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Edward P Walsh - One of the best experts on this subject based on the ideXlab platform.
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adverse event rate during inpatient sotalol initiation for the management of supraventricular and ventricular Tachycardia in the pediatric and young adult population
Heart Rhythm, 2020Co-Authors: Stephanie F Chandler, Esther Chu, Robert Whitehill, Laura Bevilacqua, Vassilios J Bezzerides, Elizabeth S Dewitt, Mark E Alexander, Dominic Abrams, John K Triedman, Edward P WalshAbstract:Background Sotalol is an important antiarrhythmic drug in the pediatric population. Given the risk of proarrhythmia, sotalol is initiated in inpatient settings, with adult studies as recent as 2015 supporting this practice. Objective The purpose of this study was to determine the frequency of adverse events (AEs) during sotalol initiation for the management of Atrial, supraventricular, or ventricular arrhythmias in pediatric patients. Methods A retrospective cohort analysis of pediatric patients 21 years or younger initiated on oral sotalol for supraventricular Tachycardia or ventricular Tachycardia (VT) at Boston Children's Hospital from January 1, 2007, through July 1, 2016, was performed. The primary end point was an AE defined as significant bradycardia, new or increased ventricular arrhythmias, conduction block, or corrected QT interval (QTc) prolongation, resulting in dose reduction or cessation. Results There were 190 patients who met inclusion criteria, with 110 patients (58%) 6 months or younger. A total of 115 patients (60%) had congenital heart disease. Arrhythmias for which sotalol was initiated included atrioventricular reciprocating Tachycardia/atrioventricular nodal reciprocating Tachycardia (n = 105 [55%]), Atrial flutter (n = 31 [16%]), Ectopic Atrial Tachycardia (n = 26 [14%]), VT (n = 21 [11%]), and Atrial fibrillation (n = 7 [4%]). The median pre-sotalol QTc was 438 ms (interquartile range 348–530 ms). Five patients (3%) (aged 0.1–18 years) had AEs including bradycardia Conclusion The incidence of AEs in pediatric patients initiating sotalol for Atrial Tachycardia, supraventricular Tachycardia, or VT is low (3%), with no deaths or malignant rhythms reported in this series.
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epicardial ablation of tachyarrhythmia in children experience at two academic centers
Pacing and Clinical Electrophysiology, 2017Co-Authors: Shailendra Upadhyay, John K Triedman, Edward P Walsh, Frank Cecchin, Juan Villafane, Philip J SaulAbstract:Background Experience with percutaneous epicardial ablation of tachyarrhythmia in pediatrics is limited. This case series addresses the feasibility, safety, and complications of the procedure in children. Methods A total of nine patients underwent 10 epicardial ablation procedures from 2002 to 2013 at two academic centers. Activation mapping was performed in all cases, and electroanatomic map was utilized in nine of the 10 procedures. Patients had undergone one to three failed endocardial catheter ablations in addition to medical management, and all had symptoms, a high-risk accessory pathway (AP), aborted cardiac arrest with Wolff-Parkinson-White syndrome (WPW), or ventricular dysfunction. A standard epicardial approach was used for access in all cases, using a 7- or 8- Fr sheath. Epicardial ablation modality was radiofrequency (RF) in seven, cryoablation (CRYO) in one, and CRYO plus RF in one. Results Median age was 14 (range 8–19) years. Indications: drug refractory Ectopic Atrial Tachycardia (one), ventricular Tachycardia (VT) (five), high-risk AP (two), and aborted cardiac arrest from WPW – (one). Epicardial ablation was not performed in one case despite access due to an inability to maneuver the catheter around a former pericardial scar. VT foci included the right ventricular outflow tract septum, high posterior left ventricle (LV), LV outflow tract, postero-basal LV, and scar from previous rhabdomyoma surgery. WPW foci were in the area of the posterior septum and coronary sinus in all three cases. Overall procedural success was 70% (7/10), with epicardial ablation success in five and endocardial ablation success after epicardial mapping in two. The VT focus was close to the left anterior descending coronary artery in one of the unsuccessful cases in which both RF and CRYO were used. There was one recurrence after a successful epicardial VT ablation, which was managed with a second successful epicardial procedure. There were no other recurrences at more than 1 year of follow-up. Complications were minimal, with one case of inadvertent pleural access requiring no specific therapy. No pericarditis or effusion was seen in any of the patients who underwent epicardial ablation. Conclusion Epicardial ablation in pediatric patients can be performed with low complications and acceptable success. It can be considered for a spectrum of Tachycardia mechanisms after failed endocardial ablation attempts and suspected epicardial foci. Success and recurrence may be related to foci in proximity to the epicardial coronaries, pericardial scar, or a distant location from the closest epicardial location. Repeat procedures may be necessary.
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postoperative Ectopic Atrial Tachycardia in children with congenital heart disease
American Journal of Cardiology, 2001Co-Authors: Ana Maria Rosales, Edward P Walsh, David L Wessel, John K TriedmanAbstract:The causes and significance of postoperative Ectopic Atrial Tachycardia (EAT) remain unknown. To identify factors associated with postoperative EAT in children after cardiac surgery, we retrospectively studied pre-, intra-, and postoperative variables. The median age for postoperative EAT cases was younger than the general population admitted for cardiac surgical procedures (6 vs 17 months old, p = 0.09). Trends for EAT cases included lower preoperative oxygen saturation (84% vs 99%, p = 0.001), more pre- and postoperative inotropic support, and Atrial septostomy (24% vs 6%, p = 0.08). EAT cases had longer cardiopulmonary bypass times and clamp times (115 vs 88 minutes, p = 0.08; 63 vs 46 minutes, p = 0.03, respectively) and had a prolonged intensive care unit stay (10 vs 3 days, p <0.001). Deaths were recorded in 2 of 17 EAT cases versus 0 of 36 randomly selected controls (p = 0.10). EAT resolved before discharge in 10 of 16 surviving patients. The etiology of EAT appears to be multifactorial, and may include disruption of Atrial septum, longer pump times, need for inotropic support, and potassium depletion. Thus, young, ill, cyanotic patients were most at risk for postoperative EAT. Although EAT was associated with prolonged intensive care, it resolved in most cases over time.
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efficacy and risks of medical therapy for supraventricular Tachycardia in neonates and infants
American Heart Journal, 1996Co-Authors: Steven N Weindling, Philip J Saul, Edward P WalshAbstract:To assess the efficacy and safety of current pharmacologic therapy for supraventricular Tachycardia (SVT) in infants, we reviewed 112 infants treated between July 1985 and March 1993. The SVT mechanism was determined by esophageal electrophysiologic study and involved an accessory pathway in 86, atrioventricular (AV) node reentry in 10, Atrial muscle reentry in 11, and an Ectopic Atrial Tachycardia in 5 patients. Of six infants not treated, none had clinical recurrences of SVT. Of the 106 patients treated, 70% remained free of Tachycardia while receiving digoxin, propranolol, or both. Class I antiarrhythmic agents were necessary for 13 patients, and class III agents were required for another 13 infants. Verapamil was used in one infant with AV node reentry Tachycardia. Nine infants with complex clinical presentations were believed to have failed medical management and underwent radiofrequency ablation. Five patients died, four of complications related to structural heart disease and one shortly after radiofrequency ablation was performed. No deaths appeared to be related to antiarrhythmic medications. No drug-related side effects requiring medication change occurred, and no proarrhythmia was observed. Thus medical therapy appears to be effective and safe in infants with SVT. Radiofrequency ablation should be reserved for rare infants who fail aggressive medical regimens or when the situation is complicated by ventricular dysfunction, severe symptoms, or complex congenital heart disease.
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transcatheter ablation of Ectopic Atrial Tachycardia in young patients using radiofrequency current
Circulation, 1992Co-Authors: Edward P Walsh, J P Saul, J E Hulse, Larry A Rhodes, Allan J Hordof, John E Mayer, James E LockAbstract:BACKGROUNDEctopic Atrial Tachycardia (EAT) is a reversible cause of cardiomyopathy but may be quite difficult to control with conventional therapy. Transcatheter ablation with radiofrequency current was tested as an alternative to medical or surgical treatment of this condition.METHODS AND RESULTSTwelve young patients (aged 10 months to 19 years) with drug-resistant EAT were treated with direct transcatheter ablation of the Ectopic focus using radiofrequency (RF) energy. All had depressed left ventricular contractility by echocardiographic criteria, involving shortening fractions of 10-26% (median, 20%; normal, 28-35%). The EAT was mapped to the left atrium in seven cases and to the right atrium in five. Local Atrial activation at the Ectopic site preceded the onset of the surface P wave by 20-60 msec (median, 42 msec). Tachycardia terminated 0.5-13.0 seconds (median, 2.0 seconds) into a successful RF application. The ablation effectively eliminated EAT in 11 of 12 patients (92%), all of whom were dischar...
James E Lock - One of the best experts on this subject based on the ideXlab platform.
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transcatheter ablation of Ectopic Atrial Tachycardia in young patients using radiofrequency current
Circulation, 1992Co-Authors: Edward P Walsh, J P Saul, J E Hulse, Larry A Rhodes, Allan J Hordof, John E Mayer, James E LockAbstract:BACKGROUNDEctopic Atrial Tachycardia (EAT) is a reversible cause of cardiomyopathy but may be quite difficult to control with conventional therapy. Transcatheter ablation with radiofrequency current was tested as an alternative to medical or surgical treatment of this condition.METHODS AND RESULTSTwelve young patients (aged 10 months to 19 years) with drug-resistant EAT were treated with direct transcatheter ablation of the Ectopic focus using radiofrequency (RF) energy. All had depressed left ventricular contractility by echocardiographic criteria, involving shortening fractions of 10-26% (median, 20%; normal, 28-35%). The EAT was mapped to the left atrium in seven cases and to the right atrium in five. Local Atrial activation at the Ectopic site preceded the onset of the surface P wave by 20-60 msec (median, 42 msec). Tachycardia terminated 0.5-13.0 seconds (median, 2.0 seconds) into a successful RF application. The ablation effectively eliminated EAT in 11 of 12 patients (92%), all of whom were dischar...
Motonobu Hayano - One of the best experts on this subject based on the ideXlab platform.
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sequential ablation of orthodromic atrioventricular Tachycardia and Ectopic Atrial Tachycardia with a single application of radiofrequency energy
Pacing and Clinical Electrophysiology, 2003Co-Authors: Norihiro Komiya, Motonobu Hayano, Kentaro Amenomori, Koujiro Nakao, Kiyotaka Matsuo, Katsusuke YanoAbstract:A 62-year-old woman with Wolff-Parkinson-White syndrome had two types of Tachycardia; Ectopic AT and orthodromic-type AVRT. A radiofrequency application 2 cm inside the coronary sinus ostium eliminated Ectopic AT and accessory pathway conduction at once.
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a case of Tachycardia induced cardiomyopathy due to chronic Ectopic Atrial Tachycardia
Clinical Cardiology, 1993Co-Authors: Motonobu Hayano, M Tomomro D Kawasaki, M Yoshiki D Egucm, M Shinsuke D Tsuji, M Takasw D Tokushima, M Tohru D Ogata, M Swnji D Eguchi, Moronari Matsunaga, M Kazuyo D MatsunagaAbstract:Only a few reports exist that chronic supraventricular Tachycardia causes ventricular dilation and poor left ventricular contraction—so-called “Tachycardia-induced cardiomyopathy.”1-4 Clinical and electrophysiologic features of chronic supraventricular Tachycardia including chronic persistent Ectopic Atrial Tachycardia (EAT)5-7 in adults have also been described by a few investigators.5-9 We report a rare case of long follow-up of chronic EAT-induced severe cardiomyopathy and mitral regurgitation that was well controlled after medical treatment.
John K Triedman - One of the best experts on this subject based on the ideXlab platform.
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adverse event rate during inpatient sotalol initiation for the management of supraventricular and ventricular Tachycardia in the pediatric and young adult population
Heart Rhythm, 2020Co-Authors: Stephanie F Chandler, Esther Chu, Robert Whitehill, Laura Bevilacqua, Vassilios J Bezzerides, Elizabeth S Dewitt, Mark E Alexander, Dominic Abrams, John K Triedman, Edward P WalshAbstract:Background Sotalol is an important antiarrhythmic drug in the pediatric population. Given the risk of proarrhythmia, sotalol is initiated in inpatient settings, with adult studies as recent as 2015 supporting this practice. Objective The purpose of this study was to determine the frequency of adverse events (AEs) during sotalol initiation for the management of Atrial, supraventricular, or ventricular arrhythmias in pediatric patients. Methods A retrospective cohort analysis of pediatric patients 21 years or younger initiated on oral sotalol for supraventricular Tachycardia or ventricular Tachycardia (VT) at Boston Children's Hospital from January 1, 2007, through July 1, 2016, was performed. The primary end point was an AE defined as significant bradycardia, new or increased ventricular arrhythmias, conduction block, or corrected QT interval (QTc) prolongation, resulting in dose reduction or cessation. Results There were 190 patients who met inclusion criteria, with 110 patients (58%) 6 months or younger. A total of 115 patients (60%) had congenital heart disease. Arrhythmias for which sotalol was initiated included atrioventricular reciprocating Tachycardia/atrioventricular nodal reciprocating Tachycardia (n = 105 [55%]), Atrial flutter (n = 31 [16%]), Ectopic Atrial Tachycardia (n = 26 [14%]), VT (n = 21 [11%]), and Atrial fibrillation (n = 7 [4%]). The median pre-sotalol QTc was 438 ms (interquartile range 348–530 ms). Five patients (3%) (aged 0.1–18 years) had AEs including bradycardia Conclusion The incidence of AEs in pediatric patients initiating sotalol for Atrial Tachycardia, supraventricular Tachycardia, or VT is low (3%), with no deaths or malignant rhythms reported in this series.
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epicardial ablation of tachyarrhythmia in children experience at two academic centers
Pacing and Clinical Electrophysiology, 2017Co-Authors: Shailendra Upadhyay, John K Triedman, Edward P Walsh, Frank Cecchin, Juan Villafane, Philip J SaulAbstract:Background Experience with percutaneous epicardial ablation of tachyarrhythmia in pediatrics is limited. This case series addresses the feasibility, safety, and complications of the procedure in children. Methods A total of nine patients underwent 10 epicardial ablation procedures from 2002 to 2013 at two academic centers. Activation mapping was performed in all cases, and electroanatomic map was utilized in nine of the 10 procedures. Patients had undergone one to three failed endocardial catheter ablations in addition to medical management, and all had symptoms, a high-risk accessory pathway (AP), aborted cardiac arrest with Wolff-Parkinson-White syndrome (WPW), or ventricular dysfunction. A standard epicardial approach was used for access in all cases, using a 7- or 8- Fr sheath. Epicardial ablation modality was radiofrequency (RF) in seven, cryoablation (CRYO) in one, and CRYO plus RF in one. Results Median age was 14 (range 8–19) years. Indications: drug refractory Ectopic Atrial Tachycardia (one), ventricular Tachycardia (VT) (five), high-risk AP (two), and aborted cardiac arrest from WPW – (one). Epicardial ablation was not performed in one case despite access due to an inability to maneuver the catheter around a former pericardial scar. VT foci included the right ventricular outflow tract septum, high posterior left ventricle (LV), LV outflow tract, postero-basal LV, and scar from previous rhabdomyoma surgery. WPW foci were in the area of the posterior septum and coronary sinus in all three cases. Overall procedural success was 70% (7/10), with epicardial ablation success in five and endocardial ablation success after epicardial mapping in two. The VT focus was close to the left anterior descending coronary artery in one of the unsuccessful cases in which both RF and CRYO were used. There was one recurrence after a successful epicardial VT ablation, which was managed with a second successful epicardial procedure. There were no other recurrences at more than 1 year of follow-up. Complications were minimal, with one case of inadvertent pleural access requiring no specific therapy. No pericarditis or effusion was seen in any of the patients who underwent epicardial ablation. Conclusion Epicardial ablation in pediatric patients can be performed with low complications and acceptable success. It can be considered for a spectrum of Tachycardia mechanisms after failed endocardial ablation attempts and suspected epicardial foci. Success and recurrence may be related to foci in proximity to the epicardial coronaries, pericardial scar, or a distant location from the closest epicardial location. Repeat procedures may be necessary.
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postoperative Ectopic Atrial Tachycardia in children with congenital heart disease
American Journal of Cardiology, 2001Co-Authors: Ana Maria Rosales, Edward P Walsh, David L Wessel, John K TriedmanAbstract:The causes and significance of postoperative Ectopic Atrial Tachycardia (EAT) remain unknown. To identify factors associated with postoperative EAT in children after cardiac surgery, we retrospectively studied pre-, intra-, and postoperative variables. The median age for postoperative EAT cases was younger than the general population admitted for cardiac surgical procedures (6 vs 17 months old, p = 0.09). Trends for EAT cases included lower preoperative oxygen saturation (84% vs 99%, p = 0.001), more pre- and postoperative inotropic support, and Atrial septostomy (24% vs 6%, p = 0.08). EAT cases had longer cardiopulmonary bypass times and clamp times (115 vs 88 minutes, p = 0.08; 63 vs 46 minutes, p = 0.03, respectively) and had a prolonged intensive care unit stay (10 vs 3 days, p <0.001). Deaths were recorded in 2 of 17 EAT cases versus 0 of 36 randomly selected controls (p = 0.10). EAT resolved before discharge in 10 of 16 surviving patients. The etiology of EAT appears to be multifactorial, and may include disruption of Atrial septum, longer pump times, need for inotropic support, and potassium depletion. Thus, young, ill, cyanotic patients were most at risk for postoperative EAT. Although EAT was associated with prolonged intensive care, it resolved in most cases over time.
Michael E. Cain - One of the best experts on this subject based on the ideXlab platform.
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Long-term effectiveness of surgical treatment of Ectopic Atrial Tachycardia
Journal of the American College of Cardiology, 1993Co-Authors: Nelson A. Prager, T. Bruce Ferguson, Judy L. Osborn, Bruce D Lindsay, Michael E. CainAbstract:OBJECTIVES: The purpose of this study was to determine the long-term clinical outcome of patients with Ectopic Atrial Tachycardias treated surgically. BACKGROUND: Ectopic Atrial Tachycardia is an uncommon arrhythmia that can be symptomatic and is associated with the development of a cardiomyopathy. Management strategies are not well defined because of the paucity of data on the long-term effectiveness of pharmacologic and nonpharmacologic therapies. METHODS: The long-term clinical impact of medical and surgical therapy was determined in 15 consecutive patients with Ectopic Atrial Tachycardia. All 15 patients were initially treated with antiarrhythmic drugs (mean 5.7 +/- 2.2 drugs/patient). An effective drug regimen was identified in only 5 (33%) of the 15 patients; the remaining 10 patients were treated surgically. In each, individualized surgical procedures were guided by computer-assisted intraoperative mapping, with Atrial plaques comprising up to 156 electrodes. Focal ablation was performed in four patients and Atrial isolation procedures in six. RESULTS: The 10 patients treated surgically were followed up a mean of 4 +/- 3.2 years. Ectopic Atrial Tachycardia recurred in one patient. A permanent pacemaker was implanted in two patients, one of whom also required reoperation for constrictive pericarditis. There were no operative deaths. Ectopic Atrial Tachycardia recurred in three (60%) of the five patients discharged on antiarrhythmic drug therapy during a mean follow-up interval of 6.4 +/- 4.3 years. There was one nonarrhythmic death. CONCLUSIONS: Map-guided surgery demonstrated long-term efficacy in abolishing symptoms in 9 of the 10 patients with Ectopic Atrial Tachycardia. Results demonstrate that surgery is effective for patients with Ectopic Atrial Tachycardias who are not easily treated with antiarrhythmic drugs.
