Fabrizio Drago

PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern

C PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern Developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS)

Heart rate variability in healthy children and adolescents is partially related to age and gender

We evaluated 24-h time-domain heart rate variability (HRV) in 103 (46 females) healthy children and adolescents. Subjects were divided into four male and four female groups (ages 1-5, 6-10, 11-15, 16-20 years) and 24-h ambulatory Holter monitoring was performed. HRV was assessed by SDNN, SDNN index (SDNN-i), SDANN, rMSSD, pNN50. Males showed SDNN and SDANN values significantly higher than females while for SDNN-i, rMSSD, pNN50 there were no significant differences between sexes. With increasing age, there is a progressive and significant decrease of HR and increase of SDANN. On the other hand, SDNN, SDNNi, pNN50 and rMSSD increased significantly only between the first two age-groups. rMSSD and pNN50 were significantly related to body mass index. Thus, SDNN and SDANN, overall HRV measures, increased with age and were gender-related. HRV indices of parasympathetic function (rMSSD, pNN50) and SDNN-i increased up to 10 years of age and were gender-unrelated. These data demonstrate that in healthy children and adolescents there is a progressive modification of HRV that may reflect a progressive evolution of the autonomic nervous system, with different pattern measure-dependent. This paper enables us to compare, in future works, HRV in pediatric subjects in different groups according to the different HRV measures under examination.

Exclusion of Fluoroscopy During Ablation Treatment of Right Accessory Pathway in Children

Electroanatomic Ablation of Accessory Pathways. Introduction: The field of pediatric electrophysiology poses many challenges to electrophysiologists. In particular there are two major concerns: (1) to reduce the amount of fluoroscopy exposure to patients and medical staff in the catheterization laboratory and (2) to minimize the number of vascular accesses. Prolonged fluoroscopy times are associated with radiofrequency (RF) ablation of right accessory pathways (APs), particularly the right free‐wall AP. The aim of this study was to eliminate the use of fluoroscopy during treatment of right‐sided APs in children while using a single‐catheter approach.

Outcome of Young Patients with Abandoned, Nonfunctional Endocardial Leads

Background: Transvenous leads may fail and may be extracted or abandoned. There are no reports of the outcome of children with abandoned nonfunctional leads.

Radiofrequency Catheter Ablation of Idiopathic Left Ventricular Outflow Tract Tachycardia: Utility of Intracardiac Echocardiography

Idiopathic LVOT Tachycardia. Introduction: The site of origin of idiopathic ventricular tachycardia (VT) arising from the left ventricular outflow tract (LVOT) may be closely related to the aortic valve leaflets, and radiofrequency (RF) delivery potentially can damage them. Intracardiac echocardiography (ICE) can identify accurately the ablation electrode and anatomic landmarks, and contact with the endocardium can be easily assessed. The aim of this study was to define the utility and the accuracy of ICE in guiding RF ablation of idiopathic VT of the LVOT.

Ventricular Tachycardia in Non-Compaction of Left Ventricle: Is This a Frequent Complication?

Background: Isolated left ventricular non‐compaction is the result of incomplete myocardial morphogenesis, leading to persistence of the embryonic myocardium. The condition is recognized by an excessively prominent trabecular meshwork and deep intertrabecular recesses of the left ventricle. Whether these intertrabecular recesses are a favorable substrate for ventricular arrhythmias is unclear. Some reports have found that the fatal ventricular arrhythmias may occur in approximately half of the patients. In this report we investigated about this association.

Amiodarone Used Alone or in Combination with Propranolol: A Very Effective Therapy for Tachyarrhythmias in Infants and Children

Abstract. The aim of the study was to evaluate the efficacy of amiodarone used alone or in combination with propranolol in infants and children affected by life-threatening or drug-resistant tachyarrhythmias. The study included 27 children (median age 3 months), affected by life-threatening and/or drug-resistant supraventricular or ventricular tachyarrhythmias. The loading dose of amiodarone was 10–20 mg/kg/day and the maintenance dose ranged between 3 and 20 mg/kg/day. When amiodarone was ineffective, propranolol was added at a dosage of 2–4 mg/kg/day. The study population was divided into two groups: group A was composed of patients <1 year and group B of patients >1 year. The effectiveness of the therapy was assessed by clinical evaluation, Holter monitoring, exercise testing, and, in patients with reentry tachycardias, electrophysiological testing. Amiodarone used alone was effective or partially effective in 4/14 (28%) patients in group A and in 11/13 (85%) patients in group B (p < 0.006). Among amiodarone-resistant patients, the combined therapy with propranolol was effective in 8/10 patients in group A and 2/2 patients in group B. Therefore, amiodarone used alone or in combination with propranolol was effective in 25/27 (93%) patients. During the follow-up (20.5 ± 13 months) there were no arrhythmic effects but side effects were noted in 5/27 (18.5%) patients. Amiodarone seems to be an effective drug in the control of the life-threatening and/or drug-resistant supraventricular and ventricular tachyarrhythmias in children. The addition of propranolol can significantly enhance the success rate of this class III drug, especially in the treatment of reentry tachycardias due to accessory pathways.

Cryoablation of Typical Atrioventricular Nodal Reentrant Tachycardia in Children: Six Years’ Experience and Follow‐Up in a Single Center

Background: Cryoablation is an effective and safe treatment for children with supraventricular tachycardias when the reentry circuit is located near the atrioventricular (AV) junction. We retrospectively reviewed consecutive cryoablation procedures for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT) in children and young adults in a single pediatric center.

Permanent overdrive atrial pacing in the chronic management of recurrent postoperative atrial reentrant tachycardia in patients with complex congenital heart disease

This study investigated the value of permanent atrial pacing as an adjunct to the current therapy in the chronic management of recurrent postoperative atrial reentrant tachycardia in patients with complex congenital heart disease. We studied the postpacing clinical course in 18 patients with recurrent atrial reentrant tachycardias unresponsive to conventional therapy who had an implanted atrial pacemaker. The pacemaker was programmed at a lower pacing rate 20% faster than the spontaneous mean daily rate previously determined with 24‐hour Holter monitoring. Serial Holter recordings and pacemaker programming sessions were subsequently performed trying to mantain a paced atrial rhythm overdriving the spontaneous rhythm as long as possible. Twenty‐four hour Holter monitoring documented a prevalent (> 80%) paced rhythm during the daily hours in all patients during the follow‐up; all patients, however, required at least once a variation In programmed mode and pacing rate. Antiarrhythmic medications were discontinued after 6 months if the patient remained arrhythmia free while on pacing. Recurrences of atrial reentrant tachycardia occurred in five patients (29%) during the initial 6 months interval after the pacemaker implantation, while late recurrences occurred in only two patients (11 %). One patient died suddenly 10 months after the pacemaker implant. At the end of the follow‐up, 15 patients (83%) were arrhythmia‐free and only 2 of them were still on antiarrhythmic drugs. We conclude that permanent atrial overdrive pacing can be an important tool in the management of patients with atrial reentrant tachycardia following repair of congenital heart disease.

Oral propafenone therapy for children with arrhythmias: Efficacy and adverse effects in midterm follow-up

The use of oral propafenone was assessed in 57 children. Mean age was 4.8 +/- 5.2 years (range 1 day to 17 years). Twenty-three patients were less than 1 year of age (40%) and 10 were less than 1 month of age (18%). Arrhythmias included supraventricular tachycardia in 32 patients (57%), atrial flutter in six (10%), and ventricular tachycardia in 19 (33%). Cardiac diagnoses included: an otherwise normal heart in 30 (53%); unoperated congenital heart defect in 11 (19%); cardiomyopathy in nine (16%); and an operated congenital heart defect in seven (12%). Mean dose of propafenone was 13.1 mg/kg/day (range 8 to 15). Success (assessed by relief of symptoms and serial 24-hour ECGs) was achieved in 16 of 32 patients with supraventricular tachycardia (50%), three of six with atrial flutter (50%), and 8 of 19 with ventricular tachycardia (42%). Drug efficacy in patients with and without organic heart disease was 30% (8 of 27) and 63% (19 of 30), respectively (p less than 0.05). Mean duration of therapy in patients in whom the drug was effective was 22.9 +/- 13.2 months (range 6 to 60). Growth was unimpaired in all patients. A neonate with nonsustained monomorphic ventricular tachycardia had sustained ventricular tachycardia during the second day of propafenone therapy at a dose of 13 mg/kg/day. Sustained ventricular tachycardia disappeared when the drug was discontinued. Another patient had an asymptomatic and transient increase in the glutamic pyruvic transaminase level. No adverse hemodynamic effects were observed. In conclusion, propafenone is an effective antiarrhythmic drug in children with normal hearts; it is less effective in patients with heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)