Midterm Results of Implantable Cardioverter Defibrillators in Children and Young Adults from a Single Center in Turkey.

BACKGROUND: Despite concerns about complications with the implantable cardioverter defibrillator (ICD), it is effective for the prevention of sudden cardiac death (SCD). We aimed to analyze our midterm experience with ICD in children and young adults. METHODS: This retrospective study included patients who were implanted with an ICD between 2001 and 2014. Demographic characteristics, clinical information, shock features, and complications for all patients with ICD were analyzed. The study population was divided into two groups: early-era patients implanted before 2008, and late-era patients implanted after 2008. RESULTS: Sixty-nine patients (median age: 12 years, median follow-up: 52 months) were implanted with an ICD. Diagnostic categories were channelopathy (56.6%), cardiomyopathy (36.2%), congenital heart disease (5.8%), and other (1.4%). We performed implantation for primary prevention in 66.6% (39.3% in early-era patients and 85.4% in late-era patients). Thirty-one (44.9%) received 139 appropriate shocks (66% of total shocks) while 14 (20.2%) received 71 inappropriate shocks. However, there was no statistically significant difference in the use of appropriate shocks in the primary (66.7%) versus the secondary (72.2%) prevention groups. The incidence of appropriate and inappropriate shock was 66.7% and 33.3% in the primary prevention group, and 72.2% and 27.8% in the secondary prevention group, respectively. Two patients died, although only one death was the result of a lead problem. CONCLUSIONS: Although lead integrity problems, inappropriate shocks, and infections are significant issues, ICD therapy appears to be a safe, effective, and necessary option for the prevention of SCD in both children and young adults.

Serum Bcl-2 values in children with pulmonary hypertension.

In this study, we aimed to assess levels of serum B cell lymphoma 2 (sBcl-2) in children, which has been implicated in the etiopathogenesis of pulmonary hypertension (PH), as well its association with tissue Doppler echocardiographic imaging (TDI) data and parameters used in the follow-up of PH. The sBcl-2 level was assessed in 35 children with PH (24 had eisenmenger syndrome, and 11 had idiopathic PH) and in 38 healthy children as controls. TDI was performed on 25 patients whose cardiac anatomy allowed the test. The respective sBcl-2 values in patients and controls were 35.69 ± 18.83 and 2.66 ± 7.95 ng/ml (p < 0.001). The sBcl-2 levels were significantly greater in the New York Heart Association (NYHA) functional class 3 patients than those in the NYHA class 2 patients (p = 0.033). The sBcl-2 value in patients who walked <475 m in the 6-min walk distance (6MWD) test was significantly greater than in those who walked ≥475 m (p = 0.038). The sBcl-2 level showed a negative correlation with ejection time measured at the septal anulus (p = 0.026) and a positive correlation with interventricular septum-Tei (p = 0.018). The results of this study showed for the first time that there is an increase in the levels of sBcl-2 as an inflammatory marker and that the sBcl-2 levels are associated with prognostic parameters in children with PH. Because sBcl-2 levels were greater in patients who walked <475 meters during the 6MWD test, we suggest 475 ms as the cut-off value for the 6MWD test to differentiate between a good and a bad prognosis.

Comparison of Transesophageal and Intracardiac Electrophysiologic Studies for the Diagnosis of Childhood Supraventricular Tachycardias.

In this study, we aimed to compare the results of transesophageal electrophysiologic studies (TEEPS) and intracardiac electrophysiologic studies (IEPS) in a cohort of pediatric patients with SVTs. The medical records of children aged between 0 and 18 years who underwent TEEPS between January 2007 and June 2012 were systematically reviewed, and those without pre-excitation and who underwent subsequent IEPS were identified. Post-procedural diagnoses were compared for compatibility. A total of 162 patients were included in the study with a mean age at diagnosis 11.6 ± 3.6 years. Tachycardia was induced in 152 patients by TEEPS and in 154 patients by IEPS. Overall, in 147 patients, tachycardia was induced by both TEEPS and IEPS. Diagnoses were compatible in 135 out of 147 patients (91.8 %). Nine out of the 12 patients with discrepant results were diagnosed with atrioventricular-reentrant tachycardia (AVRT) and three with atrioventricular nodal reentrant tachycardia (AVNRT) after TEEPS. Following IEPS, TEEPS diagnosis of AVRT was revised to typical AVNRT in 5 patients and atypical AVNRT in 4 patients. Two of the 3 patients who were diagnosed as having AVNRT following TEEPS were confirmed to have atrial tachycardia after IEPS, while the other patient was diagnosed with AVRT. Tachycardia terminated spontaneously in 3 patients, while overdrive pacing was attempted to terminate the tachycardia in 149 patients, with a success rate of 93.2 % (139/149). The diagnostic compatibility between TEEPS and IEPS is quite high. A diagnostic discrepancy mostly occurs in patients diagnosed with AVRT by TEEPS, and the possibility of atypical AVNRT should be considered in patients with a VA ≥70 ms to avoid such discrepancies.

Sensitivity of transesophageal electrophysiologic study in children with supraventricular tachycardia on electrocardiography.

INTRODUCTION: The aim of this study was to evaluate the inducibility of tachycardia by transesophageal electrophysiologic study (TEEPS) in patients with documented supraventricular tachycardia (SVT) on electrocardiography and to investigate the accuracy of TEEPS records by comparing with intracardiac electrophysiologic study (IEPS). MATERIAL AND METHODS: The TEEPS records of patients having documented electrocardiography during SVT were reviewed. The results of TEEPS in 43 of 85 patients were compared with results of IEPS for compatibility of diagnosis. RESULTS: A total 85 patients, 46 male and 39 female, mean weight 35.1 kg (36-87), aged 1 month-17 years, were included. Tachycardia was induced by TEEPS in 79 of 85 patients with documented electrocardiography (sensitivity 92.9%). IEPS for diagnosis or ablation was conducted in 40 patients having inducible tachycardia and three of six who had no inducible tachycardia by TEEPS. Tachycardia was induced by IEPS in 39 of 40 (97.5%) patients who had inducible tachycardia and two of three who had no inducible tachycardia by TEEPS. Mechanisms of tachycardias were similar in 97.5% of patients (37/39) who had inducible tachycardia in TEEPS and IEPS. One of the patients with atrioventricular reentry tachycardia by TEEPS was diagnosed as atrioventricular nodal reentry tachycardia (AVNRT) and the other one was diagnosed as atypical AVNRT and atrial tachycardia by IEPS. CONCLUSION: The rates of inducibility and mechanisms of tachycardias by TEEPS in children having documented SVT were similar with those obtained from IEPS.

Efficacy and safety of cryoablation of parahissian accessory pathways in children: a single institution study.

BACKGROUND: Catheter cryoablation of supraventricular tachycardias involving the perinodal regions is considered to be a safer alternative compared to radiofrequency ablation. Limited information is available for efficacy, midterm outcomes, and complications regarding the ablation of parahissian accessory pathways (APs) in pediatric patients. METHODS: A retrospective review of all pediatric patients who underwent cryoablation for treatment of a parahissian AP was performed. RESULTS: Twenty-five patients (median age 13 years and weight 45.6 kg) underwent cryoablation of a parahissian AP. Median number of cryolesions applied was four (range: 3-6). Initial procedural success was achieved in 23 patients (23/25, 92%). Transient third-degree atrioventricular (AV) block was noted in two patients. There was no permanent AV block. Transient right bundle branch block (RBBB) was observed in one patient and permanent RBBB occurred in two patients. Of the patients successfully ablated with cryo, there was only one recurrence (1/23, 4.3%) over a follow-up of 17.5 months (range 6-34 months). CONCLUSION: Cryoablation of parahissian APs is both safe and effective with a low risk of recurrence in pediatric patients.

The efficacy of amiodarone-propranolol combination for the management of childhood arrhythmias.

BACKGROUND: The aim of this study was to present our data regarding the efficacy and safety of combining amiodarone and propranolol for the management of arrhythmias in infants. METHODS: Children aged between 0 and 18 years who received combination therapy with amiodarone and propranolol for persistent monotherapy resistance tachyarrhythmia between 2007 and 2011 were included in the study. Treatment efficacy and adverse effects were evaluated by review of clinical signs and symptoms, 12-lead electrocardiogram, 24-hour Holter monitorization, liver enzymes, thyroid function tests, chest x-ray, and ophthalmologic examination. RESULTS: A total of 25 patients (15 male and 10 female) were enrolled in this study with a mean age of 17.9 months (0-132) and a mean weight of 8.65 kg (2.2-25). In 18 patients, treatment was started before their first age. Tachyarrhythmia persisted in two patients despite combination therapy, and treatment regimen was changed. Complete control of the arrhythmia was achieved within the first 2 months of combination treatment in 20 patients, whereas in the remaining three patients short attacks of tachycardia who responded to dose increases were controlled beyond 2 months of treatment and no recurrence were observed. Overall, success of amiodarone-propranolol combination treatment was 92%. Mild elevation in thyroid-stimulating hormone level was observed in one patient that required discontinuation of treatment. CONCLUSION: Our results suggest that a combination of amiodarone and propranolol is an effective and safe option for the treatment of persistent arrhythmias in neonates and infants, and may serve as a bridge to ablation therapy in older children.

Closure of the patent ductus arteriosus with the Amplatzer Duct Occluder II: a clinical experience.

BACKGROUND: The aim of our study was to share our clinical experience on cases with patent ductus arteriosus treated with the Amplatzer Duct Occluder II. METHODS: Between 2008 and 2012, 26 of 31 patients with patent ductus arteriosus underwent successful transcatheter closure of patent ductus arteriosus using the Amplatzer Duct Occluder II. Mean age was 3.3 years and mean weight was 15.7 kilograms. The presence of a residual shunt, left pulmonary artery or aortic obstruction was explored by administering contrast material during the procedure. The patients were discharged 24 hours after the procedure. RESULTS: The procedure was successful in 26 of 31 patients and failed in five patients. According to the Krichenko classification, 26 patients had type A, one patient had type B and 4 patients had type C ductus. The mean narrowest ductus diameter was 3.2 mm and the mean ductus length was 6.7 mm. Complete angiographic occlusion occurred immediately after the procedure in 22 out of 26 patients in whom the ductus was closed successfully with the Amplatzer Duct Occluder II. Complete occlusion was achieved in the remaining patients with residual shunt one month after the procedure. The procedure was preceded by closure with an Amplatzer Duct Occluder I in two patients and an Amplatzer Vascular Plug I in one patient. CONCLUSION: Amplatzer Duct Occluder II is highly effective in transcatheter closure of patent ductus arteriosus. We think that an alternative closure device and alternative techniques can be attempted in patients with type C ductus. The success rate could increase with accumulating experience.

Long-term inhaled iloprost use in children with pulmonary arterial hypertension.

BACKGROUND: We performed a retrospective analysis of patients with pulmonary arterial hypertension receiving inhaled iloprost in a single centre to evaluate long-term tolerability, safety, and efficacy of chronic inhaled iloprost therapy in children. METHODS: A total of 20 patients with either idiopathic or associated pulmonary arterial hypertension were treated with iloprost between April, 2003 and January, 2010. The median age and weight of the patients were 3.8 years--ranging from 4 months to 19 years--and 12.3 kilograms--ranging from 4 to 73 kilograms-- respectively. Pulmonary arterial hypertension was idiopathic or hereditary in eight patients (40%) and associated with congenital cardiac disease in 12 patients (60%). RESULTS: Of the 20 patients, 15 had combined therapy--12 patients with two and three patients with three different classes of drugs. In all, six patients died during follow-up. The median follow-up time was 18 months, ranging from 6 to 74 months. The 6-minute walking test was performed in 7 out of 20 patients at baseline and on follow-up. The median 6-minute walking test increased from 420 to 490 metres after iloprost therapy (p = 0.028). After initiation of iloprost therapy, one patient complained of headache and another had a rash around his mouth, none necessitating discontinuation of therapy. Overall compliance with inhaled iloprost was good. CONCLUSION: Pulmonary hypertension is associated with significant morbidity and mortality. Careful assessment of each patient and timely combination of specific vasodilator therapy is needed to improve clinical outcomes. This study suggests that inhaled iloprost, with or without concomitant endotelin receptor antagonist and/or phosphodiesterase inhibitor, is safe and efficacious for treatment of pulmonary arterial hypertension in children.

Clinical features and mid- and long-term outcomes of pediatric patients with subclinical carditis.

A study to examine mid- and long-term outcomes in patients with subclinical carditis was conducted. Data obtained at the time of diagnosis and during the follow-up of 158 patients diagnosed with subclinical carditis were retrieved and analyzed. Most patients had isolated mitral insufficiency. Frequency of morphological changes in the mitral valve was significantly lower in patients with at least one additional Jones criterion both at baseline (10.3% vs. 48.8%, p < 0.01) and at the end of the follow-up (27.8% versus 43.5%, p = 0.11). Mean jet size for mitral (12.0 +/- 8.8 versus 18.2 +/- 5.5 mm, p < 0.01) and aortic (4.1 +/- 4.0 versus 14.0 +/- 5.8 mm, p = 0.008) insufficiency were decreased compared to baseline. Improvement in mitral insufficiency was more frequent among patients with more than five years of follow-up (82.6% versus 60.0%, p = 0.039). Subclinical carditis due to acute rheumatic fever is not a benign and temporary condition. These patients should be given secondary prophylaxis.

Analysis of idiopathic ventricular tachycardia in childhood.

Idiopathic ventricular tachycardia (VT) is a relatively benign and rare form of VT. It is seen in young people without demonstrable cardiac pathology. The aim of our study was to review the clinical picture of idiopathic VT, before evaluating the indications for antiarrhythmic treatment and the efficacy of radiofrequency ablation (RFA). The notes of patients diagnosed with idiopathic VT in the last 13 years (n: 22) were included in the study. The median age of onset was 11 years (1 month-16 years). We evaluated the findings regarding the diagnosis, treatment and prognosis of these patients. The most common initial symptom was palpitation, in 15 cases. Five children with idiopathic VT were symptom-free. VT was of right ventricular origin in 10 patients and left ventricular origin in 8 patients. Beta-blockers were the mainstay of medical treatment in right VT and calcium channel blockers (Ca-channel blocker) were mostly used in left VT cases. The success rate of RFA was 57% in right VT and 100% in left VT. The median follow-up was 41 months (9 months-60 months), and all patients are alive currently with no symptoms. VT without demonstrable cardiac pathology is associated with a good prognosis. Treatment is unnecessary for asymptomatic non-sustained VT. RFA is useful in patients with symptomatic drug-refractory idiopathic VT arising from the left or right ventricle.

Midterm experience with implantable cardioverter-defibrillators in children and young adults.

AIMS: This single-centre study was undertaken to review our experience with implantable cardioverter-defibrillator (ICD) implantation in children with relatively different aetiologies. METHODS AND RESULTS: We retrospectively reviewed the records of the paediatric patients who underwent ICD implantation between October 2001 and December 2008. The data of these patients were collected by reviewing the patients' medical records and computerized departmental pacemaker databases. A total of 28 patients who underwent ICD implantation during this period were included in this study. The median age was 12 years and median weight was 32 kg. Most of the patients had ion-channel diseases (n = 13) or cardiomyopathy (n = 11). Devices were implanted for either secondary (n = 22) or primary (n = 6) prevention. The selected ICD generator type was single chamber in 22 patients, dual chamber in 5 patients, and biventricular in 1. Nineteen patients received 122 shocks. Fifteen of 22 patients (68.2%) from the secondary prevention group and 2 of 6 patients (33.3%) from the primary prevention group experienced at least one appropriate shock during a median period of 11.3 months (range: 4 days-6.5 years). Forty-two inappropriate shocks were delivered in seven (31.8%) patients from the secondary prophylaxis group during a median period of 11.3 months. The most important reason for inappropriate shocks was T-wave oversensing. In six patients, lead-related acute or chronic complications occurred. CONCLUSION: The ICD was safe and effective in interrupting malignant arrhythmias in children and adolescents with a high risk of sudden cardiac death. However, the occurrence of lead complications is significant. The incidence of therapies delivered by the device, with appropriate and inappropriate shocks, was high and interfered with the quality of life. The most important reason for inappropriate shocks was T-wave oversensing. Careful programming is mandatory to reduce the inappropriate shocks.

Transesophageal electrophysiologic study to determine the inducibility after successful ablation of supraventricular tachycardia in children.

BACKGROUND: Radiofrequency ablation has become first-line therapy for supraventricular tachycardia in all age groups, but there has been a concern regarding the long-term effectiveness of the procedure in children. This study aimed to determine the inducibility after successful ablation of supraventricular tachycardia in children; assessment was performed using a transesophageal electrophysiologic study. RESULTS: A total of 63 patients who had been treated successfully for supraventricular tachycardia with radiofrequency ablation were included in the study. A transesophageal electrophysiologic study was performed 2 months after radiofrequency ablation. Tachycardia was induced in nine of 34 symptomatic and five of 29 asymptomatic patients by a transesophageal electrophysiologic study. Ten patients had recurrence of the same type of supraventricular tachycardia seen previously, and two had a new type of arrhythmia during a transesophageal electrophysiologic study. Tachycardia inducibility rate was 16% in all patients, 22.8% in patients with atrioventricular reentrant tachycardia, and 8% in patients with atrioventricular nodal reentrant tachycardia. CONCLUSION: Radiofrequency ablation is a safe and effective method to manage children with supraventricular tachycardia, but patients must be observed for recurrence and new arrhythmias. Sustained tachycardia may also be induced in asymptomatic patients. A transesophageal electrophysiologic study is effective and safe for follow-up of radiofrequency ablation for assessment, diagnosis, and treatment of patients.

Clinical experiences of patients with catecholaminergic polymorphic ventricular tachycardia.

Catecholaminergic polymorphic ventricular tachycardia is a rare entity that can occur in children without cardiac disease and with a normal QT interval. It may cause syncope, convulsions, and sudden death during physical activity or emotional distress. We report the clinical features, treatment, and follow-up of 16 children with this diagnosis, emphasizing the potentially fatal nature of the disease.The mean age of patients at the onset of symptoms and at the time of diagnosis was 7.8 plus or minus 2.5 years, and 10.6 plus or minus 3.5 years, respectively. Syncope was the main complaint in 11, and 7 were treated as erroneously as having epilepsy. Diagnosis was confirmed by exercise and/or infusion of isoproterenol. Once the diagnosis was made, we started propranolol in all patients, and added verapamil if ventricular tachycardia was still inducible on a treadmill exercise test. An intracardiac defibrillator was implanted in 4 patients. Of the 16 patients, 4 died suddenly, giving a rate of mortality of 25%. In 2 of those dying suddenly, there was evidence of poor compliance to the recommended treatment. Another 2 patients had been resuscitated because of sudden cardiac arrest.Catecholaminergic polymorphic ventricular tachycardia must be considered in the differential diagnosis of syncope in children without heart disease but with a normal QT interval. Medical treatment with propranolol and verapamil may decrease the incidence of arrhythmia. Implantation of intracardiac defibrillators should be considered in those resistant to drug therapy. Delay in diagnosis, and inadequate treatment, can result in sudden cardiac death.

Isotretinoin (13-cis-retinoic acid)-associated premature ventricular contractions.

Isotretinoin (13-cis-retinoic acid), a synthetic vitamin A derivative, is used to treat a wide variety of dermatologic conditions including severe acne. Isotretinoin can trigger premature ventricular contractions (PVCs). We describe a 17-year-old boy who presented with PVCs on electrocardiogram during isotretinoin (Roaccutane, Roche) treatment for nodular facial acne. Presence of documented PVCs -on electrocardiogram and Holter monitoring- and the disappearance of these PVCs after cessation of the treatment strongly suggest isotretinoin-related PVCs in our case. The impact of isotretinoin on ventricular rhythm can not be ruled out in our case as we have revealed the presence of the temporal association of isotretinoin and documented PVCs. Thus, clinicians should be aware of possible arrhythmogenic effect(s) of isotretinoin.

Clinical importance of transesophageal electrophysiologic study in the management of supraventricular tachycardia in children.

Transesophageal electrophysiologic study (TEEPS) is a semi-invasive method widely used for evaluation of symptoms related to arrhythmia. In this study, we aimed to determine the accuracy of TEEPS in the diagnosis and differentiation of mechanisms of supraventricular tachycardias (SVTs) by comparing results of transesophageal and intracardiac electrophysiologic studies. We performed TEEPS and a subsequent radiofrequency ablation (RFA) procedure in 76 patients. Indications of TEEPS were risk assessment for Wolff-Parkinson-White syndrome in 32 patients and diagnosis and differentiation of tachycardia mechanisms in 44 patients. The procedure was well tolerated in all patients. Positive predictive value of TEEPS in our study was 91% for differentiation of SVT mechanisms. The results suggest that TEEPS is safe, useful and effective in the evaluation of symptoms related to arrhythmia, in differentiation of mechanisms of SVTs, and finally in defining the treatment options of SVT. The technique also provides an opportunity for risk assessment and deciding the treatment modality in Wolff-Parkinson-White patients.

Treatment of dilated cardiomyopathy with carvedilol in children.

We performed a study to examine the clinical use of carvedilol, its dosage and its effects on systolic functions in children. Twenty-one patients with dilated cardiomyopathy who were treated with carvedilol adjacent to standard heart failure therapy were enrolled in the study. Echocardiographic assessment was obtained before and during carvedilol therapy, and left ventricular fractional shortening and left ventricular ejection fraction were determined in order to estimate left ventricular function. At a follow-up of six months, left ventricular ejection fraction and fractional shortening significantly improved from 38 +/- 10% to 53 +/- 13% and from 19 +/- 6 % to 27 +/- 8%, respectively, following carvedilol treatment. The results of the present study indicate that carvedilol is well tolerated in children with dilated cardiomyopathy and there is a significant improvement in the clinical status and left ventricular ejection fraction in patients not responding to conventional therapy. Patient selection criteria, optimal timing of carvedilol therapy, its dosage and its long-term effects need to be investigated with multi-institutional trials and large numbers of patients.

Congenital aortic stenosis: a novel technique for ventricular pacing during valvuloplasty.

OBJECTIVES: The main objective of this study is to describe a new technique for rapid ventricular pacing to maintain balloon stability during balloon aortic valvuloplasty (BAV) without using transvenous temporary pacemaker electrode. BACKGROUND: The safety and efficacy of rapid right ventricular pacing to facilitate balloon stability during BAV has been previously reported. However, it necessitates an additional femoral venous access, an additional sheath, and a temporary pacemaker electrode. METHODS: This was a prospective pilot study. Rapid ventricular pacing was performed through back-up guidewires inserted into the left ventricle for balloon advancement and by an adhesive patch placed on the back of the patient. The technique was performed during BAV procedure in all of 15 consecutive children diagnosed as congenital aortic stenosis. Pacing was performed at a rate decreasing systolic aortic pressure to the point of 40-50% of baseline. RESULTS: The technique was successful in all patients. Effective capture, stable pacing, and balloon stability were achieved in all children using very low outputs. No sustained arrhythmias or other procedure-related complications occurred. Mean aortic valve gradient decreased from 68.5 +/- 20.4 mm Hg to 20.4 +/- 10.2 mm Hg. Degree of aortic regurgitation progressed from grade 0 to 1 in three patients and remained unchanged in 12 patients. CONCLUSIONS: This study demonstrated that back-up guidewires can be used effectively and safely for pacing during BAV procedures. This technique omits probable complications related to a second vascular access and may shorten the procedure time and decreases costs by eliminating the use of an additional sheath and a temporary pacemaker electrode.

Premature ventricular contractions in normal children.

Premature ventricular contractions (PVCs) are frequently seen in children with normal cardiac findings. The purpose of this study was to evaluate the characteristics and the prognosis of PVCs in children with normal heart. This study included 149 children with PVC who did not have systemic or cardiac disease. Their median age at diagnosis was 10 years (range 1 month to 17 years). Seventy-six children (51%) were symptomatic. Most of the patients had unifocal PVC, whereas 5 (3.1%) of them had multifocal PVCs. The patients were evaluated by repeated Holter recordings and exercise test. In the first Holter monitoring recordings, PVCs were in the form of isolated PVC in 122 (82%) patients, couplet-triplet in 14 (9%) patients and nonsustained ventricular tachycardia in 13 (9%) patients. The exercise test was performed in 105 (70.5%) patients. The frequency of PVCs decreased and disappeared in 65 (61.9%) children, increased in 8 (7.6%), and were unchanged during exercise in 32 (30.5%). There was no difference between the groups according to exercise response regarding PVC quantity. Fifty-two of 149 children (35%) were followed up for a median period of 22 months. After follow-up, PVCs of 25 of the 52 patients (48.1%) decreased and disappeared. We did not find any correlation between the frequency of PVC and treatment, age, gender or the PVC frequency decrease with exercise. In conclusion, PVCs in normal children have benign prognosis and during follow-up a considerable percent show improvement.

Device closure of congenital ventricular septal defects with Amplatzer devices: first experiences in Turkey.

Ventricular septal defects (VSD), which cause volume overload, may be closed by interventional method. The success depends on the precise anatomic definition of the defect and its relation to other cardiac structures. We report our first experiences of transcatheter closure of perimembranous and muscular VSD. Between May 2005 and September 2006, transcatheter closure of VSD was attempted in 38 patients. Implantation was successful in 37 patients. In one patient, the procedure failed because of the long sheath kinking. We observed important complications in three patients: severe tricuspid valve regurgitation, residual VSD and tricuspid valve regurgitation and right bundle branch block in the short-term follow-up. Transcatheter device closure with Amplatzer device seems to be effective and safe in the treatment of perimembranous and muscular VSDs. Tricuspid valve incompetence may cause problems. Long-term results are required to determine the efficacy and safety.

Transesophageal electrophysiologic study in children and young patients.

Transesophageal electrophysiologic study (TEEPS) is a semi-invasive method of atrial stimulation and recording. The aim of the study was to report our experience with TEEPS in children and young adults. A total of 153 TEEPS were performed in 147 consecutive patients aged between 26 days to 26 years (mean 9.8 years) with the following indications: evaluation of symptoms that may be signs of any arrhythmias in 89 procedures (Group A), risk assessment of Wolff-Parkinson-White syndrome (WPW) in 17 procedures (Group B), determination of the mechanism of previously detected or ongoing tachycardia on ECG or Holter monitoring in 22 procedures (Group C), assessment of antiarrhythmic therapy effectiveness in 17 procedures (Group D), and follow-up of radiofrequency ablation procedure (RFA) in 8 procedures (Group E). A similar pacing protocol was performed for induction of tachycardia in each patient. Tachycardia was induced in a total of 72 procedures (72/153, 47%): 32/89 (36%) in Group A, 13/17 (76.5%) in Group B, 12/22 (54.5%) in Group C, 12/17 (70.6%) in Group D and 3/8 (37.5%) in Group E. In Group A, the ventriculoatrial (VA) interval of inducible tachycardia was found to be shorter than 70 msec in 16/32 (50%) and longer than 70 msec in 12/32 (37.5%) patients and these patients were diagnosed as having atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT), respectively. In this group, 1 atrial tachycardia, 2 junctional ectopic tachycardia, 1 sinus node reentrant tachycardia and 1 permanent junctional reciprocating tachycardia (PJRT) were also diagnosed. In conclusion, transesophageal atrial stimulation is a valuable tool in the initial evaluation of patients with symptoms possibly related with arrhythmia or in the management of patients who have any arrhythmia.