[Fetal arrhythmias]. / Sikiön rytmihäiriöt.

The majority of referrals for fetal arrhythmias represent benign atrial premature beats. However, a small number of fetuses might have life-threatening conditions associated with bradycardia or tachycardia. Fetal echocardiography is essential to establish the diagnosis. Transplacental treatment is most often used to prevent heart failure. There is no clinical trial evidence as to the drug of first choice. Prognosis is determined by the type of arrhythmia, the association with structural cardiac anomaly and the co-existence of intrauterine cardiac failure. Treatment of fetal dysrhythmias should be executed in experienced maternal-fetal medicine centers.

Automatic ventricular threshold measurement in children with epicardial pacing leads.

BACKGROUND: The aim of the study was to evaluate the safety and reliability of automatic ventricular pacing threshold measurement, the Medtronic Capture Management (CM), in children with epicardial pacing leads. CM has not been recommended for use with epicardial leads due to lack of pertinent data. METHODS: During a 2-year study period, 34 children (mean age 6.1 years, range 0 days to 17.7 years) with epicardial leads were prospectively enrolled. The CM measurements were compared with in-office ventricular pacing threshold measurements. Thirty bipolar and five unipolar epicardial leads were assessed. RESULTS: CM measurements were successful and reliable in 30 out of 35 leads (86%). The mean threshold with CM was 1.16 V (95% CI 1.07-1.26 V), and with standard measurement was 1.18 V (95% CI 1.09-1.28 V), at a pulse width of 0.40 ms. The reasons for failure were evoked response undersensing in two cases (5.7%), and high intrinsic rate in one case. High pacing thresholds prevented accurate CM measurements in two cases. CONCLUSIONS: CM automatic threshold measurements are consistent with standard ventricular pacing threshold measurements in children with epicardial leads. We recommend a period of monitoring CM performance before programming it to adjust output according to automatic threshold measurements, in order to find the patients in whom it does not work. The CM feature provides increased pacing safety when it measures well (86% of leads). A larger study is needed to prove the tendency for extending battery life in children with epicardial leads.

Long-term results of pediatric cardiac surgery in Finland: education, employment, marital status, and parenthood.

OBJECTIVE: This population-based study was designed to examine the psychosocial outcome of Finnish patients who had been operated on for congenital heart disease during childhood. METHODS: A questionnaire was mailed to 3789 adult patients who had been operated on for congenital heart defects in Finland. Of these, 2896 (76%) answered the questionnaire. The mean age of patients was 33 years (range: 18-59 years), and they had had their first operation 9 to 46 years earlier. RESULTS: The patients had coped well with their defects when compared with the general Finnish population. The educational level of patients was comparable to and employment level was higher than expected (70% vs 66%, respectively). They were living in a steady relationship as often as the general population, but the number of parents among the patients was lower than that expected (47% vs 49%, respectively). The incidence of congenital heart disease among the 2697 children of the patients was 2.4%. CONCLUSION: Our results confirm that in addition to high survival rate, the long-term psychosocial outcome of patients with surgically treated congenital heart defects is good if they do not have any additional syndromes that cause mental retardation.