RESUMO
Insertable cardiac monitors (ICMs) have been used more frequently and in a wider variety of circumstances in recent years. ICMs are used for symptom-rhythm correlation when patients have potentially arrhythmogenic syncope and for less traditional reasons such as rhythm surveillance in patients with genetic arrhythmia syndromes or other diseases with high arrhythmia risk. ICMs have good diagnostic yield in pediatric patients and in adults with congenital heart disease and have a low rate of complications. Implantation techniques should take patient-specific factors into account to optimize diagnostic yield and minimize risk.
Assuntos
Eletrocardiografia Ambulatorial , Cardiopatias Congênitas , Adulto , Humanos , Criança , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Síncope/diagnóstico , Síncope/etiologia , Cardiopatias Congênitas/diagnósticoRESUMO
Block in accessory pathway (AP) conduction with adenosine has been previously described. However, conduction characteristics of these APs has not been well defined to date. All patients with APs = 21 years old who underwent an EP study from 2014 to 2017 were included in our study. Patients with adenosine sensitive APs were identified (group 1). Demographic and AP conduction characteristics were compared between group 1 and the entire cohort of patients. Local atrioventricular (AV) or ventriculoatrial (VA) time, cycle length and need for isoproterenol were compared to a control group matched by age and AP location (group 2). Student's t test, Wilcoxon rank sum, χ2 and Fisher's exact were used for analysis. Fourteen (7%) out of 207 patients had an adenosine sensitive AP. The median age of patients with adenosine sensitive APs was 11.8 (IQR 8.5-13.5) years vs. 14 (IQR 10.6-16.7) for the rest of the cohort (p = 0.04). Three of the 134 patients with preexcitation had adenosine sensitive APs (2%) vs. 11 of the 73 patients with concealed APs (15%) (p = 0.001). The median local AV/VA time at the site of successful ablation was longer in group 1 vs group 2 [78 ms, IQR 62-116 vs. 31 ms, IQR 30-38; p < 0.001]. Antegrade AP effective refractory period and total procedure time were longer in patients with adenosine sensitive APs (p = 0.03 & p = 0.04, respectively). Adenosine sensitive APs which occur in children are more often concealed. These APs have a longer conduction time at the site of successful ablation.
Assuntos
Feixe Acessório Atrioventricular/cirurgia , Adenosina/farmacologia , Ablação por Cateter/métodos , Eletrocardiografia/métodos , Frequência Cardíaca/fisiologia , Síndromes de Pré-Excitação/cirurgia , Feixe Acessório Atrioventricular/tratamento farmacológico , Feixe Acessório Atrioventricular/fisiopatologia , Adolescente , Antiarrítmicos/farmacologia , Criança , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Síndromes de Pré-Excitação/fisiopatologiaRESUMO
Supraventricular tachycardia is the most common tachyarrhythmia encountered in infants. In older children and adults, definitive treatment of the supraventricular tachycardia substrate with catheter ablation is a common approach to management. However, in infants, the risks of catheter ablation are significantly higher, and the patients often outgrow the potential to experience episodes. Therefore, antiarrhythmic medications are often utilized to minimize the likelihood of experiencing episodes. This article reviews the common arrhythmia mechanisms encountered in infants and the medications used to treat these patients.
Assuntos
Antiarrítmicos/uso terapêutico , Taquicardia Supraventricular/tratamento farmacológico , Humanos , Lactente , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologiaRESUMO
Transthoracic echocardiography is the most common noninvasive method of evaluating pulmonary hypertension (PH) in infants. Identification of reliable, quantitative indices of myocardial function may enhance the diagnostic value of echocardiography in this population. We hypothesized that pulsed wave tissue Doppler imaging (TDI) and tricuspid annular plane systolic excursion (TAPSE) would be reproducible measurements and would suggest decreased ventricular function, in infants with PH. This retrospective case-control study involved subjects diagnosed clinically and echocardiographically with PH at <12 months of age, matched with controls by age and gestational age (GA). TAPSE was measured by M-mode in the apical 4-chamber view. TDI velocities were averaged from three consecutive cardiac cycles. Observers were blinded to patient identity and clinical status. Fifty-seven subjects, including 35 term or near-term infants ≥35 weeks GA [mean GA 39 weeks (±1.7), median age 1 day (range 0-2)] and 22 preterm infants [median GA 25.4 weeks (24.1-26.6), age 66 days (4-128)], were matched with 57 controls. Subjects with PH had lower TAPSE (term p < 0.001, preterm p = 0.03) and TAPSE indexed to body surface area (term p < 0.001, preterm p = 0.005). Mitral annular, septal, and tricuspid annular systolic (S') and early diastolic (E') TDI velocities were also decreased compared to controls (all p < 0.05). Intraclass correlation demonstrated 84-99% agreement between observers in measuring TDI and 92% for TAPSE. Intraobserver reliability for these measures was 98-99% and 96%, respectively. We concluded that TDI and TAPSE are reproducible indices of myocardial function and may serve as useful adjuncts to standard echocardiographic measures in infants with PH.