Use of the advisor™ HD Grid mapping catheter in transcatheter ablation of atrial arrhythmias in palliated CHD and children without CHD.

OBJECTIVE: In this study, we describe our experience utilising Advisor™ High Density (HD) Grid mapping catheter in transcatheter ablation of intraatrial re-entrant and focal atrial tachycardias with or without CHD. METHODS: Forty-five consecutive patients with intraatrial re-entrant and focal atrial tachycardia who underwent a transcatheter ablation procedure by using Advisor™ HD Grid mapping catheter and high-density mapping system in our hospital from January 2017 to January 2023 were included into the study. RESULTS: The mean age of the patients was 14.2 ± 7.3 years (6-32 years), and the mean weight was 48.3 ± 16.2 kg (22-83 kg). Of the total 45 patients, 21 were intraatrial re-entrant tachycardia and 25 were focal atrial tachycardia. Of the 21 re-entrant circuits, 15 were classified as cavotricuspid isthmus-dependent and 5 were non-cavotricuspid isthmus-dependent. In one patient, two re-entrant circuits were identified. A transbaffle ablation was successfully performed from the left atrium in one patient. Of the 25 focal atrial tachycardia, 19 were from right atrium and 6 were from left atrium. A cryoablation was performed in only one patient and radiofrequency ablation in others. The mean procedure time was 180 ± 64 minutes. The mean follow-up period was 69.3 ± 35.3 months. Acute success was 95.5%. Recurrence was noted in two patients (4.4%). CONCLUSION: Advisor™ HD Grid mapping catheter was found to be safe and achieved an acceptable success in transcatheter ablation of patients with intraatrial re-entrant tachycardia and focal atrial tachycardias.

Experience of left ventricular outflow tract arrhythmia ablation in paediatric patients using limited fluoroscopy and three-dimensional mapping technique.

OBJECTIVE: The left ventricular outflow tract is an important source of ventricular arrhythmias. Up to one-third of all idiopathic ventricular arrhythmias in patients with structurally normal hearts may arise from this region. We would like to share the results of our left ventricular outflow tract ablation using three-dimensional mapping and limited fluoroscopy. MATERIALS AND METHODS: This is a single-centre retrospective cohort study. Forty-six consecutive patients who underwent left ventricular outflow tract ablation procedures between January 2015 and June 2023 were included in the study. The EnSite Precision System (Abbott, St. Paul, MN, USA) was used to facilitate mapping and to reduce or eliminate the need for fluoroscopy. RESULTS: The study group comprised 29 males and 17 females, with a mean age of 13.4 ± 4.5 years. The most common location for arrhythmias was the left coronary cusp (n : 21). Other locations, in sequence, included the junction of the right and left coronary commissure (n : 10), right coronary cusp (n : 10), left ventricular outflow tract endocardium (n:4), aorto-mitral junction (n : 1), and great cardiac vein (n : 1). Nine of these patients had previously undergone unsuccessful right ventricular outflow tract ablation at another centre. Cryoablation was performed in three patients, irrigated radiofrequency ablation in three patients, and conventional radiofrequency ablation in the remaining patients. The acute success rate was 100%, and no recurrences were observed. The mean follow-up period was 49.6 ± 24.4 months. All patients were asymptomatic and were being followed without antiarrhythmic medication. CONCLUSION: Although left ventricular outflow tract ablations pose a risk for coronary artery and heart valve complications, they can be performed successfully and safely with the guidance of three-dimensional mapping.

Transcatheter ablation using near-zero fluoroscopy in children with focal atrial tachycardia: a single-centre experience.

OBJECTIVE: Focal atrial tachycardia accounts for up to 10-15% of supraventricular tachycardiasubstrates in patients < 30 years. In this study, we aimed to demonstrate the outcome of transcatheter ablation procedures performed through three-dimensional electroanatomic mapping systems using minimal fluoroscopy in a paediatric cohort with focal atrial tachycardia. METHODS: Forty-nine consecutive patients with focal atrial tachycardia who underwent an electrophysiologic study and a transcatheter ablation procedure in our hospital from September 2014 to February 2020 were included into the study. RESULTS: The mean weight of the patients was 48.63 ± 15.4 kg, and the mean age was 14.56 ± 3.5 (5.5-18.4) years. The tachycardia was defined as incessant in 26 patients. Thirteen patients had left ventricular systolic dysfunction with a mean left ventricular ejection fraction of 38.47 ± 12.4% on echocardiography. The mean procedure time was 148.7 ± 94.5 minutes. Transseptal puncture and thus fluoroscopy were required in nine patients. The mean fluoroscopy time was 4.51 ± 5.9 minutes. No fluoroscopy was needed in ablations performed in the right atrium. The acute success rate of the ablation procedures was 97.9%. The mean follow-up period was 50.71 ± 23.5 months. Recurrence was noted in two patients (4.2%). CONCLUSION: The outcomes of three-dimensional electroanatomic mapping-guided transcatheter ablation procedures are promising with high acute success, low recurrence and complication rates in children with focal atrial tachycardia. The use of fluoroscopy can be significantly decreased with three-dimensional mapping systems in this group of patients.

Transcatheter radiofrequency ablation using near-zero fluoroscopy in children with fascicular ventricular tachycardia: a single-centre experience.

OBJECTIVE: Fascicular tachycardia is a common form of sustained idiopathic left ventricular tachycardia. This study aimed to achieve successful results with catheter ablation procedures performed through three-dimensional electroanatomic mapping using near-zero fluoroscopy in fascicular tachycardia patients. METHODS AND RESULTS: In this study, we included 33 consecutive children with fascicular tachycardia, for whom we performed a transcatheter radiofrequency ablation procedure using the EnSite® system. Activation mapping was performed in all patients during tachycardia, and the earliest presystolic purkinje potentials were the target site for radiofrequency lesions. RESULTS: Twenty-five patients were male, and eight were female. The mean weight of the patients was 39.6 ± 10.4 kg, and the mean age was 13.6 ± 2.5 years. The mean procedure time was 121.3 ± 44.3 minutes. The mean follow-up period was 18.4 ± 6.5 months. No fluoroscopy was needed in 30 patients. The mean fluoroscopy time in the remaining patients was 166.6 ± 80 seconds. All of the patients had left posterior fascicular tachycardia except for one who had left anterior fascicular tachycardia. The acute success rate was perfect (100%). No patients developed left bundle branch block or complete atrioventricular block. Recurrence developed in one patient. CONCLUSION: We suggest that radiofrequency ablations via an electroanatomic mapping system are quite safe and effective, with high success rates in paediatric patients with fascicular tachycardia. This method has the advantage of avoiding ionising radiation exposure for both the patient and operator, thus reducing the lifetime risk of malignancy in the paediatric population.

Early outcomes of usage of cryoFORM® probe for cryomaze procedure in congenital heart surgery.

OBJECTIVES: This study aimed to evaluate the early outcomes of patients who underwent a concomitant therapeutic maze procedure for congenital heart surgery. MATERIALS AND METHODS: Between 2019 and 2020, eight patients underwent surgical cryoablation by using the same type of cryoablation probe. RESULTS: Three patients had atrial flutter, two had Wolf-Parkinson-White syndrome, two intra-atrial reentrant tachycardia, and one had atrial fibrillation. Four patients underwent electrophysiological study. Preoperatively, one patient was on 3, two were on 2, five were on 1 antiarrhythmic drug. Six patients underwent right atrial maze and two underwent bilateral atrial maze. Five out of six right atrial maze patients underwent right atrial reduction. Nine different lesion sets were used. Some of the lesions were combined and applied as one lesion. In Ebstein's anomaly patients, the lesion from coronary sinus to displaced tricuspid annulus was delicately performed. The single ventricle patient with heterotaxy had junctional rhythm at the time of discharge and was the only patient who experienced atrial extrasystoles 2 months after discharge. Seven of the eight patients were on sinus rhythm. No patient needed permanent pacemaker placement. CONCLUSION: Cryomaze procedure can be applied in congenital heart diseases with acceptable arrhythmia-free rates by selecting the appropriate materials and suitable lesion sets. The application of cryomaze in heterotaxy patients can be challenging due to differences in the conduction system and complex anatomy. Consensus with the electrophysiology team about the choice of the right-left or biatrial maze procedure is mandatory for operational success.

Transcatheter Cryoablation Procedures without Fluoroscopy in Pediatric Patients with Atrioventricular Nodal Reentrant Tachycardia: A Single-Center Experience.

BACKGROUND: Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common supraventricular tachycardia substrates. The aim of this study was to demonstrate the excellent outcomes of cryoablation without fluoroscopy in pediatric patients with AVNRT. METHODS: From September 2015 to October 2016, a transcatheter cryoablation procedure was performed in 109 patients using the EnSite® system. After electrophysiologic studies, a cryoablation catheter was advanced for the purpose of ablation of the slow pathway. Six to eight lesions were delivered in 240-300 seconds at -70 °C, with special effort being paid to obtain an eyeball formation around the first effective lesion. RESULTS: The mean weight and age of the patients were 24.6 ± 5.3 kg (15-68 kg) and 9.8 ± 2.6 years (5-18 years), respectively. The mean procedure time was 109.8 ± 46 minutes, and the acute procedural success rate was excellent (100%). Ablation procedures were performed during induced tachycardia in 67 patients and during sinus rhythm in 42. The mean follow-up period was 13.3 ± 5.8 months (4-17 months). Recurrence was noted in one patient during the follow-up period who received the ablation procedure with a 6-mm tip catheter. No recurrence was noted among the patients treated with an 8-mm cryocatheter. No permanent cryoablation-related complications occurred. CONCLUSIONS: Cryoablation using an electroanatomic mapping system is safe and effective in pediatric patients with AVNRT, and has the advantage of avoiding ionizing radiation.

Stenting of the ductus arteriosus in infants with functionally univentricular heart disease and ductal-dependent pulmonary blood flow: A single-center experience.

OBJECTIVE: To determine the short- and medium-term outcomes of ductal stenting (DS) in patients with functionally univentricular hearts (FUHs) and ductal-dependent pulmonary blood flow. BACKGROUND: Several studies have evaluated the outcomes of DS in a limited number of patients with FUHs. Nonetheless, there is still no consensus regarding the indications for this procedure, and no appropriate patient selection criteria have been devised. METHODS: From 2005 to 2015, cardiac catheterization for DS was performed in 68 patients with FUHs. Of these patients, 49 had single source pulmonary blood flow from ductus arteriosus. Procedural and follow-up data were evaluated. RESULTS: The median weight of the patients was 3.6 kg (2.3-6.8 kg), and the median age was 26 days (3 days-8 months). The technical success rate of the procedure was 95% (65 of 68 patients). Mean oxygen saturation increased from 70% ± 7.6% to 87% ± 4.6% (P < 0.0001). Among patients in whom DS was successful, 55 (84.6%) were bridged to a Glenn procedure after a median of 9.1 months (6.4-14 months), and 41 (63%) were successfully bridged to a Glenn procedure without additional interventions. Of the 16 patients with preexisting mild pulmonary artery stenosis, five required a surgical shunt due to progressive branch pulmonary artery stenosis, while nine were bridged to a Glenn operation without shunt placement. Five (7.3%) patients died, including patients who were sent to surgery. CONCLUSION: DS is a reasonable and effective alternative to surgical shunt placement as a first-stage palliative procedure in patients with FUHs. © 2016 Wiley Periodicals, Inc.

Intervention in Patients with Critical Pulmonary Stenosis in the Ductal Stenting Era.

We aimed to assess early and midterm outcomes of balloon valvuloplasty (BVP) procedure in patients with critical pulmonary stenosis (CPS) and to describe the predictors of the need for additional pulmonary flow and reintervention in this subgroup of patients. From 2005 to 2014, 56 neonates were diagnosed with CPS and were included in this study. All echocardiographic, catheterization and angiographic data obtained prior to the initial BVP and at follow-up were reviewed. BVP was successful in 55 neonates (98 %). Twenty-one neonates needed pulmonary blood flow augmentation after BVP (38 %). Ductal stenting (DS) was performed in 20. The patients' mean tricuspid valve (TV) annulus diameter was 10.4 ± 2 mm, and the Z score was -1.29 ± 1 (-3.7 to 0.78). The mean pulmonary valve (PV) annulus diameter was 6 ± 0.9 mm, and the Z score was -1.74 ± 1 (-4.34 to 0.05). A transcatheter or surgical reintervention was performed in 11 patients. A TV Z score < -1.93 SD predicted the need for pulmonary blood flow augmentation after a successful BVP, with a sensitivity of 63.2% and a specificity of 84.4%. A PV Z score < -1.69 SD predicted the need for pulmonary flow augmentation, with a sensitivity of 74 %. The presence of bipartite RV was found to be a significant predictor of the need for reintervention (odds ratio 9.6). Our study showed the excellent immediate outcomes of BPV and DS in a pure cohort of patients with CPS. Prophylactic DS in selected cases seems reasonable and safe.

Initial Experience with the Nit-Occlud ASD-R: Short-Term Results.

We aim to assess the safety, feasibility and efficacy of the new Nit-Occlud ASD-R (NOASD-R) device. From 2014 to 2015, transcatheter closure of atrial septal defect (ASD) using the NOASD-R was performed in 30 consecutive patients. The standard deployment technique as the left upper pulmonary vein approach was used in 25 patients. Right upper pulmonary vein approach was required in five. The median age was 6 years (range 3.5-60 years), and median weight was 21.5 kg (14-79 kg). Implantation was successful in all patients. The median size of devices was 16 mm (12.0-26.0 mm). The mean device size/2D defect diameter ratio was 1.26 ± 0.09 (1.12-1.40). The mean device size/color flow diameter ratio was 1.07 ± 0.06 (range 1.0-1.22). Releasing problem was encountered in three patients. A device-related erosion on the day after the closure was observed in one patient. No further device-related complication (erosion, embolization or dislodgement of the device) was encountered in a median follow-up period of 10 months (range 2-14 months). Complete occlusion has occurred in all at follow-up. NOASD-R is a feasible and effective device for use in the transcatheter occlusion of moderate to large secundum ASDs in selected patients. The occurrence of the erosion on the right atrial roof may be due to the high localization of the device and the larger size of the right disk.

Percutaneous transcatheter closure of a descending aorta to vertebral venous plexus fistula using an Amplatzer Vascular Plug 2: a case report.

A descending aorta to vertebral venous plexus fistula is an extremely rare form of arteriovenous fistula. A 10-month-old infant was referred to the hospital for evaluation of a murmur. On examination, a continuous murmur was heard in the entire back. Transthoracic echocardiography revealed left heart chamber dilatation in the presence of preserved left ventricle systolic function. Computerized tomography angiography with 3-dimensional reconstruction, and lateral projection aortography revealed a descending aorta-vertebral venous plexus fistula measuring 4.8 mm in the aortic orifice. The fistula was embolized using an Amplatzer Vascular Plug 2.

Assessment of cardiac functions in infants with cow's milk allergy.

BACKGROUND: Cow's milk allergy is the most common food allergy in children, with rates estimated at 1.9% to 4.9%. Clinical phenotypes of cow's milk allergy are varied and involve 1 or more target organs, with the main targets being the skin, respiratory system, and gastrointestinal tract. To date, no studies have investigated detailed cardiac function in children with cow's milk allergy. The current study aimed to investigate cardiac function in infants with cow's milk allergy. MATERIAL/METHODS: We studied 42 infants with cow's milk allergy and 30 age- and sex-matched healthy subjects. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. RESULTS: There were no significant differences in ejection fraction or mitral and tricuspid annular plane systolic excursion between the 2 groups. Pulsed-wave Doppler-derived E/A ratios in mitral and tricuspid valves were similar in both groups. Ea/Aa ratios in the left ventricle posterior wall and right ventricle free wall were lower in patients with cow's milk allergy than in the control group. The E/Ea ratio in the left ventricle, isovolumic relaxation time, deceleration time, and right and left ventricular myocardial performance indices were higher in patients in the study group. CONCLUSIONS: Our study identified reduced early diastolic tissue Doppler velocities in infants with cow's milk allergy.

The effects of pre-pregnancy obesity on fetal cardiac functions.

Obesity is a substantial public health problem with a rapidly increasing prevalence in numerous industrialized nations. The objective of this study was to evaluate the effects of maternal pre-pregnancy obesity on fetal cardiac functions. We studied 55 fetuses of obese mothers and 44 fetuses of healthy mothers at 26-38 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, gestational age, estimated birth weight, serum lipids, and systolic-diastolic blood pressure. Fetal heart rate, diameters of the aortic and pulmonary valve annulus, aortic and pulmonary peak systolic velocities, ventricular systolic function, and cardiothoracic ratio were similar in the two groups. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the obese mothers. In the interventricular septum, left ventricle posterior wall, and right ventricle free wall, the E a and A a were higher, and E a/A a ratios were significantly lower in the study group than in the control group. The E/E a ratio was higher in the obese group than in the control group. The isovolumic relaxation time and the right and left ventricle myocardial performance indices were higher in the fetuses of the obese mothers than in the fetuses of the healthy mothers. We believe that maternal obesity has an important influence on fetal cardiac diastolic functions.

Assessment of cardiac functions in fetuses of gestational diabetic mothers.

We investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E a-wave (p = 0.02), A a-wave (p = 0.04), and S a-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E a (p = 0.02) and A a (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E a/A a ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E a ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.

Effect of antiepilepsy drug therapy on ventricular function in children with epilepsy: a tissue Doppler imaging study.

Impaired cardiac myocardial function may contribute to the risk for sudden unexpected death of a patient with epilepsy. This study aimed to investigate the effect of antiepilepsy drugs (AEDs) on cardiac function in pediatric epileptic patients using standard and tissue Doppler imaging (TDI) echocardiography. This hospital-based, prospective cross-sectional study investigated 52 epileptic children (mean age 9.3 ± 3.1 years) treated with AEDs (duration 2.4-10.0 years) and 36 healthy children (mean age 9.5 ± 4.0 years). In the epilepsy group, standard echocardiography showed increased left ventricular (LV) end-diastolic and end-systolic diameters, an increased LV mass index, and preserved ejection fraction. The patients also exhibited increased mitral peak A-wave velocity and mitral E-wave deceleration time as well as a decreased mitral E/A ratio. The E/Em ratio was significantly higher in the epilepsy group (5.6 ± 1.2) than in the control group (5.2 ± 1.1) (p = 0.016). In the epilepsy group, TDI showed an increased isovolumetric relaxation time and myocardial performance index (MPI). It also exhibited decreased early diastolic velocity (Em) and a decreased mitral annular displacement index in these patients. There were positive correlations between the LV lateral wall MPI (r = 0.231), septal MPI (r = 0.223), and LV mass index (p < 0.05) but no correlation with the duration of AED treatment. The authors detected subclinical ventricular dysfunction associated with AEDs at a preclinical stage. They suggest that TDI can be useful for determining the short- and long-term cardiac effects of AEDs.

Evaluation of cardiac functions of patients with benign joint hypermobility syndrome.

We sought to investigate whether echocardiography with tissue Doppler imaging identifies myocardial dysfunction in children with benign joint hypermobility syndrome (BJHS). This cross-sectional study enrolled 75 children with BJHS and 70 healthy children. We performed detailed echocardiography in individuals with BJHS without inherited connective tissue disorders. Any congenital or acquired cardiac disease was excluded by clinical and echocardiographic examination. Both groups were similar in terms of age, sex, and body mass index. The diameter of the aortic annulus and sinus valsalva were wider in patients with BJHS. There was no significant differences in ejection fraction or mitral and tricuspid annular plane systolic excursion between the two groups. Pulsed-wave Doppler-derived E/A ratios in mitral and tricuspid valves were similar in both groups. Deceleration time of early mitral inflow was prolonged in patients with BJHS. Mitral and tricuspid annulus Ea velocity were significantly lower in children with BJHS. Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in patients with BJHS than in the control group. The E/Ea ratio was greater in patients with BJHS than in the control group. Isovolumic relaxation time and right-ventricular (RV) and left-ventricular (LV) myocardial performance indices (MPIs) were greater in patients with BJHS. This study showed the diastolic dysfunction in patients with BJHS. In addition, we detected increased LV and RV MPI. We believe that BJHS may affect proteins of the myocardial cytoskeleton and extracellular matrix.

P-wave and QT interval dispersion analysis in children with Eisenmenger syndrome.

OBJECTIVES: P-wave and QT dispersion are increased and associated with atrial and ventricular arrhythmia and an increase in sudden death in a variety of diseases. This study aimed to investigate P-wave and QT dispersion in children with Eisenmenger syndrome (ES). STUDY DESIGN: The study group included 27 children (15 females, 12 males) with both congenital heart disease (CHD) and ES. The control group consisted of 30 children with CHD without pulmonary arterial hypertension. Electrocardiographic records were used to determine P-wave, QT, and corrected QT (QTc) dispersions. 24-hour (h) rhythm Holter was fitted in all patients. Atrial volumes, ventricular dimensions and tricuspid annular plane systolic excursion (TAPSE) were measured by echocardiography. RESULTS: There was no difference between groups with regard to age, sex, weight, and body surface area (p>0.05). Right atrial volume was significantly larger in the ES group than in the control group. P-wave, QT and QTc dispersions were higher in the patients with ES (50.10±11.12 vs. 26.32±8.90, p<0.001; 57.40±24.21 vs. 38.20±8.92 ms, p<0.001; and 78.20±16.02 vs. 56.52±13.92 ms, p<0.001, respectively). Ventricular and supraventricular ectopy were significantly more frequent in the ES group. Four patients (14.8%) in the study group had tachyarrhythmias during 24-h Holter monitoring. CONCLUSION: In our study, P-wave and QT dispersion were found to be greater in children with ES than in the healthy control subjects.

Effects of carvedilol therapy on cardiac autonomic control, QT dispersion, and ventricular arrhythmias in children with dilated cardiomyopathy.

BACKGROUND: The purpose of this study was to examine the effects of carvedilol therapy on autonomic control of the heart and QT-interval dispersion (QTd) among children with idiopathic dilated cardiomyopathy (DCM) whose symptoms were not adequately controlled with standard congestive heart failure therapy. MATERIAL AND METHODS: Patients with DCM who were treated with carvedilol were enrolled in the study. All patients had undergone carvedilol therapy in addition to standard therapy for at least 6 months. Clinical, echocardiographic, and electrocardiographic parameters, and 24-h Holter records of patients were retrospectively evaluated before and after carvedilol treatment. RESULTS: A total 34 patients (mean age: 7.4 ± 4.3 years) with DCM were analyzed in the study. The median follow-up period was 9.5 months. After the 6 months of carvedilol therapy the clinical score significantly improved, left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) significantly increased, and left ventricle end-diastolic dimensions and end-systolic dimensions significantly decreased. There were statistically significant increases in mean SDNN, SDANN, rMSSD, and pNN50 (p = 0.002, p = 0.001, p = 0.008, and p = 0.026, respectively). After the carvedilol therapy, SDNN was correlated with the clinical score, heart rate, LVEF, LVFS, and total premature ventricular contractions (PVCs). In addition, rMSSD and pNN50 were correlated with heart rate, LVEF and LVFS. A significant reduction was observed in QTc-minimum, QTc-maximum, and QTd values (434.9 ± 40.7 vs. 416.1 ± 36.5, 497.8 ± 43.6 vs. 456.3 ± 41.7, 58.6 ± 17.1 vs. 49.3 ± 15.6; p < 0.001, p = 0.001, and p = 0.008, respectively). QTd was significantly related to PVCs (r = 0.62, p = 0.02). CONCLUSIONS: We conclude that the addition of carvedilol to standard therapy can improve clinical symptoms and heart rate variability, and reduce in arrhythmia markers in children with DCM.

Rhythm and conduction analysis of patients with acute rheumatic fever.

Various rhythm and conduction abnormalities can develop in acute rheumatic fever. This study investigated rhythm and conduction abnormalities in children with acute rheumatic fever using a standard 12-lead electrocardiogram and 24-h rhythm Holter recordings. This multicenter retrospective study, performed between August 2011 and March 2012, enrolled 73 consecutive children with acute rheumatic fever. Standard electrocardiography was used to measure PR and corrected QT intervals. Holter recordings were evaluated for all the patients, and 52 of the patients (71.2 %) had carditis that was either isolated or together with other major criteria. A positive correlation was detected between carditis and the mean PR interval on standard electrocardiography, but this was not significant (p > 0.05). Standard electrocardiography showed a significant positive correlation between PR and corrected QT intervals (p = 0.03; r = 0.55). Standard electrocardiography showed only three patients (4.2 %) with premature contractions, whereas 24-h electrocardiography showed 26 patients (35.6 %) with premature contractions. Carditis was positively correlated with premature contractions (p < 0.01; r = 0.57). One patient with junctional rhythm and one patient with left bundle block were detected by standard electrocardiography. Whereas some patients with carditis exhibited no arrhythmic evidence on standard electrocardiograms, complete atrioventricular block, supraventricular tachycardia, and Mobitz type 1 block were observed on 24-h Holter recordings. A positive correlation also was observed between the presence of premature contractions and serum levels of acute-phase reactants (p = 0.03; r = 0.62). These findings led to the conclusion that rhythm and conduction disorders in acute rheumatic fever are more common than previously thought.

Assessment of fetal cardiac function in mild preeclampsia.

This study investigated cardiac function in 65 fetuses of mildly preeclamptic mothers and 55 fetuses of healthy mothers at 26-40 weeks of gestation. Fetuses with intrauterine growth restriction were excluded. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, and gestational age. Peak systolic aortic and pulmonary artery velocities were significantly lower in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. The two groups did not differ significantly in terms of shortening fraction or with regard to mitral or tricuspid annular plane systolic excursion. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the preeclamptic mothers. The Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in the preeclampsia group than in the control group. The E/Ea ratio was higher in the preeclampsia group than in the control group. The isovolumic relaxation time and the right and left myocardial performance indices were higher in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. An increased ductus venosus pulsatility index (PI) and a decreased middle cerebral artery (MCA) PI were found in the fetuses of the preeclamptic mothers. All the fetuses were asymptomatic. The results suggest that the increase in fetal cardiac afterload in mild preeclampsia may have caused early subclinical changes in fetal systolic and diastolic cardiac function. In addition, the decrease in MCA-PI may have been caused by redistribution of fetal cardiac output in favor of the left ventricle, secondary to increased placental vascular resistance.

Early subclinical left-ventricular dysfunction in obese nonhypertensive children: a tissue Doppler imaging study.

A direct effect of obesity on myocardial function has not been not well established. Our aim was to investigate the effect of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children by tissue Doppler imaging (TDI). We calculated the mitral annular displacement index (DI) and myocardial performance index (MPI) using TDI indices of systolic and diastolic LV function. In this hospital-based, prospective cross-sectional study, we studied 60 obese (mean age 13.2 ± 2.0 years) and 50 normal children. Subjects were divided into three groups: group 1 (BMI < 25, n = 50, control), group 2 (BMI 25-29.9 kg/m(2), n = 30, overweight), and group 3 (BMI ≥ 30 kg/m(2), n = 30, morbidly obese). Standard echocardiography showed increased LV diameters and LV mass/index and preserved ejection fraction in obese children. By TDI, LV systolic and diastolic function showed that peak late myocardial velocity (Em = 15.4 ± 2 cm/s), peak early myocardial velocity (Am = 8.7 ± 1.3 cm/s), Em/Am ratio (1.8 ± 0.3), isovolumetric relaxation time (IVRT = 59.2 ± 8.2 ms), MPI (0.39 ± 0.03), and DI (25.5 ± 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 ± 1.2 cm/sn, 6.9 ± 0.6 cm/sn, 2.6 ± 0.2, 51.2 ± 9.6 ms, 0.34 ± 0.03, and 33.13 ± 5.0 %, respectively; p < 0.001). These structural and functional abnormalities were significantly related to BMI. There were positive correlations between HOMA-IR, septal MPI, and LV mass. DI and MPI data indicated impaired subclinical LV function in all grades of isolated obesity at a preclinical stage. Insulin resistance and BMI correlated significantly with indices of LV function.