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Efficacy of implantable cardioverter defibrillators in young patients with catecholaminergic polymorphic ventricular tachycardia: success depends on substrate.

https://arctichealth.org/en/permalink/ahliterature113949
Source
Circ Arrhythm Electrophysiol. 2013 Jun;6(3):579-87
Publication Type
Article
Date
Jun-2013
Author
Christina Y Miyake
Gregory Webster
Richard J Czosek
Michal J Kantoch
Anne M Dubin
Kishor Avasarala
Joseph Atallah
Author Affiliation
Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA. cymiyake@texaschildrens.org
Source
Circ Arrhythm Electrophysiol. 2013 Jun;6(3):579-87
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Anti-Arrhythmia Agents - therapeutic use
Canada
Child
Cohort Studies
Confidence Intervals
Defibrillators, Implantable
Electrocardiography - methods
Female
Follow-Up Studies
Humans
Male
Patient compliance
Recurrence
Retrospective Studies
Risk assessment
Statistics, nonparametric
Survival Rate
Tachycardia, Ventricular - diagnosis - drug therapy - mortality - physiopathology - therapy
Treatment Outcome
United States
Young Adult
Abstract
The effectiveness of implantable cardioverter-defibrillator (ICD) therapy for the management of catecholaminergic polymorphic ventricular tachycardia (VT) in young patients is not known. ICD discharges are not always effective and inappropriate discharges are common, both resulting in morbidity and mortality.
This is a multicenter, retrospective review of young patients with catecholaminergic polymorphic VT and ICDs from 5 centers. ICD discharges were evaluated to determine arrhythmia mechanism, appropriateness, efficacy of therapy, and complications. A total of 24 patients were included. Median (interquartile range) ages at onset of catecholaminergic polymorphic VT symptoms and ICD implant were 10.6 (5.0-13.8) years and 13.7 (10.7-16.3) years, respectively. Fourteen patients received 140 shocks. Ten patients (42%) experienced 75 appropriate shocks and 11 patients (46%) received 65 inappropriate shocks. On actuarial analysis, freedom from appropriate shock at 1 year after ICD implant was 75%. Of appropriate shocks, only 43 (57%) demonstrated successful primary termination. All successful appropriate ICD discharges were for ventricular fibrillation. No episodes of polymorphic VT or bidirectional VT demonstrated successful primary termination. The adjusted mean (95% confidence interval) cycle length of successful discharges was significantly shorter than unsuccessful discharges (168 [152-184] ms versus 245 [229-262] ms; adjusted P=0.002). Electrical storm occurred in 29% (4/14) and induction of more malignant ventricular arrhythmias in 36% (5/14). There were no deaths.
ICD efficacy in catecholaminergic polymorphic VT depends on arrhythmia mechanism. Episodes of ventricular fibrillation were uniformly successfully treated, whereas polymorphic and bidirectional VT did not demonstrate successful primary termination. Inappropriate shocks, electrical storm, and ICD complications were common.
PubMed ID
23667268 View in PubMed
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Lone atrial fibrillation in the pediatric population.

https://arctichealth.org/en/permalink/ahliterature107001
Source
Can J Cardiol. 2013 Oct;29(10):1227-33
Publication Type
Article
Date
Oct-2013
Author
Lindsay C Mills
Robert M Gow
Kim Myers
Michal J Kantoch
Gil J Gross
Anne Fournier
Shubhayan Sanatani
Author Affiliation
Division of Pediatric Cardiology, University of Ottawa, Ottawa, Ontario, Canada.
Source
Can J Cardiol. 2013 Oct;29(10):1227-33
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Alberta - epidemiology
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - epidemiology - physiopathology - therapy
British Columbia - epidemiology
Catheter Ablation
Electric Countershock
Female
Follow-Up Studies
Humans
Male
Morbidity - trends
Ontario - epidemiology
Quebec - epidemiology
Recurrence
Retrospective Studies
Abstract
There are few reports of pediatric studies of atrial fibrillation (AF). We sought to describe the clinical characteristics, management strategies, and recurrence rates and to identify predictors of AF recurrence in a contemporary pediatric population.
A retrospective review was performed of patients = 18 years with lone AF who were seen at 4 pediatric institutions from 1996-2011. Patients with AF in the setting of thyroid disease, ventricular pre-excitation, coexisting congenital heart disease, or a history of cardiac surgery were excluded. Demographics, clinical presentation, investigations, treatment, and follow-up were analyzed.
Forty-two patients were diagnosed with a first episode of lone AF, and 4 of these cases were later classified as persistent AF. Thirty-one (74%) were male patients, median age was 15.3 years, and median (interquartile range [IQR]) duration of AF episode was 12 (IQR, 7-24) hours. AF recurred in 39% (15 of 38) of patients. The Kaplan-Meier median time to estimated recurrence was 19 months. By univariate analysis, initial AF episode duration was associated with a higher risk of recurrence (hazard ratio [HR], 1.01; 95% confidence interval [CI], 1-1.02; P = 0.034). Sex, age, family history, size of the left atrium, and history of cardioversion were not associated with recurrence. Recurrence with another supraventricular tachyarrhythmia (SVT) was observed in 6 of 38 (16%) patients, and 12 patients underwent electrophysiology (EP) study, with 6 patients receiving ablation.
Our reported rate of recurrence of 39% is important when counseling pediatric patients and their parents on the expected course and treatment goals.
PubMed ID
24074972 View in PubMed
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