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Use Of Supra-Therapeutic Phenytoin For Management Of Ventricular Arrhythmias In Children: Case Series And Literature Review

Bhansali, Suneet; Tan, Reina Bianca M; Spilios, Maria; Cecchin, Frank
Phenytoin is a versatile drug with utility in neurological, dermatological, and even cardiac disease processes. Though phenytoin is widely available due to its excellent anti-epileptic properties, it is now rarely used as an antiarrhythmic. Phenytoin has well-studied sodium-channel blocking abilities which can be taken advantage of to treat ventricular arrhythmias. Thus, it should remain in the arsenal of antiarrhythmics for any electrophysiologist. We present two cases of intractable ventricular arrhythmia in children that were controlled with phenytoin at supra-therapeutic serum levels, preventing the need for heart transplantation. This article is protected by copyright. All rights reserved.
PMID: 35903996
ISSN: 1540-8159
CID: 5276942

Non-surgical treatment of congenital left ventricle to coronary sinus fistula and Wolf-Parkinson-White

Minocha, Prashant K; Saharan, Sunil; Chun, Anne; Presti, Salvatore; Cecchin, Frank; Argilla, Michael
Congenital left ventricle to coronary sinus fistula is a rare entity. We report a case of an infant with prenatal finding of left ventricle to right atrial shunt. The anatomy was defined by multi-modality imaging. Baseline electrocardiogram was notable for a Wolff-Parkinson-White pattern. He underwent successful catheter device closure of the left ventricle to coronary sinus fistula. The patient developed supraventricular tachycardia and underwent successful ablation of the accessory pathway.
PMID: 35383549
ISSN: 1467-1107
CID: 5201622

2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients

Shah, Maully J; Silka, Michael J; Avari Silva, Jennifer N; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Von Bergen, Nicholas H; Wackel, Philip L
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
PMCID:8577100
PMID: 34333141
ISSN: 0972-6292
CID: 5066652

2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients: Executive summary

Silka, Michael J; Shah, Maully J; Avari Silva, Jennifer N; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Von Bergen, Nicholas H; Wackel, Philip L
Guidelines for the implantation of cardiac implantable electronic devices (CIEDs) have evolved since publication of the initial ACC/AHA pacemaker guidelines in 1984 [1]. CIEDs have evolved to include novel forms of cardiac pacing, the development of implantable cardioverter defibrillators (ICDs) and the introduction of devices for long term monitoring of heart rhythm and other physiologic parameters. In view of the increasing complexity of both devices and patients, practice guidelines, by necessity, have become increasingly specific. In 2018, the ACC/AHA/HRS published Guidelines on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay [2], which were specific recommendations for patients >18 years of age. This age-specific threshold was established in view of the differing indications for CIEDs in young patients as well as size-specific technology factors. Therefore, the following document was developed to update and further delineate indications for the use and management of CIEDs in pediatric patients, defined as ≤21 years of age, with recognition that there is often overlap in the care of patents between 18 and 21 years of age. This document is an abbreviated expert consensus statement (ECS) intended to focus primarily on the indications for CIEDs in the setting of specific disease/diagnostic categories. This document will also provide guidance regarding the management of lead systems and follow-up evaluation for pediatric patients with CIEDs. The recommendations are presented in an abbreviated modular format, with each section including the complete table of recommendations along with a brief synopsis of supportive text and select references to provide some context for the recommendations. This document is not intended to provide an exhaustive discussion of the basis for each of the recommendations, which are further addressed in the comprehensive PACES-CIED document [3], with further data easily accessible in electronic searches or textbooks.
PMCID:8577082
PMID: 34333142
ISSN: 0972-6292
CID: 5066662

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Developed in collaboration with and endorsed by the Heart Rhythm Society (HRS), the American College of Cardiology (ACC), the American Heart Association (AHA), and the Association for European Paediatric and Congenital Cardiology (AEPC) Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS)

Shah, Maully J; Silka, Michael J; Silva, Jennifer N Avari; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Bergen, Nicholas H Von; Wackel, Philip L
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
PMID: 34794667
ISSN: 2405-5018
CID: 5049572

2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients: executive summary

Silka, Michael J; Shah, Maully J; Silva, Jennifer N Avari; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannakeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Von Bergen, Nicholas H; Wackel, Philip L
PMID: 34796795
ISSN: 1467-1107
CID: 5049672

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Executive Summary [Comment]

Silka, Michael J; Shah, Maully J; Silva, Jennifer N Avari; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Von Bergen, Nicholas H; Wackel, Philip L
PMID: 34363987
ISSN: 1556-3871
CID: 5103652

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients

Shah, Maully J; Silka, Michael J; Silva, Jennifer N Avari; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Bergen, Nicholas H Von; Wackel, Philip L
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
PMID: 34363988
ISSN: 1556-3871
CID: 5171792

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients

Shah, Maully J; Silka, Michael J; Silva, Jennifer Avari; Balaji, Seshadri; Beach, Cheyenne; Benjamin, Monica; Berul, Charles; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell; Dalal, Aarti; Dechert, Brynn; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince; Karpawich, Peter; Kim, Jeffery; Krishna, Mani Ram; Kubuš, Peter; Malloy-Walton, Lindsey; LaPage, Martin; Mah, Doug; Miyazaki, Aya; Motonaga, Kara; Niu, Mary; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth; Silvetti, Massimo Stefano; Stephenson, Elizabeth; Tan, Reina; Triedman, John; Von Bergen, Nicholas; Wackel, Philip
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consenus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology, (ACC) and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate follow-up in pediatric patients.
PMID: 34338183
ISSN: 1467-1107
CID: 4979802

OUTCOMES FOR CATHETER ABLATION OF ANTEROSEPTAL AND MIDSEPTAL ACCESSORY PATHWAYS IN PEDIATRIC PATIENTS

Kovach, Joshua R; Mah, Douglas Y; Abrams, Dominic J; Alexander, Mark E; Cecchin, Frank; Triedman, John K; Walsh, Edward P
BACKGROUND:Outcomes for catheter ablation of accessory pathways in pediatric patients have steadily improved, with the exception of pathways located in the anteroseptal (AS) and midseptal (MS) regions, which is limited by the close proximity of normal atrioventricular (AV) conduction. OBJECTIVE:Evaluate the efficacy of different catheter approaches and ablation energy modalities used for catheter ablation at these sites. METHODS:A retrospective review was performed of all electrophysiologic (EP) studies performed between July, 2001 and July, 2017. Acute success and recurrence rates were assessed, comparing catheter approaches and energy utilized for ablation. RESULTS:255 EP procedures were performed in 223 patients (178 AS, 72 MS, 5 Unspecified). Ablation was attempted in 241 procedures, with acute success in 87% (AS 89%, MS 83%). Recurrence was evident in 18% of successful ablations (AS 18%, MS 19%). Success rates were higher with repeat procedures than primary procedures (P = 0.006). Multiple approaches were more often utilized for AS pathways, though no single approach was superior. There was no difference in success when comparing energy modalities, though overall recurrence was higher for cryoablation. Significant complications occurred in 1.2% of procedures, though no patient suffered from complete heart block. CONCLUSION/CONCLUSIONS:Ablation of AS and MS pathways remains challenging. Multiple approaches are often necessary to successfully ablate AS pathways. While both ablation energy modalities were equally successful, cryoablation may be associated with a higher chance of recurrence. Recurrences and repeated procedures may be anticipated to minimize risk to normal AV conduction during ablation in these regions.
PMID: 31838200
ISSN: 1556-3871
CID: 4241892