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  • 1
    Electronic Resource
    Electronic Resource
    Concurrent Failure of Active and Redundant Ventricular Epicardial Electrodes in Children (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 2 (1989), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Implanting an unused or redundant epicardial ventricular pacing electrode in children at the time of initial electrode placement for later use is a common practice. To investigate the ultimate utilization of this redundant electrode, the records of 38 children who had undergone implantation of 47 redundant epicardial electrodes between 1974 and 1987 were reviewed. As the primary electrode remains functional, 12 electrodes have not been in-vasively tested or used; 11 were in nine children lost to follow-up. The remaining 24 redundant electrodes implanted in 16 children, (ages 1 day to 18 years, median 5 years, at implantation) together with the utilized electrode were evaluated at the time of pacing system revision. At implant, all electrodes had thresholds 〈 1.4 volts at a pulse duration of0.5 msec. At follow-up 0.2 to 11.7 years (mean 3.7 years) after implant, an electrode was considered functional if the threshold at 0.5 msec pulse duration was 〈 2.5 volts, and 14 of 24 redundant electrodes were nonfunctional. Of the ten functional redundant electrodes, the active electrode was functional in seven cases. In only three of 24 cases was the redundant electrode functional when the active electrode was nonfunctional. In all cases, when the active electrode exhibited exit block, the redundant electrode also exhibited exit block. Two of five redundant electrodes paired with a fractured active electrode were fractured. Two other redundant electrodes were fractured when the active electrode was functional. The state of the redundant and the active electrode was the same in 80% of the cases, P 〈 0.03. Of the 36 redundant electrodes implanted for which follow-up data is available, 33 had not been used by the end of the study period. (J Interven Cardiol 1989:2:1)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1989.tb00752.x
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  • 2
    Electronic Resource
    Electronic Resource
    Tachycardia Related Cardiomyopathy: Response to Control of the Arrhythmia (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 2 (1989), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To evaluate the clinical response of five children with automatic atrial tachycardia (AAT) and associated cardiomyopathy to arrhythmia control, we compared pretreatment and posttreatment 24-hour ECG heart rates, cardiothoracic ratio by chest radiograph, and echocardiographic measures of ventricular function. Two children were treated with amiodarone, two with surgical excision and cryoablation of the ectopic focus, and one with digoxin alone. Significantly slower mean heart rates were achieved, along with a dominant sinus rhythm and improvement in symptoms. Control of the AAT resulted in improved mean cardiothoracic ratio (0.53 pre vs 0.49 post; P = 0.02), as well as improvement in a number of echocardiographic measurements: mean shortening fraction (20% pre vs 34% post; P = 0.006), mean ejection fraction (36% pre vs 50% post; P 〈 0.01), mean velocity of circumferential fiber shortening (0.62 pre vs 1.20 post; P = 0.003). Mean E-point septal separation corrected for end-diastolic dimension also showed a trend toward improvement (0.25 pre vs 0.16 post; P = 0.11). Right ventricular endocardial biopsies in four were nonspecific; an atrial biopsy from surgery showed a Purkinje fiber-like tissue in one patient, but was nonspecific in another. We conclude that cardiomyopathy can be causally linked to automatic atrial tachycardia and that aggressive medical and/or surgical management is warranted in those patients with signs and symptoms of impaired ventricular function. (J Interven Cardiol 1989:2:4)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1989.tb00780.x
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  • 3
    Electronic Resource
    Electronic Resource
    Prospective Assessment after Pediatric Cardiac Ablation: (2004)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 15 (2004), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: 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. (J Cardiovasc Electrophysiol, Vol. 15, pp. 759-770, July 2004)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.03645.x
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  • 4
    Electronic Resource
    Electronic Resource
    Prospective Assessment After Pediatric Cardiac Ablation: Design and Implementation of the Multicenter Study (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: VAN HARE, G.F., et al.: Prospective Assessment After Pediatric Cardiac Ablation: Design and Imple-mentation of the Multicenter Study. 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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.00332.x
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  • 5
    Electronic Resource
    Electronic Resource
    Use of a Single Coil Transvenous Electrode with an Abdominally Placed Implantable Cardioverter Defibrillator in Children (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: While transvenous defibrillator electrode placement avoiding a thoracotomy is preferable, electrode size, a large intercoil spacing, and the need for subclavicular device placement preclude this approach in most children. We investigated a single RV coil to an abdominally placed active can ICD device. Five children ages 8–16 years (weight 21–50 kg, mean 35 kg) underwent ICD placement. Placement of a single coil Medtronic model 6932 or 6943 electrode was performed via the left subclavian vein approach and the electrode positioned in the RV apex with the coil lying along the RV diaphragmatic surface. The ICD (Medtronic Micro Jewel II model 7223Cx) was implanted in a left abdominal pocket with the lead tunneled from the infraclavicular region to the pocket. Implant DFTs were ± 15 J using a biphasic waveform. DFTs rechecked within 3-month postimplant were unchanged. Lead impedance at implant ranged from 38 to 56 Ω, mean 51 Ω. Follow-up was 3–21 months (total 82 months) with no electrode dislodgment. lead fractures, or inappropriate discharges. Two of the five patients have had successful appropriate ICD discharges. Transvenous ICD electrode placement can be performed in children as small as 20 kg with the device implanted in a cosmetically acceptable abdominal pocket that is well tolerated. Excellent DFTs can be achieved. This approach avoids a thoracotomy in all but the smallest child, does not require subclavicular placement of the device, and avoids use of a second intravascular coil.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2000.tb00859.x
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  • 6
    Electronic Resource
    Electronic Resource
    Heart block in children (1982)
    Springer
    Pediatric cardiology 2 (1982), S. 39-45 
    Details
    ISSN: 1432-1971
    Keywords: Congenital heart block ; Surgical heart block ; Syncope ; Pacemaker function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To evaluate subsidiary ventricular pacemaker function in 20 children with congenital or surgically induced complete heart block, we measured recovery times following overdrive ventricular pacing. Long-term ECG tape recordings were performed in eight of these children. Ages ranged fom 1 month to 17 years. The resting R-R intervals ranged from 595 to 1,740 msec. The ventricles were paced at various cycle lengths of 400 to 1,000 msec with either transvenous electrode catheters or surgically implanted epicardial electrodes. His bundle recordings showed that the site of block did not allow separation of patients with symptoms from those without symptoms. Prolonged recovery times were present in patients with block above the His bundle recording site who had symptoms of syncope or dizziness, as well as in patients who had a wide QRS. However, some asymptomatic patients with heart block above the His bundle recording site also had long recovery times. None of the asymptomatic patients who had ECG tape recordings had paroxysmal tachycardia in more than 300 hours of recordings. However, one symptomatic patient with congenital heart block and a prolonged recovery time had brief episodes of paroxysmal ventricular tachycardia that produced no symptoms at the time of recording. The results suggest that the coexistence of prolonged recovery times and paroxysmal tachycardia may be predisposing factors to the development of symptoms in patients with complete heart block. We believe that further electrophysiologic investigation of this possibility is warranted in patients with heart block.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02265615
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  • 7
    Electronic Resource
    Electronic Resource
    Partial anomalous pulmonary venous connection to the azygos vein with intact atrial septum (1986)
    Springer
    Pediatric cardiology 7 (1986), S. 115-117 
    Details
    ISSN: 1432-1971
    Keywords: Anomalous pulmonary venous drainage ; Congenital heart disease ; Cardiac catheterization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The case of a 13-year-old girl with an unusual form of partial anomalous pulmonary venous connection is reported. Cardiac catheterization revealed anomalous connection of the right pulmonary veins to the azygos vein and an intact atrial septum. Rationale for nonsurgical management and four-year follow-up results are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02328962
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  • 8
    Electronic Resource
    Electronic Resource
    Surgical management of children and young adults with the Wolff-Parkinson-White syndrome (1988)
    Springer
    Heart and vessels 4 (1988), S. 229-236 
    Details
    ISSN: 1615-2573
    Keywords: Wolff-Parkinson-White ; Surgery ; Supraventricular tachycardia ; Sudden death ; Electrophysiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The Wolff-Parkinson-White syndrome, as originally described, includes palpitations, tachycardia, and an abnormal electrocardiogram (short PR interval and wide QRS complex). The clinical manifestations are dependent upon a reentrant tachycardia supported by an accessory connection bridging the atrioventricular junction and frequently appear during the first two decades of life. Palpitations are the usual symptoms; less frequently, severe symptoms, such as syncope and sudden death, may result from very rapid atrioventricular conduction across the accessory connection during atrial fibrillation. We report the surgical management of 30 young patients with this syndrome, including 6 with life-threatening tachycardia. Surgical interruption of the accessory connection(s) was curative in 90% (27/30) of the patients; life-threatening symptoms were eliminated in the other three. Based on the limited knowledge of the natural history of the Wolff-Parkinson-White syndrome, the individual patient symptoms, and the electrophysiologic properties of each patient's accessory pathway(s), an algorithm is presented outlining the treatment options. This experience strongly suggests that surgical treatment of the Wolff-Parkinson-White syndrome is safe, effective, and possibly the preferred treatment for this disorder in selected young symptomatic patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02058591
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