURES: Right ventricular dP/dT(max) and RV dP/dT(neg) (high-fidelity transducer-tipped catheters, Millar Instruments, Houston, TX, USA), cardiac index (Fick), blood pressure, and QRS duration were measured at each pacing condition. Intra- and interventricular mechanical dyssynchrony, systolic- and diastolic peak tissue velocities, and isovolumic acceleration were recorded by tissue Doppler imaging at the lateral mitral, septal, and tricuspid annuli at each condition. Results at each pacing condition were compared by repeated-measures analysis of variance. Results. Pacing prolonged QRS duration, causing electrical dyssynchrony (86 +/- 19 ms [baseline], 141 +/- 44 ms [RV apex], 121 +/- 18 ms [RV outflow], and 136 +/- 34 ms [LV], P < .01). Right ventricular outflow pacing caused LV intraventricular delay (63 +/- 52 vs. 12 +/- 7 ms, P < .05). Right ventricular apical pacing caused interventricular delay (61 +/- 29 vs. 25 +/- 18 ms, P < .05). There were no significant changes in blood pressure, cardiac index, RV dp/dT(max), RV dP/dT(neg), regional tissue velocities, or isovolumic acceleration during any of the pacing conditions, indicating preserved ventricular function and hemodynamics. No important ventricular-ventricular interactions were seen. CONCLUSIONS: In children with normal cardiac anatomy and function, single-site RV apical, RV outflow, and LV pacing induce electromechanical dyssynchrony without significantly changing ventricular function or hemodynamics, or adversely affecting ventricular-ventricular interactions.


Asunto(s)
Estimulación Cardíaca Artificial/métodos , Hemodinámica , Taquicardia Supraventricular/fisiopatología , Función Ventricular Izquierda , Función Ventricular Derecha , Adolescente , Presión Sanguínea , Ablación por Catéter , Niño , Criocirugía , Ecocardiografía Doppler de Pulso , Técnicas Electrofisiológicas Cardíacas , Femenino , Humanos , Masculino , Contracción Miocárdica , Estudios Prospectivos , Taquicardia Supraventricular/diagnóstico por imagen , Taquicardia Supraventricular/cirugía
7.
Anesth Analg ; 106(1): 79-83, table of contents, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-18165557

RESUMEN

BACKGROUND: Dexmedetomidine (DEX) is an alpha2-adrenergic agonist that is approved by the Food and Drug Administration for short-term (<24 h) sedation in adults. It is not approved for use in children. Nevertheless, the use of DEX for sedation and anesthesia in infants and children appears to be increasing. There are some concerns regarding the hemodynamic effects of the drug, including bradycardia, hypertension, and hypotension. No data regarding the effects of DEX on the cardiac conduction system are available. We therefore aimed to characterize the effects of DEX on cardiac conduction in pediatric patients. METHODS: Twelve children between the ages of 5 and 17 yr undergoing electrophysiology study and ablation of supraventricular accessory pathways had hemodynamic and cardiac electrophysiologic variables measured before and during administration of DEX (1 microg/kg IV over 10 min followed by a 10-min continuous infusion of 0.7 microg x kg(-1) x h(-1)). RESULTS: Heart rate decreased while arterial blood pressure increased significantly after DEX administration. Sinus node function was significantly affected, as evidenced by an increase in sinus cycle length and sinus node recovery time. Atrioventricular nodal function was also depressed, as evidenced by Wenckeback cycle length prolongation and prolongation of PR interval. CONCLUSION: DEX significantly depressed sinus and atrioventricular nodal function in pediatric patients. Heart rate decreased and arterial blood pressure increased during administration of DEX. The use of DEX may not be desirable during electrophysiology study and may be associated with adverse effects in patients at risk for bradycardia or atrioventricular nodal block.


Asunto(s)
Agonistas alfa-Adrenérgicos/efectos adversos , Dexmedetomidina/efectos adversos , Electrocardiografía , Técnicas Electrofisiológicas Cardíacas , Sistema de Conducción Cardíaco/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Hipnóticos y Sedantes/efectos adversos , Taquicardia Supraventricular/fisiopatología , Adolescente , Agonistas alfa-Adrenérgicos/administración & dosificación , Nodo Atrioventricular/efectos de los fármacos , Nodo Atrioventricular/fisiopatología , Nodo Atrioventricular/cirugía , Presión Sanguínea/efectos de los fármacos , Ablación por Catéter , Niño , Dexmedetomidina/administración & dosificación , Femenino , Sistema de Conducción Cardíaco/fisiopatología , Sistema de Conducción Cardíaco/cirugía , Humanos , Hipnóticos y Sedantes/administración & dosificación , Infusiones Intravenosas , Masculino , Mecánica Respiratoria/efectos de los fármacos , Nodo Sinoatrial/efectos de los fármacos , Nodo Sinoatrial/fisiopatología , Nodo Sinoatrial/cirugía , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/cirugía , Resultado del Tratamiento
8.
J Cardiovasc Electrophysiol ; 18(6): 592-7, 2007 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17472717

RESUMEN

INTRODUCTION: This is a multicenter retrospective study evaluating the immediate- and mid-term outcomes of cryoablation of accessory pathways in the coronary sinus in children or in patients with congenital heart disease. METHODS AND RESULTS: Twenty-one patients (median age 13.0 years, range 2-40) from six institutions were included. The accessory pathways were concealed in 11 and manifest in 10. Of 12 patients who had coronary sinus angiography, two had large coronary sinus diverticula, one had a dilated coronary sinus due to a left superior vena cava to coronary sinus, and one had a "pouch" at the mouth of the coronary sinus. Six patients underwent ablation procedures with cryoablation alone, while in the remaining 15 patients, both cryoablation and radiofrequency ablation were utilized. The ablation procedure included left-sided endocardial mapping via a retrograde or transseptal approach in 13 (62%). Procedural success was achieved with cryoablation in the coronary sinus in 15/21 (71%). Four patients (19%) had successful radiofrequency ablation at the right or left posterior septum. Two patients (10%) had unsuccessful procedures. Of the 15 patients with initially successful cryoablation procedures, six (40%) had arrhythmia recurrences at a median of 17 days (range 1-120). Recurrences could not be explained by differences in patient or procedural variables. CONCLUSION: Cryoablation in the coronary venous system in young patients is feasible but associated with a high arrhythmia recurrence rate. Cryoablation techniques and/or equipment need to be improved in order to safely create more permanent lesions in this arrhythmia substrate.


Asunto(s)
Anomalías de los Vasos Coronarios/cirugía , Criocirugía/métodos , Sistema de Conducción Cardíaco/cirugía , Adolescente , Adulto , Niño , Preescolar , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico , Técnicas Electrofisiológicas Cardíacas/métodos , Estudios de Seguimiento , Humanos , Estudios Retrospectivos , Taquicardia/diagnóstico , Taquicardia/etiología , Resultado del Tratamiento
9.
J Cardiovasc Electrophysiol ; 17(6): 638-44, 2006 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-16836714

RESUMEN

INTRODUCTION: Dual atrioventricular (AV) nodal physiology, defined as an AH jump > or =50 msec with a 10 msec decrease in A1A2, is the substrate for atrioventricular nodal reentrant tachycardia (AVNRT) and yet it is present in a minority of pediatric patients with AVNRT. Our objective was to characterize dual AV nodal physiology as it pertains to a pediatric population. METHODS/RESULTS: We retrospectively reviewed invasive electrophysiology studies in 92 patients with AVNRT (age12.1 +/- 3.7 yrs) and in 46 controls without AVNRT (age 13.3 +/- 3.7 yrs). Diagnoses in controls: syncope (N = 31), palpitations (N = 6), atrial flutter (N = 3), history of atrial tachycardia with no inducible arrhythmia (N = 3), and ventricular tachycardia (N = 3). General anesthesia was used in 49% of AVNRT and 52% of controls, P = 0.86. There were no differences in PR, AH, HV, or AV block cycle length. With A1A2 atrial stimulation, AVNRT patients had a significantly longer maximum AH achieved (324 +/- 104 msec vs 255 +/- 67 msec, P = 0.001), and a shorter AVNERP (276 +/- 49 msec vs 313 +/- 68 msec P = 0.0005). An AH jump > or =50 msec was found in 42% of AVNRT versus 30% of controls (P = 0.2). Using a ROC graph we found that an AH jump of any size is a poor predictor of AVNRT. With atrial overdrive pacing, PR > or = RR was seen more commonly in AVNRT versus controls, (55/91(60%) vs 6/46 (13%) P = 0.000). CONCLUSIONS: Neither the common definition of dual AV nodes or redefining an AH jump as some value <50 msec are reliable methods to define dual AV nodes or to predict AVNRT in pediatric patients. PR > or = RR is a relatively good predictor of AVNRT.


Asunto(s)
Nodo Atrioventricular/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Adolescente , Niño , Técnicas Electrofisiológicas Cardíacas , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Factores de Tiempo
10.
Heart Rhythm ; 3(5): 557-63, 2006 May.
Artículo en Inglés | MEDLINE | ID: mdl-16648061

RESUMEN

BACKGROUND: Cryoablation for treatment of atrioventricular nodal reentrant tachycardia (AVNRT) is safe and efficacious. Information on the effects of cryoablation on atrioventricular (AV) nodal conduction is limited. OBJECTIVES: The purpose of this study was to evaluate the effects of cryoablation on AV nodal conduction in pediatric patients with AVNRT. METHODS: We retrospectively analyzed electrophysiologic studies before and after successful cryoablation. Patients were divided into two groups: group 1 (n = 22, age 14 +/- 3 years) had baseline discontinuous atrial-to-His interval (AH) conduction curves; and group 2 (n = 13, age 12 +/- 4 years, P = .054) had continuous curves. RESULTS: At baseline, group 1 had longer measurements of maximal AH with A1A2, AV nodal effective refractory period, and AV block cycle length. Postcryoablation, both group 1 and group 2 showed decreases in maximal AH with A1A2 pacing or atrial overdrive pacing and in the finding of PR > or = RR with atrial overdrive pacing (group 1: 55% vs 5%, P < .001; group 2: 69% vs 0%, P < .001). A significant increase in overall AV effective refractory period and a decrease in AV block cycle length were found in group 1 but not group 2. Fifty percent of group 1 patients had complete abolition of slow pathway conduction. CONCLUSION: Successful cryoablation for treatment of AVNRT is associated with a reduction in PR > or = RR and with decreases in maximal AH with A1A2 pacing or atrial overdrive pacing. Further study is needed to determine the usefulness of these parameters for assessment of ablation efficacy or as proxies for AVNRT inducibility.


Asunto(s)
Criocirugía , Técnicas Electrofisiológicas Cardíacas , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Adolescente , Función Atrial , Fascículo Atrioventricular/fisiopatología , Fascículo Atrioventricular/cirugía , Niño , Femenino , Estudios de Seguimiento , Bloqueo Cardíaco/fisiopatología , Bloqueo Cardíaco/cirugía , Humanos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
11.
Heart Rhythm ; 3(5): 564-70, 2006 May.
Artículo en Inglés | MEDLINE | ID: mdl-16648062

RESUMEN

BACKGROUND: Initial reports have shown cryoablation to be safe and efficacious for treatment of atrioventricular nodal reentrant tachycardia (AVNRT). No direct comparisons of cryoablation vs radiofrequency (RF) catheter ablation in pediatric patients have been made. OBJECTIVES: The purpose of this study was to compare the outcomes of cryothermal vs RF catheter ablation for treatment of AVNRT in pediatric patients. METHODS: We retrospectively reviewed consecutive ablation procedures for treatment of AVNRT at a single arrhythmia center. The RF group consisted of patients who underwent RF ablation from 2002 until cryothermy became available. The cryoablation group consisted of patients who underwent cryothermal ablation from 2004 to 2005. The groups were compared for procedural and electrophysiologic outcomes. RESULTS: RF (n = 60, age 14 +/- 4 years) and cryoablation (n = 57, age 14 +/- 4 years) groups had similar demographic and baseline parameters. Procedural times were shorter in the RF group (RF ablation 112 +/- 31 minutes vs cryoablation 148 +/- 46 minutes, P < .001). Fluoroscopy times were comparable (RF ablation 21 +/- 15 minutes vs cryoablation 20 +/- 13 minutes, P = .77). In an intention-to-treat analysis, success of the procedure was 100% for RF ablation and 95% for cryoablation (P = .11). No permanent AV block occurred in either group. Recurrence rates were higher for the cryoablation group, but this did not reach statistical significance (RF ablation 2% vs cryoablation 8%, P = .19). CONCLUSION: Cryoablation appears to be similar to RF for ablation of AVNRT with respect to short-term efficacy and safety of the procedure in a pediatric population. Recurrence rates are higher with cryoablation.


Asunto(s)
Ablación por Catéter , Criocirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Adolescente , Ablación por Catéter/efectos adversos , Niño , Criocirugía/efectos adversos , Criocirugía/instrumentación , Técnicas Electrofisiológicas Cardíacas , Femenino , Bloqueo Cardíaco/etiología , Humanos , Masculino , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
12.
Heart Rhythm ; 3(1): 95-101, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16399063

RESUMEN

Adult and pediatric interventional electrophysiology practices have been diverging for the past 10 years, and so we review current pediatric ablation practice. Radiofrequency ablation (RFA) is safe and efficacious as documented by recent prospective, multi-center pediatric studies. Computer assisted mapping systems used for complex arrhythmias in adult patients have been successfully deployed in selected pediatric substrates. With increased computational power, decreased catheter size, and increased maneuverability, we expect increased use in the pediatric population. Finally, cryoablation has demonstrated efficacy and safety in locations traditionally associated with increased risk when using RFA, particularly around the AV node. As larger, multi-institutional studies are undertaken, the benefits of this technology in pediatric patients will be better defined.


Asunto(s)
Ablación por Catéter , Adolescente , Niño , Criocirugía , Técnicas Electrofisiológicas Cardíacas , Humanos , Seguridad , Taquicardia/cirugía
13.
J Cardiovasc Electrophysiol ; 15(7): 759-70, 2004 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-15250858

RESUMEN

INTRODUCTION: A multicenter prospective study was designed and implemented to assess the short- and longer-term results and risks associated with radiofrequency (RF) ablation in children. METHODS AND RESULTS: Patients recruited for the study were aged 0 to 16 years with supraventricular tachycardia due to accessory pathways or AV nodal reentrant tachycardia (AVNRT), excluding patients with nontrivial congenital heart disease. A national registry also was established, and contributing centers were encouraged to enroll all pediatric patients, aged 0 to 21 years, undergoing ablation at their center. This report summarizes acute results of these procedures. For analysis, subjects were divided into three groups: the prospective cohort (n = 481), cohort-eligible registry participants (n = 504), and not cohort eligible registry participants (n = 1,776). Prospectively enrolled cohort patients were similar to cohort-eligible patients in terms of demographic and other patient characteristics. Overall success rates for RF ablation were high (95.7%), with higher success rates for left-sided and particularly left free-wall pathways (97.8%) than right free-wall pathways (90.8%). Complications of both electrophysiologic study and RF ablation were infrequent (4.2% and 4.0%, respectively), and there were no deaths. AV block was uncommon overall (1.2%) and was limited to ablation in AVNRT (2.1%) and septal accessory pathways (3.0%). CONCLUSION: Despite the multicenter and prospective design, the study demonstrates high success rates and low complication rates, which are comparable to prior single-center retrospective studies. These results may serve as the current best benchmark for expected results in the pediatric population, aged 0 to 16 years, both in terms of acute success rates and the occurrence of complications.


Asunto(s)
Ablación por Catéter , Evaluación de Resultado en la Atención de Salud , Taquicardia Supraventricular/cirugía , Adolescente , Niño , Ecocardiografía , Electrocardiografía Ambulatoria , Técnicas Electrofisiológicas Cardíacas , Femenino , Humanos , Masculino , Complicaciones Posoperatorias , Estudios Prospectivos , Sistema de Registros , Taquicardia Supraventricular/fisiopatología
14.
Am J Cardiol ; 93(5): 643-6, 2004 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-14996601

RESUMEN

To compare usefulness of a ventricular extrastimulus (VES) from the right ventricular (RV) apex versus the RV septum in patients with a septal accessory pathway (AP), VES was applied from the RV apex and the summit of the RV septum in patients with septal APs. A VES from the RV apex and from the summit was diagnostic of the presence of an AP in 13 of 28 patients (83%) and in 10 of 12 patients, respectively (46% p <0.05), and VES proved an AP as a part of the tachycardia circuit in 5 of 28 patients (18%) and 6 of 12 patients, respectively (50%, p <0.05). A VES during His bundle refractoriness from the RV summit increases the diagnostic yield for both the presence of an AP and its participation in the tachycardia circuit with respect to RV apical VES.


Asunto(s)
Estimulación Eléctrica/métodos , Técnicas Electrofisiológicas Cardíacas/métodos , Tabiques Cardíacos/fisiopatología , Ventrículos Cardíacos/fisiopatología , Transducción de Señal/fisiología , Taquicardia Supraventricular/fisiopatología , Adolescente , Adulto , Anciano , Fascículo Atrioventricular/fisiopatología , Niño , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Taquicardia Supraventricular/terapia
15.
Pediatrics ; 111(3): e245-7, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12612279

RESUMEN

OBJECTIVE: To determine the approach that pediatric electrophysiologists use as they evaluate asymptomatic patients with Wolff-Parkinson-White (WPW) syndrome regarding electrophysiologic testing and radio frequency ablation. METHODS: A 21-question survey was mailed to 66 pediatric electrophysiologists who had voluntarily submitted patient data at any time to the Pediatric Radio Frequency Ablation Registry since its inception in 1990. The survey addressed issues regarding physician experience with electrophysiologic testing and radio frequency ablation, risk assessment, electrophysiology study, and factors that influence the decision to perform radio frequency ablation in asymptomatic patients. RESULTS: Returned surveys (43 of 66 [65%]) were analyzed blindly. The 43 physicians who responded were experienced, with 37 reporting >5 years of performing radio frequency ablation and 30 having performed >200 radio frequency ablation procedures. Thirty-six of the 43 electrophysiologists used invasive electrophysiologic study for risk stratification in asymptomatic patients with WPW. Electrophysiologic findings guided selection of patients for radio frequency ablation procedures. Expected radio frequency ablation outcome quotes to the family were consistent with recently published data from the Electrophysiology Society regarding current-era experience with radio frequency ablation. CONCLUSION: The majority of responding electrophysiologists use invasive electrophysiologic study both to stratify risk for asymptomatic WPW and to select appropriate patients for radio frequency ablation. This current practice should be communicated to other pediatric cardiologists and pediatricians.


Asunto(s)
Ablación por Catéter/estadística & datos numéricos , Electrofisiología , Selección de Paciente , Pediatría , Síndrome de Wolff-Parkinson-White/cirugía , Adolescente , Actitud del Personal de Salud , Niño , Preescolar , Comunicación , Comorbilidad , Muerte Súbita Cardíaca/prevención & control , Técnicas Electrofisiológicas Cardíacas , Paro Cardíaco/prevención & control , Humanos , Lactante , Relaciones Profesional-Familia , Medición de Riesgo , Encuestas y Cuestionarios , Resultado del Tratamiento , Síndrome de Wolff-Parkinson-White/diagnóstico
16.
Cardiol Young ; 12(3): 248-52, 2002 May.
Artículo en Inglés | MEDLINE | ID: mdl-12365171

RESUMEN

In adults with Wolff-Parkinson-White syndrome, the likelihood of sudden death can be estimated based upon the presence or absence of symptoms. Comparable data in children do not exist. To date, therefore, invasive risk stratification has been used to guide management regarding radiofrequency ablation in symptomatic children. As the safety of electrophysiology study and radiofrequency ablation in children has improved, asymptomatic patients have been referred more commonly for invasive risk stratification. We sought to compare the findings from electrophysiologic studies in symptomatic children with Wolff-Parkinson-White syndrome to the findings in asymptomatic children with Wolff-Parkinson-White pattern on their electrocardiogram. Thus, we compared the findings from electrophysiologic studies carried out in patients seen at Stanford University and University of California, San Francisco, from April 1999 to February 2001 with a preexcitation pattern on their electrocardiogram. The patients were divided into three groups: 23 asymptomatic patients studied for risk stratification, 19 patients who presented with syncope, and 77 patients presenting with documented supraventricular tachycardia. Data were collected for commonly accepted invasive criterions for stratification of risk: an effective refractory period of the accessory pathway less than 270 ms, multiple pathways, septal location of pathway, and inducibility of supraventricular tachycardia. Groups were compared by chi-square. No differences were found between the groups for any of the variables. These data suggest that risk factors for sudden death, developed in studies of adult patients, are not clearly applicable to children. Further studies are needed better to define the indications for study and ablation in children.


Asunto(s)
Muerte Súbita Cardíaca/etiología , Técnicas Electrofisiológicas Cardíacas , Medición de Riesgo , Síndrome de Wolff-Parkinson-White/complicaciones , Síndrome de Wolff-Parkinson-White/fisiopatología , Adolescente , Adulto , Ablación por Catéter , Niño , Preescolar , Electrocardiografía , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Síndrome de Wolff-Parkinson-White/cirugía
17.
J Cardiovasc Electrophysiol ; 13(8): 735-9, 2002 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12212688

RESUMEN

INTRODUCTION: We hypothesized that in humans there is an epicardial fat pad from which parasympathetic ganglia supply the AV node. We also hypothesized that the parasympathetic nerves innervating the AV node also innervate the right atrium, and the greatest density of innervation is near the AV nodal fat pad. METHODS AND RESULTS: An epicardial fat pad near the junction of the left atrium and right inferior pulmonary vein was identified during cardiac surgery in seven patients. A ring electrode was used to stimulate this fat pad intraoperatively during sinus rhythm to produce transient complete heart block. Subsequently, temporary epicardial wire electrodes were sutured in pairs on this epicardial fat pad, the high right atrium, and the right ventricle by direct visualization during coronary artery bypass surgery in seven patients. Experiments were performed in the electrophysiology laboratory 1 to 5 days after surgery. Programmed atrial stimulation was performed via an endocardial electrode catheter advanced to the right atrium. The catheter tip electrode was moved in 1-cm concentric zones around the epicardial wires by fluoroscopic guidance. Atrial refractoriness at each catheter site was determined in the presence and absence of parasympathetic nerve stimulation (via the epicardial wires). In all seven patients, an AV nodal fat pad was identified. Fat pad stimulation during and after surgery caused complete heart block but no change in sinus rate. Fat pad stimulation decreased the right atrial effective refractory period at 1 cm (280 +/- 42 msec to 242 +/- 39 msec) and 2 cm (235 +/- 21 msec to 201 +/- 11 msec) from the fat pad (P = 0.04, compared with baseline). No significant change in atrial refractoriness occurred at distances >2 cm. The response to stimulation decreased as the distance from the fat pad increased. CONCLUSION: For the first time in humans, an epicardial fat pad was identified from which parasympathetic nerve fibers selectively innervate the AV node but not the sinoatrial node. Nerves in this fat pad also innervate the surrounding right atrium.


Asunto(s)
Nodo Atrioventricular/inervación , Nodo Atrioventricular/patología , Sistema Nervioso Parasimpático/patología , Tejido Adiposo/efectos de los fármacos , Tejido Adiposo/inervación , Adulto , Anciano , Antiarrítmicos/administración & dosificación , Nodo Atrioventricular/efectos de los fármacos , Atropina/administración & dosificación , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Estimulación Eléctrica , Electrodos Implantados , Técnicas Electrofisiológicas Cardíacas , Femenino , Atrios Cardíacos/efectos de los fármacos , Atrios Cardíacos/inervación , Atrios Cardíacos/patología , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Ohio , Sistema Nervioso Parasimpático/efectos de los fármacos , Pericardio/efectos de los fármacos , Pericardio/inervación , Resultado del Tratamiento
19.
Pacing Clin Electrophysiol ; 25(3): 332-41, 2002 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11990663

RESUMEN

A multicenter prospective study was designed and implemented as an activity of the Pediatric Electrophysiology Society to assess the risks associated with radiofrequency ablation in children. Patients (age 0-15 years) with supraventricular tachycardia due to accessory pathways or atrioventricular nodal reentry were enrolled and studied prior to ablation and periodically by clinical evaluation, electrocardiogram (ECG), Holter monitor, and echocardiogram. In addition, a national registry was established, to which the contributing centers report all pediatric patients undergoing ablation at their center. Initial electrophysiological study tracings and all noninvasive studies undergo blinded outside review for quality control. Clinical endpoints were death, recurrence, proarrhythmia, and echocardiographic abnormality. A pilot study demonstrated excellent agreement concerning diagnoses of previously reported ablation patients between the reporting center and the blinded reviewer (kappa = 0.938 +/- 0.062). A total of 317 patients were enrolled in the ongoing study from April 1, 1999 to December 31, 2000. The success rate of ablations was 96% with a complication rate of 4.3% for electrophysiological study and 2.9% for the ablation procedure. Comparison of the registry group versus the study group shows that the groups are comparable in terms of patient characteristics, diagnoses, and the results of ablation making it less likely that the sample of prospectively enrolled patients is biased.


Asunto(s)
Ablación por Catéter , Taquicardia Supraventricular/cirugía , Adolescente , Niño , Ecocardiografía , Electrocardiografía Ambulatoria , Técnicas Electrofisiológicas Cardíacas , Femenino , Humanos , Masculino , Proyectos Piloto , Estudios Prospectivos , Recurrencia , Sistema de Registros , Taquicardia Supraventricular/fisiopatología , Resultado del Tratamiento
20.
J Electrocardiol ; 35 Suppl: 165-74, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12539115

RESUMEN

While noninvasive techniques, including esophageal recording and pacing, clearly have advantages in the pediatric population; they also have significant limitations. Invasive electrophysiology (EP) in children now encompasses the use of many advanced engineering applications, which contribute to the efficacy of such procedures. This is particularly true with respect to the performance of radiofrequency catheter ablation. First, microcatheters (eg, Cardima) offer advantages as diagnostic catheters in small hearts, and allow pacing and recording from both atrium and ventricle in even the smallest infants using limited venous access. In addition, there is the possibility of mapping the distal coronary sinus, and the right atrioventricular groove via the right coronary artery. Second, electroanatomic mapping using the CARTO system (Biosense Webster) allows complex maps to be constructed in patients with congenital heart disease and a history of cardiac surgery. Although somewhat laborious to construct, such maps offer great detail to guide ablation, and also provide voltage information to guide identification of patches and scars. Similarly, non-contact mapping systems (eg, EnSite, Endocardial Solutions) are available which record far-field potentials and employ solutions to the inverse problem to reconstruct endocardial potentials. Three-dimensional mapping based on a single beat is possible, and the success of ablation in creating conduction block in unique channels can be evaluated. Both of these three-dimensional mapping systems have the potential to improve outcomes in patients with complex disease undergoing ablation. Finally, patients are now undergoing combined procedures with interventional catheterization (eg, device closure, stenting) along with EP procedures (eg, ablation, device implant) in the same laboratory session. The state of the art in invasive pediatric EP increasingly involves the use of advanced technology adapted for use in pediatric and congenital heart disease applications.


Asunto(s)
Técnicas Electrofisiológicas Cardíacas/normas , Adolescente , Ablación por Catéter , Preescolar , Anomalía de Ebstein/complicaciones , Cardioversión Eléctrica , Femenino , Cardiopatías Congénitas/cirugía , Humanos , Imagenología Tridimensional , Lactante , Masculino , Taquicardia Paroxística/diagnóstico , Taquicardia Paroxística/cirugía , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/cirugía
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