ARRHYTHMIAS IN CHILDREN WITH PERIPHERALLY INSERTED CENTRAL CATHETERS (PICCS)

Abstract

s S35 METHODS: Pregnancies complicated by fetal PA-IVS, fetal HLHS, and healthy pregnancies with no maternal or fetal pathology were prospectively recruited. Echocardiograms were performed at 37 weeks gestational age (fetal), 4-6, 20-24, and 40-48 hours for all neonates, and at 3-5 days for neonates with HLHS and PA-IVS. Semilunar valve diameters were recorded and Dopplerderived velocity time integrals (VTI) of outflows were used to determine stroke volume (SV) (valve radius x VTI) and CCO (heart rate (HR) x SV, reported as cc/ kg/min). Middle cerebral artery (MCA) pulsatility index (PI) ([maximum velocity-minimum velocity] /mean velocity) was also determined. RESULTS: Four PA-IVS, 11 HLHS patients, and 9 controls were prospectively recruited for this study. In PA-IVS there was no change in HR, SV or CCO of the single LV from the fetal stage to 3-5 days, findings comparable to that of controls. In contrast, in HLHS, the single RV demonstrated a progressively increasing CCO from 48 hours onward which was associated with an increase in SV and less marked increase in HR. MCA PI was low in fetuses with both PA-IVS and HLHS, suggesting possible brain sparing, but increased relative to controls in the first 4-6 hours and remained higher thereafter. This effect was more marked in HLHS than PAIVS. CONCLUSION: Within the first 24 hours after birth, the single LV in PA-IVS and RV in HLHS maintain a CCO comparable to that of the late gestation normal fetus. Although the CCO does not change thereafter in the single LV and biventricular circulation, the single RV in HLHS demonstrates increasing CCO, differences that could relate to variability in ductus arteriosus size and pulmonary vascular resistance. Despite differences in CCO, MCA PI flow patterns were comparable in the single LV and RV and could reflect cerebral steal after birth. Women & Children’s Health Research Institute, Mazankowski Alberta Heart Institute, University of Alberta 067 ARRHYTHMIAS IN CHILDREN WITH PERIPHERALLY INSERTED CENTRAL CATHETERS (PICCS) S Dhillon, B Connolly, R Hamilton Halifax, Nova Scotia BACKGROUND: Cardiac arrhythmias may occur as a complication after peripherally inserted central catheters (PICCs) in children. We sought to analyze the incidence, types and timing of arrhythmias and associated risk factors with PICCs in children. METHODS: We reviewed retrospectively 3180 children with PICC line (<18 yrs old) from January 2009 to June 2013 at the Hospital for Sick Children, Toronto. The patients who developed arrhythmias related to PICC line insertion were selected from hospital mortality and morbidity records, vascular & ECG database and cardiology consults. Information about demographics, timing and type of arrhythmias and possible risk factors were obtained. ECGs, rhythm strips, physician’s record or administration of antiarrhythmic medications were used to confirm arrhythmias. The position of tip of PICC into superior vena cava or heart determined by calculating rib count (RC), vertebra count (VC) and length from carina (CTL) on chest x-rays and fluoroscopic images (27 cases, 29 controls) at the time of insertion (Table). Cases were matched (1:1 ratio) to controls with age and date of insertion. Statistical analysis performed using two-tail, unpaired with unequal variance t test. A two sided p value<0.05 was considered significant. RESULTS: As shown in Table, 31 (1%) (17 males) developed arrhythmia after 14.8 23.2 (mean SD) catheter days. There were 17 cases (13 controls), 12 cases (7 controls), and 8 cases (4 controls) with underlying structural heart disease (SHD), history of previous arrhythmias and inotrope use respectively. 22 (71%) and 10 (32%) children developed atrial and ventricular arrhythmia respectively. 23 (74%) patients were less than 1 year old. 17 (55%) & 13 (42%) required treatment with antiarrhythmic agents and exchange or manipulation of PICC respectively. Catheter ablation, overdrive pacing and direct cardioversion were performed in two patients each. All arrhythmias resolved completely with exchange or removal of PICC line except nine patients who were maintained on antiarrhythmic agents till follow up. Two children died and two required ECMO unrelated to arrhythmia during study period. Comparison of X-ray findings is shown in table. CONCLUSION: This study showed that the incidence of arrhythmia secondary to PICC line insertion in children is low (1%). Children who developed arrhythmia were found to have a significantly more low-lying tip compared to controls at the time of insertion. However, there was a trend of higher number of children with arrhythmia having structural heart disease and inotropic therapy suggestive of suboptimal cardiac status.