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  • 1
    Electronic Resource
    Electronic Resource
    Electrocardiographic Markers of Late Sudden Death Risk in Postoperative Tetralogy of Fallot Children (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 8 (1997), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Late Sudden Death Risk in Postoperative TOF. Following surgery for tetralogy of Fallot (TOP), children may develop late onset ventricular arrhythmias. Many patients have both depolarization and repolarization abnormalities, including right bundle branch block (RBBB) and QT prolongation. The goal of this study was to improve prospective risk-assessment screening for late onset sudden death. Resting ECG markers including QRS duration, QTc, JTc, and interlead QT and JT dispersion were statistically analyzed to identify those patients at risk for ventricular arrhythmias and sudden cardiac death. To determine predictive markers for future development of arrhythmia, we examined 101 resting ECGs in patients (age 12 ± 6 years) with postoperative TOF and RBBB, 14 of whom developed late ventricular tachycardia (VT) or sudden death. These ECGs were also compared with an additional control group of 1000 age- and gender-matched normal ECGs. The mean QRS (± SD) in the VT group was 0.18 ± 0.02 seconds versus 0.14 ± 0.02 seconds in the non-VT group (P 〈 0.01). QTc and JTc in the VT group was 0.53 ± 0.05 seconds and 0.33 ± 0.03 seconds compared with 0.50 ± 0.03 seconds and 0.32 ± 0.03 seconds in the non-VT group (P = NS). There was no increase in QT dispersion among TOF patients with VT or sudden death compared with control patients or TOF patients without VT, although JT dispersion was more common in the TOF groups. A prolonged QRS duration in postoperative TOF with RBBB is more predictive than QTc, JTc, or dispersion indexes for identifying vulnerability to ventricular arrhythmias in this population, while retaining high specificity. The combination of both QRS prolongation and increased JT dispersion had very good positive and negative predictive values. These results suggest that arrhythmogenesis in children following TOF surgery might involve depolarization in addition to repolarization abnormalities. Prospective identification of high-risk children may be accomplished using these ECG criteria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1997.tb01031.x
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  • 2
    Electronic Resource
    Electronic Resource
    Normal Dispersion of Ventricular Repolarization in Patients with Kawasaki Disease Who Develop Coronary Artery Abnormalities (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of noninvasive electrocardiology 3 (1998), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Kawasaki disease (KD) is complicated by coronary artery abnormalities (CAA) in 3%-25% of patients, depending on acute therapy. ECG markers of ventricular vulnerability such as QT and JT dispersion, SAECG, and ambulatory monitoring have been shown to have predictive value in disparate diseases such as long QT syndrome, postmyocardial infarction, and atherosclerotic coronary artery disease. The aim of this study was to evaluate the association between QT and JT dispersion and the occurrence of CAA in KD.〈section xml:id="abs1-2"〉〈title type="main"〉MethodsOver the past 15 years, we evaluated 814 children with acute KD, of which 24 (3%) developed significant CAA (aneurysms, stenoses). An additional 40 children (5%) developed milder CAA (4–5 mm dilation). Multivariate analysis was used to compare QTc, JTc, and dispersion in the 24 patients who developed significant CAA with three other groups: 40 patients with mild CAA, 750 KD patients without evidence of CAA, and 1000 normal control children. A small prospective study included additional noninvasive ECG markers using ambulatory (Holter) monitoring and SAECG.〈section xml:id="abs1-3"〉〈title type="main"〉ResultsThere were no significant differences in any ECG measures of ventricular repolarization among any of the three KD groups and the normal control pediatric ECGs.〈section xml:id="abs1-4"〉〈title type="main"〉ConclusionsIncreased dispersion of ventricular repolarization is not associated with coronary-artery abnormalities in KD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1542-474X.1998.tb00042.x
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  • 3
    Electronic Resource
    Electronic Resource
    Provocative Testing in Children with Suspect Congenital Long QT Syndrome (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of noninvasive electrocardiology 3 (1998), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study was designed to evaluate several alternative ECG measurements and provocative tests in order to identify markers for children with suspect congenital long QT syndrome (LQTS).〈section xml:id="abs1-2"〉〈title type="main"〉BackgroundA single QTc measurement on a resting ECG does not identify all children with LQTS. Alternative ECG measurements have been established for identification of LQTS patients, with varied degrees of accuracy. Additionally, findings of QT prolongation during exercise or catecholaminergic stimulation have been suggested as indicators for the presence of LQTS and associated arrhythmias.〈section xml:id="abs1-3"〉〈title type="main"〉MethodsThe ECGs from 40 children with suspect congenital LQTS were compared with 1000 gender and age matched control patients. Complete exercise ECG studies were performed on 32 of the 40 suspect LQTS patients and compared with 29 controls. ECGs recorded during isoproterenol infusion were obtained in 9 suspect LQTS patients and compared with 44 matched control subjects.〈section xml:id="abs1-4"〉〈title type="main"〉ResultsDuring exercise, the QTc was mildly prolonged in both groups, without a similar increase in JTc, suggesting prolongation of depolarization time. QT and JT dispersion shortened with exercise in control subjects, but not in the suspect LQTS patients. During isoproterenol infusion, the QTc and JTc are prolonged in the suspect LQTS group, without an increase in the control patients.〈section xml:id="abs1-5"〉〈title type="main"〉ConclusionsWe describe the ECG findings with provocative testing in patients in whom there is a clinical suspicion of LQTS, yet have a normal or borderline QTc. Exercise or isoproterenol may aid in identification of patients with congenital long QT syndrome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1542-474X.1998.tb00023.x
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  • 4
    Electronic Resource
    Electronic Resource
    Early ECG Abnormalities Associated with Transcatheter Closure of Atrial Septal Defects Using the Amplatzer® Septal Occluder (2000)
    Springer
    Journal of interventional cardiac electrophysiology 4 (2000), S. 469-474 
    Details
    ISSN: 1572-8595
    Keywords: device closure ; amplatzer ; conduction ; atrial septal defect ; arrhythmias
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Conduction abnormalities and arrhythmias may occur in patients following secundum atrial septal defect (ASD) closure using the Amplatzer® septal occluder (ASO). Therefore, the aim of this study was to prospectively perform ambulatory ECG monitoring to assess the electrocardiographic effects of transcatheter closure (TCC) of ASD using the ASO device. From 5/97 to 3/99, 41 patients with secundum ASD, underwent TCC using the ASO device at a median age of 9.2[emsp4 ]y. (0.5–87[emsp4 ]y.) and median weight of 34[emsp4 ]kg (5.6–88[emsp4 ]kg.). Ambulatory Holter monitoring was performed pre- and immediately post TCC. Holter analysis included heart rate (HR), ECG intervals, supraventricular ectopy (SVE), ventricular ectopy (VE), and AV block. No change in baseline rhythm was noted in 37 patients (90%). Changes in AV conduction occurred in 3 patients (7%), including intermittent second degree AV block type II, and complete AV dissociation post closure. SVE was noted in 26 patients (63%) post closure, ranging from 5–2207 supraventricular premature beats (SVPB), including 9 patients (23%) with non-sustained supraventricular tachycardia (SVT), 3 of whom had short runs of SVT prior to closure. A significant increase in post-closure number of SVPB per hour (p=0.047) was noted. No significant difference was noted in PR interval, ventricular premature beats per hour, or QRS duration. Conclusions: Based on ambulatory ECG analysis, TCC of ASD with the ASO device is associated with an acute increase in SVE and a small risk of AV conduction abnormalities, including complete heart block. Long term follow-up studies will be necessary to determine late arrhythmia prevalence and relative frequency compared with standard surgical ASD repair.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009852312907
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  • 5
    Electronic Resource
    Electronic Resource
    Neonatal Radiofrequency Catheter Ablation of Junctional Tachycardias (1997)
    Springer
    Journal of interventional cardiac electrophysiology 2 (1997), S. 91-100 
    Details
    ISSN: 1572-8595
    Keywords: radiofrequency catheter ablation ; pediatric electrophysiology ; junctional tachycardia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Junctional tachycardias comprise several arrhythmia types with differing mechanisms, principally involving the region of the atrioventricular (A-V) junction. Neonatal radiofrequency catheter ablation has typically been reserved for life-threatening, drug-refractory cases due to the unique concerns regarding patient size and development. We performed radiofrequency catheter ablation on two neonates with incessant, rapid junctional tachycardias and hemodynamic compromise after failing conventional medical therapy. This report describes 2 neonates who underwent emergent radiofrequency catheter ablation, and compares these two patients to a larger pediatric catheter ablation patient cohort. Both neonates had an acutely successful outcome and were able to be discharged within a week of the ablation procedure. Fluoroscopy time and total procedure time were shorter in these two patients than in the course of the average pediatric catheter ablation. Though long-term developmental consequences of neonatal catheter ablation are yet unknown, in unique extreme situations, radiofrequency catheter ablation can be performed in neonates, as in older children and adults, without excessive acute morbidity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009777126508
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