Tachyarrhythmias In Children Research Articles

Sympathetic denervation — a promising method for treatment of ventricular tachyarrhythmia in children

Ventricular tachycardia is a rare but potentially life-threatening arrhythmia. Ventricular tachycardia in patients with structural pathology and cardiac channelopathies is associated with the highest risk of sudden cardiac death. The stratification of patients depending on the risk of developing a life-threatening arrhythmia determines the choice of treatment method. Left cardiac sympathetic denervation is a surgical method of treatment aimed at preventing attacks of ventricular tachycardia. The antiarrhythmic effect of sympathetic denervation has been proven in both experimental and clinical studies. Currently, the technique of left cardiac sympathetic denervation consists of a video-assisted sympathectomy by thoracoscopic access, which makes the procedure safe and effective. Left cardiac sympathectomy is used in the treatment of patients with recurrent ventricular tachycardia despite adequate medical therapy. The authors recommend the use of left cardiac sympathectomy in those types of channelopathies, in which stress is the main proven provoking factor of ventricular tachycardia.

A novel image integration technology mapping system significantly reduces radiation exposure during ablation for a wide spectrum of tachyarrhythmias in children.

Radiofrequency catheter ablation (RFCA) has evolved into an effective and safe technique for the treatment of tachyarrhythmia in children. Concerns about children and involved medical staff being exposed to radiation during the procedure should not be ignored. "Fluoroscopy integrated 3D mapping", a new 3D non-fluoroscopic navigation system software (CARTO Univu Module) could reduce fluoroscopy during the procedure. However, there are few studies about the use of this new technology on children. In the present study, we analyzed the impact of the CARTO Univu on procedural safety and fluoroscopy in a wide spectrum of tachyarrhythmias as compared with CARTO3 alone. The data of children with tachyarrhythmias who underwent RFCA from June 2018 to December 2021 were collected. The CARTO Univu was used for mapping and ablation in 200 cases (C3U group) [boys/girls (105/95), mean age (6.8 ± 3.7 years), mean body weight (29.4 ± 7.9 kg)], and the CARTO3 was used in 200 cases as the control group (C3 group) [male/female (103/97), mean age (7.2 ± 3.9 years), mean body weight (32.3 ± 19.0 kg)]. The arrhythmias were atrioventricular reentrant tachycardia (AVRT, n = 78), atrioventricular node reentrant tachycardia (AVNRT, n = 35), typical atrial flutter (AFL, n = 12), atrial tachycardia (AT, n = 20) and ventricular arrhythmias [VAs, premature ventricular complexes or ventricular tachycardia, n = 55]. ① There was no significant difference in the acute success rate, recurrence rate, and complication rate between the C3 and C3U groups [(94.5% vs. 95.0%); (6.3% vs. 5.3%); and (2.0% vs. 1.5%); P > 0.05]. ② The CARTO Univu reduced radiation exposure: fluoroscopy time: AVRT C3: 8.5 ± 7.2 min vs. C3U: 4.5 ± 2.9 min, P < 0.05; AVNRT C3: 10.7 ± 3.2 min vs. C3U: 4.3 ± 2.6 min, P < 0.05; AT C3: 15.7 ± 8.2 min vs. C3U: 4.5 ± 1.7 min, P < 0.05; AFL C3: 8.7 ± 3.2 min vs. C3U: 3.7 ± 2.7 min, P < 0.05; VAs C3: 7.7 ± 4.2 min vs. C3U: 3.9 ± 2.3 min, P < 0.05. Corresponding to the fluoroscopy time, the fluoroscopy dose was also reduced significantly. ③ In the C3U group, the fluoroscopy during VAs ablation was lower than that of other arrhythmias (P < 0.05). The usage of the "novel image integration technology" CARTO Univu might be safe and effective in RFCA for a wide spectrum of tachyarrhythmias in children, which could significantly reduce fluoroscopy and has a more prominent advantage for VAs ablation.

Abstract 14388: Efficacy of Intravenous Procainamide for Treatment of Tachyarrhythmia in Children

Introduction: The safety and efficacy of IV procainamide is well established in adults, however data in pediatrics is more limited. Methods: Prospective cohort study including children &lt;18 yrs old who received IV procainamide for supraventricular tachycardia (SVT) or junctional ectopic tachycardia (JET) from June 2020 to May 2021. A severity of arrhythmia score (SAS, table), including arrhythmia density score (ADS), hemodynamic severity and need for adjunctive antiarrhythmic therapy was calculated pre and post procainamide. Full success was defined as decrease of the ADS to 0 and partial success as decrease by ≥50%. Results: Fifty-three patients (6.9 [IQR 1.2-34.9] months) received IV procainamide for treatment of SVT (n = 25, 47%) or JET (n = 28, 52%), including 44 (83%) with congenital heart disease (CHD) and 39 (74%) following cardiac surgery. Fifty (93%) patients were given a bolus (median 5 mg/kg, range 2.5-13 mg/kg) and 52 (96%) received an infusion (median 20 mcg/kg/min, range 10-30 mcg/kg/min). Full success was observed in 28 (53%) patients, partial success in 13 (25%) and failure in 12 (23%); 7 (19%) patients required adjunctive IV antiarrhythmic therapy. Median SAS decreased from 6 (IQR 4-8) to 1 (IQR 1-5) following procainamide. Procainamide bolus &gt;5 mg/kg was associated with greater decrease in SAS (median decrease 5 [4-6] vs 2 [0-4], p = 0.04). Children with CHD (median decrease 1 [IQR 0-4] vs 4 [IQR 4-5], p = 0.04), those in the early post-operative period (median decrease 2 [IQR 0-4] vs 4 [IQR 4-5], p = 0.03) and those with JET (median decrease 2 [IQR 0-4] vs 4 [IQR 2-5], p = 0.04) had less improvement in SAS score with procainamide. Conclusions: IV procainamide is effective for treatment of SVT and JET in children, and associated with decreased SAS even in patients without complete rhythm control. Higher procainamide bolus dose should be considered for increased efficacy. Future studies are needed to identify optimal doses in pediatrics.

Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation.

BackgroundCatheter ablation (CA) is the first-choice treatment for tachyarrhythmia in children. Currently available CA techniques differ in mechanism of catheter navigation and energy sources. There are no large studies comparing long-term outcomes between available CA techniques in a pediatric population with atrioventricular reentry tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms.ObjectiveThis study aimed to compare procedural and long-term outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO).MethodsThis single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT performed in children without structural heart disease from 2008 to 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was long-term recurrence of tachyarrhythmia.ResultsIn total, we included 223 patients, aged 14 (IQR 12–16) years; weighting 56 (IQR 47–65) kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using CRYO. RMN had significantly lower recurrence rates compared to MAN and CRYO at mean follow-up of 5.5 ± 2.9 years (AVRT: 4.3% versus 15.6% versus 54.5%, P < 0.001; AVNRT: 7.7% versus 8.3% versus 35.7%, P = 0.008; for RMN versus MAN versus CRYO respectively). In AVNRT ablation, RMN had significantly lower fluoroscopy doses compared to CRYO [30 (IQR 20–41) versus 45 (IQR 29–65) mGy, P = 0.040).ConclusionIn pediatric patients without structural heart disease who underwent their first AV(N)RT ablation, RMN has superior long-term outcomes compared to MAN and CRYO, in addition to favorable fluoroscopy doses.

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.

Clinical analysis of right atrial appendage aneurysms complicated by atrial tachyarrhythmias in three children

Objective: To investigate the clinical features and results of treatment for right atrial appendage aneurysms complicated by atrial tachyarrhythmias in children. Methods: This retrospective study included three children with right atrial appendage aneurysm complicated by atrial tachyarrhythmias (aged 1.0 to 5.3 years, weight 10 to 17.1 kg) who were hospitalized at the Pediatric Cardiology Department (Heart Center) of the First Hospital of Tsinghua University (Beijing Huaxin Hospital) during the period from January 2016 through April 2018. The patients' clinical features, the results of electrocardiogram (ECG) and echocardiography, the effects of therapeutic interventions (antiarrhythmics, radiofrequency ablation, and surgical resection of right atrial appendage aneurysm) and the results of pathological assessment were analyzed. Results: Three cases of right atrial appendage aneurysm were diagnosed at 36 weeks of gestational age, 1 month and 4 months after birth respectively. In two cases, ECG showed alternating episodes of atrial tachyarrhythmias including atrial tachycardia, atrial flutter, and atrial fibrillation, and echocardiography showed aneurysmal dilatation of right atrial appendage. These two cases underwent right atrial appendage aneurysm resection. In the remaining one case of atrial tachycardia, echocardiography did not visualize important lesions in the right atrium, thus the intracardiac electrophysiologic study and radiofrequency ablation were performed; and focal atrial tachycardia originating from the apex of right atrial appendage was mapped but failed to be ablated; consequently, the patient received the right atrial appendage resection, in which the right atrial appendage aneurysm was found. Preoperative multiple antiarrhythmics showed only modest or no efficacy for all the three cases. The atrial tachyarrhythmias disappeared in all the three cases after right atrial appendage aneurysm resection. Postoperative atrial tachycardias associated with new foci of impulse formation developed in two cases. These two patients reverted to normal sinus rhythm and remained in this rhythm by using antiarrhythmics. Pathological assessment showed cystic dilation of parts of atrial cavity, fibrosis of cyst wall, generalized fibrosis of atrial myocardium combined with myocardial atrophy and cystic dilation, as well as uneven myocardial thickness with generalized myocardial interstitial fibrosis. Conclusions: For patients with congenital right atrial appendage aneurysm, atrial tachyarrhythmias might develop during fetal stage or early postpartum period. Reliance on echocardiography might often lead to the missed diagnosis. These patients with atrial tachyarrhythmias responded poorly to antiarrhythmics. Radiofrequency ablation might be associated with a high risk and limited efficacy. Surgical resection of right atrial appendage aneurysm showed satisfactory results and should be highly recommended.

Sustained tachyarrhythmia in children younger than 1 year of age: Six year single‐center experience

The aim of this study was to evaluate the results of non-operational sustained tachyarrhythmia in patients <1year of age at the present center. Between November 2010 and November 2016, the demographic characteristics, type and localization of the tachyarrhythmia, echocardiographic findings, and medical and/or ablation therapy for patients <1year of age with sustained tachyarrhythmia were evaluated. Of 99 patients, 91 had sustained supraventricular tachycardia, and eight had sustained ventricular tachycardia. The median age was 30days (range, 1-350days), and the median weight was 4.2kg (range, 2-13kg). The common symptoms were palpitation and restlessness (n = 49, 49.5%), or the tachycardia was detected during routine inspection (n = 25, 25.3%) or fetal echocardiography (n = 11, 11.1%). Nineteen individuals (19%) had left ventricular (LV) dysfunction on first echocardiography. Twenty individuals had congenital heart disease. Common diagnoses were Wolff-Parkinson-White syndrome (n = 27), focal atrial tachycardia (n = 10), permanent junctional reciprocating tachycardia(n = 6), and atrial flutter (n = 6). Seventeen patients underwent medical therapy combined with cardioversion. The most commonly used abortive and acute therapy agents were adenosine, esmolol, and amiodarone. The most common combination therapy was propranolol and amiodarone, followed by a propranolol and propafenone combination. Nine individuals were treated with catheter ablation due to either resistance to medical therapy or LV dysfunction. Tachyarrhythmias in children <1year of age are mostly caused by accessory pathways and require multidrug therapy. Catheter ablation is an effective alternative therapy in the case of resistance to medical therapy and/or LV dysfunction.

Safety and Efficacy of Radiofrequency Catheter Ablation for Tachyarrhythmia in Children Weighing Less Than 10\xa0kg

An increasing number of children are undergoing radiofrequency catheter ablation (RFCA) for tachyarrhythmia. However, infants and toddlers undergoing RFCA are often resistant to medication or need to eliminate arrhythmia substrate, and the risks of RFCA complications are still high in infants and toddlers. From April 2008 and December 2016, 285 children who underwent radiofrequency catheter ablation (RFCA) were stratified according to body weight (group A, less than 10 kg, n = 22; group B, over 10 kg, n = 263) and the clinical features of RFCA were retrospectively reviewed in these groups. Indications for RFCA included drug-refractory tachyarrhythmia or symptomatic tachycardia and tachycardia-induced cardiomyopathy. The acute success rate in this group was 90.9%, with a relatively low recurrence rate (15.0%) after 7.0 ± 1.6 years follow-up. We performed RFCA using only 2–4 catheters in all cases. Major complications included complete right bundle branch block in one patient. No significant differences in rates of success, recurrence, or complications were noted between children weighing less and more than 10 kg. RFCA is safe and efficacious for tachyarrhythmia even in patients weighing less than 10 kg.

Epicardial ablation of tachyarrhythmia in children: Experience at two academic centers.

Experience with percutaneous epicardial ablation of tachyarrhythmia in pediatrics is limited. This case series addresses the feasibility, safety, and complications of the procedure in children. A total of nine patients underwent 10 epicardial ablation procedures from 2002 to 2013 at two academic centers. Activation mapping was performed in all cases, and electroanatomic map was utilized in nine of the 10 procedures. Patients had undergone one to three failed endocardial catheter ablations in addition to medical management, and all had symptoms, a high-risk accessory pathway (AP), aborted cardiac arrest with Wolff-Parkinson-White syndrome (WPW), or ventricular dysfunction. A standard epicardial approach was used for access in all cases, using a 7- or 8- Fr sheath. Epicardial ablation modality was radiofrequency (RF) in seven, cryoablation (CRYO) in one, and CRYO plus RF in one. Median age was 14 (range 8-19) years. drug refractory ectopic atrial tachycardia (one), ventricular tachycardia (VT) (five), high-risk AP (two), and aborted cardiac arrest from WPW - (one). Epicardial ablation was not performed in one case despite access due to an inability to maneuver the catheter around a former pericardial scar. VT foci included the right ventricular outflow tract septum, high posterior left ventricle (LV), LV outflow tract, postero-basal LV, and scar from previous rhabdomyoma surgery. WPW foci were in the area of the posterior septum and coronary sinus in all three cases. Overall procedural success was 70% (7/10), with epicardial ablation success in five and endocardial ablation success after epicardial mapping in two. The VT focus was close to the left anterior descending coronary artery in one of the unsuccessful cases in which both RF and CRYO were used. There was one recurrence after a successful epicardial VT ablation, which was managed with a second successful epicardial procedure. There were no other recurrences at more than 1 year of follow-up. Complications were minimal, with one case of inadvertent pleural access requiring no specific therapy. No pericarditis or effusion was seen in any of the patients who underwent epicardial ablation. Epicardial ablation in pediatric patients can be performed with low complications and acceptable success. It can be considered for a spectrum of tachycardia mechanisms after failed endocardial ablation attempts and suspected epicardial foci. Success and recurrence may be related to foci in proximity to the epicardial coronaries, pericardial scar, or a distant location from the closest epicardial location. Repeat procedures may be necessary.

Efficacy of Intravenous Sotalol for Treatment of Incessant Tachyarrhythmias in Children

Our objective was to evaluate the efficacy and safety of intravenous (IV) sotalol in the treatment of incessant tachyarrhythmias in children with normal cardiac function. Eighty-three children admitted to hospital from October 2011 to December 2014 were treated with IV sotalol or IV sotalol plus IV propafenone. The time to conversion to sinus rhythm and maintaining sinus rhythm were evaluated. Blood pressure, heart rate, QTc, PR intervals, and rhythm were monitored; 50 patients (60%) were converted to sinus rhythm with IV sotalol; time to conversion was 12.0 ± 18.0hours; 12 additional patients (15%) were converted with IV sotalol combined with IV propafenone; time to conversion was 13.1 ± 17.6hours. A total of 62 patients (75%) were converted. Success rates of IV sotalol for different tachycardias were similar, whereas the time to conversion differed. The time to conversion for atrioventricular reentrant tachycardia was shorter than atrial tachycardia or atrial flutter (p <0.05). QTc prolongation (from 253 to 486ms and from 398ms to 500ms) was seen in 2 patients (2%) within 48hours after conversion. The QTc reverted to normal range at 48 and 144hours, respectively, after withdrawal of IV sotalol. A 1month old with atrial flutter developed bradycardia (7:1 atrioventricular conduction) 5minutes after IV sotalol, and heart rate increased gradually after drug withdrawal. No other adverse effects were observed. In conclusion, IV sotalol can be safely and effectively used to terminate pediatric tachycardias in patients with normal cardiac function. No proarrhythmic or significant toxicities were detected. Close monitoring of QTc and heart rate is required after IV sotalol. Adding IV propafenone to IV sotalol in resistant cases enhance conversion.

Electroanatomical mapping systems and cardiac arrhythmias: avoiding radiations in pediatric patients

Introduction. Cardiac arrhythmias are challenging conditions in pediatric patients, especially in the case of newborns. Most of the tachyarrhythmias in children (90,24%) are atrioventricular reentrant tachycardias (AVRT) and atrioventricular nodal reentrant tachycardias (AVNRT). Although the standard 12-lead ECG maintains high diagnostic value, an invasive electrophysiological study and a catheter ablation are often required. Unfortunately these procedures are burdened by the use of radiations. Materials and Methods. We performed a systematic research in PubMed and Embase. We found 257 articles of interest but we selected only 36 as the most representative. Discussion: The main concerns linked to electrophysiological procedures are the need of fluoroscopy and thus the risk of malignancy as well as dermatitis, cataracts, thyroid diseases and birth defects. Children and especially newborns have a greater life expectancy so their cumulative risk is greater than adults. For this reason the guiding principle in electrophysiological procedures involving radiations in pediatric subjects is as low as reasonably achievable (acronym: ALARA). The development of 3-dimensional (3-D) electroanatomical mapping systems allowed a significant reduction of radiation exposure during ablations. The most recent experiences demonstrated the feasibility and the safety of fluoroless ablation procedures of the most common arrhythmias in children. Conclusions: Cardiac arrhythmias could be very challenging conditions in pediatric patients. Predictors of complications are a body weight <15 kg and an age <4 years so it is clear that newborns are the most difficult patients. It is reasonable, because of these evidences, to approach cardiac arrhythmias pharmacologically in younger subjects. More than 20 years of experiences conducted by the electrophysiologists allow us to encourage the use of the electroanatomical mapping systems, with the objective of reducing the radiation exposure in children, especially when accessory pathways are involved.

Diagnosis and Acute Management of Tachyarrhythmias in Children.

Tachyarrhythmias form a significant majority of the cardiac emergencies encountered in the pediatric age group. While the initial management often depends on the hemodynamic status of the patient at presentation, a systematic approach that follows the stabilization of the patient with the tools available at bedside, specifically the surface electrocardiogram often results in optimal treatment response that is tailored towards the mechanism and severity of the arrhythmia. The goal of this review is to provide the pediatric cardiologist with such an approach based on clinical history and analysis of the electrocardiogram (ECG). Illustrative examples are used to explain this approach towards the more common tachyarrhythmias. A general overview of the initial anti-arrhythmic interventions will be provided.

Interventional therapy of tachyarrhythmias in the pediatric population

Over the past decades, interventional therapy of tachyarrhythmias in children without structural heart disease has evolved as an alternative to chronic pharmacological treatment. Catheter ablation in children over 5 years with symptomatic tachycardia using radiofrequency- or cryoenergy is nowadays performed with high success and low complication rates at experienced centers. The use of modern technologies such as non-fluoroscopic 3-dimensional mapping has further increased efficacy and safety of catheter ablation, and has led to a significant reduction of fluoroscopy time and dose.Arrhythmia substrates treated most frequently by catheter ablation in children include accessory pathways (WPW syndrome) leading to atrioventricular reentrant tachycardia (AVRT) and dual AV nodal pathways causing atrioventricular nodal reentrant tachycardia (AVNRT). Success rates of catheter ablation for these substrates during long-term follow up are over 90 %. Less common forms of tachycardias in children, such as focal atrial tachycardia, ventricular outflow tachycardias or idiopathic left ventricular tachycardia, are also amenable to catheter ablation with good long-term results. In asymptomatic children with preexcitation on the surface ECG (accessory pathway with the risk of rapid antegrade conduction during atrial fibrillation) the indication for catheter ablation of the accessory pathway for the prevention of sudden cardiac death should already be evaluated during childhood.

Interventional treatment of tachyarrhythmia in children with congenital heart disease

In children and adolescents with congenital heart disease (CHD) tachyarrhythmia occurs more frequently compared to patients with otherwise normal hearts. Arrhythmia substrates may be a natural part of certain congenital cardiac malformations or may result from long lasting myocardial deterioration as a result of CHD and/or cardiac surgery. Treatment of tachycardia is more frequently required even in early childhood, as the impact on quality of life, morbidity and mortality is higher due to an often reduced hemodynamic tolerance. Over the past 20 years interventional electrophysiology has been established as the therapy of choice for the majority of chronic or chronically recurrent tachycardia even in children with CHD. The success and risks of treatment are predominantly influenced by the individual expression of the cardiac anomaly and, if surgery has been performed, the highly variant postoperative anatomy. Introduction of 3D electroanatomical mapping systems together with modern cardiac imaging tools have significantly contributed to an improved understanding, particularly in postoperative tachycardia. Despite such progress, success rates are lower and recurrences are more frequent compared to patients without CHD. Complex and often multiple tachycardia courses account for the still limited performance as well as a frequently insufficient lesion formation with the use of radiofrequency current in the hypertrophic and fibrotic myocardium. Electrophysiology in children and adolescents, particularly if CHD is present, represents a highly specialized discipline requiring a high expertise in CHD, CHD surgery and cardiac electrophysiology and is ideally imbedded within an interdisciplinary cardiological and cardiosurgical setting.

Radiofrequency catheter ablation can be performed with high success rates and very low complication rates in children and adolescents

Radiofrequency catheter ablation is a standard treatment for tachyarrhythmia in children. Recently, several centres using cryoenergy for ablation have reported high success and low complication rates, but an increased risk of recurrence of arrhythmia. The aim of this study was to report success, complications and recurrence rates for radiofrequency catheter ablation in children under current conditions. A retrospective cohort study of 333 consecutive children undergoing radiofrequency catheter ablation over the last two decades. Radiofrequency catheter ablation was performed successfully in 96.7% of patients, but was significantly less successful in patients with a right anterior or right anterolateral accessory pathway (81.8%). Overall mortality was 0%; there was only one (0.3%) major complication, a pericardial haemorrhage, and only 2.8% of the patients developed minor vascular complications at the puncture site. None of the patients developed a persistent atrioventricular block. Over a median observation time of 4.3 years (0.1; 17.8), recurrence of arrhythmia occurred in 9.3% of all patients, but 50% of children with right lateral accessory pathways. Radiofrequency catheter ablation can be performed with high success and very low complication rates in children. Recurrence rates are substantially lower than those reported for cryoablation in the literature.

Tachyarrhythmia Following Norwood Operation

The purpose of this study was to characterize tachyarrhythmias in children following the Norwood procedure. This is a single-center retrospective study including all children who underwent stage I Norwood procedure (n = 98; January 2003-September 2011). The primary outcome measure is the development of tachyarrhythmia during hospitalization after the Norwood procedure. Secondary aims include quantification of mortality in patients with tachyarrhythmias and evaluation of potential risk factors for the development of tachyarrhythmia. Tachyarrhythmia occurred in 33 (34%) of 98 patients. The median time to onset of tachyarrhythmia was ten days (0-47 days). Tachyarrhythmia conferred no increase in overall mortality (P = .45), including operative mortality (P = .37) or interstage mortality (P = 1.00). There was no significant difference in the incidence of arrhythmia based on demographic, anatomic, or surgical variables, including shunt type (P = .23) except that patients with tachyarrhythmias were slightly larger (median weight 3.2 kg) at the time of stage I than those without tachyarrhythmia (median weight 2.93 kg; P = .02]. The odds of arrhythmia in males were 8.7 times higher than that in females (95% confidence interval 2.9-31.3; P < .0001). Postoperative tachyarrhythmia is common, occurring in 34% of patients after the Norwood operation. Onset of tachyarrhythmia occurred later after the Norwood operation than reported previously, and male gender is a risk factor. Further studies to elucidate the etiology and the timing of tachyarrhythmias after the Norwood procedure are necessary.

Paroxysmal supraventricular tachycardia in children

Introduction: Cardiac rhythm disturbances in children are rare and do not have to be associated with structural damage to the heart muscle. The most common are paroxysmal atrial tachycardia with an incidence of 1:500. These tachyarrhythmias in children are characterised by the number of strokes ranging 160- 360. Aim: The aim of this paper is to present the quality of life in children with paroxysmal supraventricular tachycardia (PSVT), and the role of Emergency Department (ED) in the treatment of attacks of tachycardia. Case report: A girl aging 7 was taken by her mother to the Emergency Department of Health Care Centre (HCC) Bečej on 1st November 2008 at 17:09 for palpitations. The attack occurred in the child for the first time, in an effort, half hour earlier. Clinical examinations revealed that the patient was hypotensive (TA 85/50 mmHg), tachycardia (300 beats/min) with oxygen saturation in the peripheral blood of 100%. On electrocardiogram (ECG) recorded the reading in sinus rhythm 300/min in frequency, levogram, the displacement of the ST segment in all leads of 3-5mm. Accompanied by a nurse, the patient was transported and diagnosed with Tachycardia Parohysmalis ( I 47.) without any pre-hospital therapy applied. She was hospitalized for ten days at the Cardiology Department of the Institute for Health Care of Children and Youth, Novi Sad (Novi Sad IZZZDiO). She was discharged with the diagnosis of Tachycardia Paroxysmalis Supraventrikularis (I 47.1) and Propranolol therapy was recommended. In spite of the treatment, attacks of PSVT were still being recorded in the patient. The therapy was replaced by the cardiologist. The applied therapy included Presolol, then Amiodarone, and then combinations Amiodarone and Presolol and since Avgusta 2011 she started using Propafen tablets. Until 10th February 2013 the patient had 27 attacks of tachycardia in total. The patient was treated at the Children's Medical Centre Bečej for five times, four times the ED HCC were invited to take her from the CMC and for18 times she was brought directly to the ED. In most cases, when the patient was cared for at ED HCC, PSVT was converted to sinus rhythm by Presolol or a combination of Presolol and Amiodaron. In two cases PSVT was converted by Valsalva maneuver. In two thirds of the visits, the patient was sent back home after the therapy and converting PSVT to a sinus rhythm. Nine times she was sent to IZZZDiO in Novi Sad, where he was hospitalized. Conclusion: If the PSVT attacks in children older than one, with a severe clinical course and frequent, continual medical therapy is applied. The highest efficiency is demonstrated by Amiodarone preventing the attacks in even 85% cases. However, in our patient the attacks continued despite of continuous drug therapy. They are frequent, with severe clinical course, limiting the child's daily activities. ED HCC physicians manage to convert most of the attacks to the sinus rhythm, so she does not have to be sent each time to a tertiary health institution and hospitalised.

GW24-e0799 Intra caridac electrophysiologic study amd radiofrequency catheter ablation for tachyarrhythmias in children: Analysis on 1000 patients

ObjectivesTo investigate the success rate, factors associated with recurrence, safety and effects of age on results of radiofrequency catheter ablation (RFCA) for different types of tachyarrhythmias in children.Methods1000 children diagnosed...

Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement

In children with structurally normal hearts, the mechanisms of arrhythmias are usually the same as in the adult patient. Some arrhythmias are particularly associated with young age and very rarely seen in adult patients. Arrhythmias in structural heart disease may be associated either with the underlying abnormality or result from surgical intervention. Chronic haemodynamic stress of congenital heart disease (CHD) might create an electrophysiological and anatomic substrate highly favourable for re-entrant arrhythmias. As a general rule, prescription of antiarrhythmic drugs requires a clear diagnosis with electrocardiographic documentation of a given arrhythmia. Risk-benefit analysis of drug therapy should be considered when facing an arrhythmia in a child.Prophylactic antiarrhythmic drug therapy is given only to protect the child from recurrent supraventricular tachycardia during this time span until the disease will eventually cease spontaneously.In the last decades, radiofrequency catheter ablation is progressively used as curative therapy for tachyarrhythmias in children and patients with or without CHD. Even in young children, procedures can be performed with high success rates and low complication rates as shown by several retrospective and prospective paediatric multi-centre studies. Three-dimensional mapping and non-fluoroscopic navigation techniques and enhanced catheter technology have further improved safety and efficacy even in CHD patients with complex arrhythmias. During last decades, cardiac devices (pacemakers and implantable cardiac defibrillator) have developed rapidly. The pacing generator size has diminished and the pacing leads have become progressively thinner. These developments have made application of cardiac pacing in children easier although no dedicated paediatric pacing systems exist.

Frequencies, Costs, and Complications of Catheter Ablation for Tachyarrhythmias in Children: 2000–2009

Over the past two decades, catheter ablation (CA) has revolutionized the treatment of tachyarrhythmias in children by providing a relatively safe and effective alternative to open heart surgery or lifelong pharmacotherapy. This study (1) described national trends in pediatric CAs and their associated costs and complications and (2) predicted the likelihood of major complications based on patient and hospital characteristics. Inpatient data were obtained from the Kids' Inpatient Database for the years 2000, 2003, 2006, and 2009. Outpatient data were obtained from the California, Maryland, and New Jersey State Ambulatory Surgery Databases for the years 2006 and 2009. Logistic regression was used to predict the odds of major complications from CA. There was a 20% increase (4,134-4,967) in the number of pediatric CAs performed from 2006 to 2009 that was concomitant with a decrease in the percentage of those procedures being performed as inpatient procedures (2,254-1,846). In 2009, a complication rate of 4.81% was estimated. For inpatient CAs, higher risk patients (with congenital heart disease, congestive heart failure, or heart transplant), ablations for ventricular tachycardias, and low-CA-volume hospitals were associated with increased risk of complications. In 2009, the mean cost of a hospitalization involving CA, but no cardiac surgery, was $17,204 (standard error = $1,015). CA has increasingly been used over the past decade for pediatric patients with a multitude of tachycardia mechanisms. There continues to be a small risk of major complications, especially for higher risk children and in hospitals with more limited experience with the procedure.