Jennifer N A Silva1, Christopher C Erickson2, Christopher D Carter2, E Anne Greene2, Michal Kantoch2, Kathryn K Collins2, Christina Y Miyake2, Michael P Carboni2, Edward K Rhee2, Andrew Papez2, Vijay Anand2, Tammy M Bowman2, George F Van Hare2. 1. From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.). Silva_j@kids.wustl.edu. 2. From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
Abstract
BACKGROUND: Pediatric patients with persistent arrhythmias may require mechanical cardiopulmonary support. We sought to classify the population, spectrum, and success of current treatment strategies. METHODS AND RESULTS: A multicenter retrospective chart review was undertaken at 11 sites. Inclusion criteria were (1) patients <21 years, (2) initiation of mechanical support for a primary diagnosis of arrhythmias, and (3) actively treated on mechanical support. A total of 39 patients were identified with a median age of 5.5 months and median weight of 6 kg. A total of 69% of patients were cannulated for supraventricular tachycardia with a median rate of 230 beats per minute. A total of 90% of patients were supported with extracorporeal membrane oxygenation for an average of 5 days. The remaining 10% were supported with ventricular assist devices for an average of 38 (20-60) days. A total of 95% of patients were treated with antiarrhythmics, with 43% requiring >1 antiarrhythmic. Amiodarone was the most frequently used medication alone or in combination. A total of 33% patients underwent electrophysiology study/transcatheter ablation. Radiofrequency ablation was successful in 9 patients on full flow extracorporeal membrane oxygenation with 3 radiofrequency-failures/conversion to cryoablation. One patient underwent primary cryoablation. A total of 15% of complications were related to electrophysiology study/ablation. At follow-up, 23 patients were alive, 8 expired, and 8 transplanted. CONCLUSIONS: Younger patients were more likely to require support in the presented population. Most patients were treated with antiarrhythmics and one third required electrophysiology study/ablation. Radiofrequency ablation is feasible without altering extracorporeal membrane oxygenation flows. There was a low frequency of acute adverse events in patients undergoing electrophysiology study/ablation, while on extracorporeal membrane oxygenation.
BACKGROUND: Pediatric patients with persistent arrhythmias may require mechanical cardiopulmonary support. We sought to classify the population, spectrum, and success of current treatment strategies. METHODS AND RESULTS: A multicenter retrospective chart review was undertaken at 11 sites. Inclusion criteria were (1) patients <21 years, (2) initiation of mechanical support for a primary diagnosis of arrhythmias, and (3) actively treated on mechanical support. A total of 39 patients were identified with a median age of 5.5 months and median weight of 6 kg. A total of 69% of patients were cannulated for supraventricular tachycardia with a median rate of 230 beats per minute. A total of 90% of patients were supported with extracorporeal membrane oxygenation for an average of 5 days. The remaining 10% were supported with ventricular assist devices for an average of 38 (20-60) days. A total of 95% of patients were treated with antiarrhythmics, with 43% requiring >1 antiarrhythmic. Amiodarone was the most frequently used medication alone or in combination. A total of 33% patients underwent electrophysiology study/transcatheter ablation. Radiofrequency ablation was successful in 9 patients on full flow extracorporeal membrane oxygenation with 3 radiofrequency-failures/conversion to cryoablation. One patient underwent primary cryoablation. A total of 15% of complications were related to electrophysiology study/ablation. At follow-up, 23 patients were alive, 8 expired, and 8 transplanted. CONCLUSIONS: Younger patients were more likely to require support in the presented population. Most patients were treated with antiarrhythmics and one third required electrophysiology study/ablation. Radiofrequency ablation is feasible without altering extracorporeal membrane oxygenation flows. There was a low frequency of acute adverse events in patients undergoing electrophysiology study/ablation, while on extracorporeal membrane oxygenation.
Authors: Samantha H Dallefeld; Andrew M Atz; Ram Yogev; Janice E Sullivan; Amira Al-Uzri; Susan R Mendley; Matthew Laughon; Christoph P Hornik; Chiara Melloni; Barrie Harper; Andrew Lewandowski; Jeff Mitchell; Huali Wu; Thomas P Green; Michael Cohen-Wolkowiez Journal: J Pharmacokinet Pharmacodyn Date: 2018-02-12 Impact factor: 2.410