Effectiveness of sotalol for atrial flutter in children after surgery for congenital heart disease

This study describes the efficacy of oral sotalol in the treatment and prevention of atrial flutter in children after surgery for congenital heart disease. In 11 of 13 children (85%), conversion to sinus rhythm was achieved, and in 8 of 11 within 24 hours

Sinus node function in children with congenital complete atrioventricular block

Aims Children with congenital complete atrioventricular block (CCAVB) often need pacemaker therapy. In these children, it may be preferable to use single-lead VDD pacing, but for VDD pacing a normal sinus node function is required. Our aim was to study sinus node function in children with CCAVB. Methods and results We longitudinally evaluated sinus rate in 36 children with CCAVB and normal anatomy of the heart. The rate of sinus rhythm on a 12-lead ECG, in Hotter recordings, and exercise tests were evaluated at regular intervals. Age at the first visit of the children was 2.5 +/- 3.3 years (mean +/- SD). Follow-up was 10.6 +/- 7.3 years. The rate of sinus rhythm on a 12-lead ECG was at every age within the normal values for age (e.g. 0-1 year: 153 +/- 24 bpm, and 17-18 years: 76 +/- 4 bpm). Lowest and highest sinus rates in the Hotter recordings were normal. During exercise, mean sinus rate in the total group of children increased from 92 +/- 8 at rest to 171 +/- 9 bpm at maximal exercise. Conclusion We conclude that sinus node function is normal in children with CCAVB. Because of the normal increase in sinus rate during exercise, a single-lead VDD pacemaker can be safety implanted in these children

Natural history of ventricular premature contractions in children with a structurally normal heart:does origin matter?

Aims Premature ventricular contractions (PVCs) are thought to be innocent in children with normal hearts, especially if they disappear during exercise. The aim of our study was to study the natural history of PVCs in childhood and whether there is a difference between PVCs originating from the right [premature ventricular contraction with left bundle branch block (PVC-LBBB)] or the left ventricle [premature ventricular contraction with right bundle branch block (PVC-RBBB)]. Methods and results We evaluated children with frequent PVCs and anatomically normal hearts (n= 59; 35M/24F) by 12-lead ECG, echocardiography, Holter recording, and an exercise test. Age at the first visit was 7.1 +/- 4.3 years (mean +/- SD), and follow-up was 3.1 +/- 3.1 years. We could evaluate each child for 2.5 +/- 1.5 times. Premature ventricular contraction with left bundle branch block was seen in 41% of the children; PVC-RBBB in 36%; and undetermined in 23%. Mean percentage PVCs in the Holter recording decreased (14.3 +/- 13.7% in the age group 1-3 years to 4.8 +/- 7.2% in the age group >= 16 years; P= 0.08). Mean percentage PVC-LBBB did not change (12.3 +/- 21.4 vs. 11.7 +/- 5.5%), whereas PVC-RBBB decreased (16.3 +/- 4.2 to 0.6 +/- 1.4%; P <0.02). Conclusion We conclude that there is a difference in the natural history between PVC-LBBB and PVC-RBBB in children with an anatomically normal heart. Premature ventricular contraction with right bundle branch block disappears during childhood. Follow-up of these children seems not necessary. Premature ventricular contraction with left bundle branch block does not disappear and, therefore, it may be necessary to follow these children even during adulthood

Drug management of fetal tachyarrhythmias:Are we ready for a systematic and evidence-based approach?

Fetal tachyarrhythmias are a life-threatening condition complicating a small proportion of normal pregnancies. Despite major advances in the (intrauterine) pharmacologic treatment of these arrhythmias over the last years major uncertainties remain. Among these are controversies in the choice of agents in relation to arrhvthmia type, and timing and duration of treatment. Currently, no evidence-based approach to the manacement of fetal tachyarrhythmias is available. An international registry is proposed as an important step toward obtaining the necessary data to develop evidence-based management strategies