Utility of Intrathoracic Impedance Monitoring in Pediatric and Congenital Heart Disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99042/1/pace12134.pd

Patient and Procedural Correlates of Fluoroscopy Use During Catheter Ablation in the Pediatric and Congenital Electrophysiology Lab

ObjectiveTo identify factors associated with fluoroscopy use in pediatric and congenital heart disease (CHD) patients.DesignRetrospective cohort.SettingPediatric electrophysiology lab in a single tertiary‐care children's hospital.PatientsThree hundred eighty‐three patients who underwent electrophysiology study and ablation between January 2010 and December 2012.MethodsAblation procedures in which nonfluoroscopic navigation was employed were reviewed. Procedures using ≥10 minutes of fluoroscopy (high‐fluoroscopy time; HF) were compared with those using <10 minutes (low‐fluoroscopy time; LF). Group comparison of characteristics was made in the entire cohort and in CHD and anatomically normal heart subsets.ResultsDuring the study period, 416 ablation procedures were performed involving 471 substrates in 383 patients. Median fluoroscopy time was 6.7 minutes overall and 5.1 minutes with anatomically normal hearts. LF comprised 61% of all ablation and 69% of anatomically normal hearts. LF procedures were associated with anatomically normal hearts (93% vs. 63%; P < .0001). In anatomically normal hearts, HF was associated with accessory pathways (64% vs. 47%; P = .01), posteroseptal substrates (22% vs. 9%; P = .002), and ventricular substrates (12% vs. 1%; P < .0001). All cases of intra‐atrial reentrant tachycardia were HF. HF was associated with trans‐septal puncture (47% vs. 23%; P < .0001) though not when controlling for atrioventricular nodal reentrant tachycardia. LF was associated with cryoablation (56% vs. 17%; P < .0001).ConclusionsIn pediatric and congenital EP, ablation procedures using cryoablation and in patients with anatomically normal hearts are associated with LF. In accessory pathway ablation, HF was not associated with trans‐septal puncture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111901/1/chd12213.pd

Antitachycardia Pacemakers in Congenital Heart Disease

BackgroundMany patients with congenital heart disease (CHD) acquire rhythm abnormalities related to their repair, most commonly intraatrial reentrant tachycardia (IART). Treatment of IART in CHD is often multifaceted, and may include medication, ablation, and pacing. Evidence regarding the use of antitachycardia pacing therapies is limited.ObjectiveThe aim of the study is to define the use and efficacy of antitachycardia pacing in patients with CHD at a single center.ResultsEighty implants were performed on 72 patients between 2000 and 2010. Follow‐up data of more than 3 months were available for 56 patients; median follow‐up time was 2.8 years. Twenty (36%) patients received successful antitachycardia pacing at a median 1.3 years postimplant. For those patients with IART after implant, antitachycardia pacing was successful in 57%. Patients with two‐ventricle repairs were more likely to have successful antitachycardia pacing than those with one‐ventricle palliation (45% vs. 17%, P = .04). Patients with documented IART had more successful antitachycardia pacing than those with no documented atrial tachycardia prior to implant (46% vs. 7%, P = .006). Early complications of antitachycardia pacemaker implant occurred in six patients (11%); late complications after implant occurred in three patients (5.6%). Of the initial 72 patients implanted, there were six deaths (8%).ConclusionsAntitachycardia pacing therapies were successful in the majority of CHD patients who had IART after implant. Patients without documented atrial tachycardia prior to implant were unlikely to require or receive successful therapy from antitachycardia pacemaker. Those patients postatrial switch procedure who had documented IART prior to implant had the highest incidence of successful antitachycardia pacing therapies. Antitachycardia pacemaker implantation is an adjunct to the management of IART in CHD patients, but may not benefit patients who have not yet demonstrated IART.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111221/1/chd12230.pd

Frequency of CIED remote monitoring: A quality improvement follow‐up study

BackgroundBased on the findings of a prior study of CIED (Cardiac Implantable Electrical Device) remote monitoring (RM) frequency at the same center, the University of Michigan Congenital Heart Center (UMCHC) instituted a quality improvement (QI) change to reduce the frequency of routine CIED RM from every 2 months to every 3 months. The objective of this study is to determine the impact of this QI initiative to reduce workload without compromising patient care.MethodsThis is a single‐center, retrospective cohort study of all UMCHC patients with CIEDs followed via Medtronic CareLink CIED remote monitoring system from July 2015 to June 2017, after the QI change in 2014. The primary outcome was success of transition to new monitoring schedule. Secondary outcomes included complications, incidence of actionable events (AES), patient compliance, and change in workload. Outcomes were compared to the prior study.ResultsThere were 325 patients (mean age was 24  ±  14 years) included, of who 293 (90%) completely transitioned to the new RM schedule. During the study period, 96 transmissions included AES (4% of total), of which 50 (52%) were asymptomatic and discovered on routine monitoring. No patient experienced a complication attributable to decreased RM frequency. The mean number of interrogations decreased by 1.6 per patient over the 2‐year period compared to prior study.ConclusionsThis study demonstrated successful implementation of a QI initiative to reduce CIED monitoring frequency at a single center with no patient adverse events. The intervention reduced workload and potentially improved patient compliance with routine RM.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150575/1/pace13707_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150575/2/pace13707.pd

Implantable Cardioverter Defibrillator Outcomes in Pediatric and Congenital Heart Disease: Time to System Revision

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122425/1/pace12878.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/122425/2/pace12878_am.pd

Impact of Feeding Aspergillus Subspecies Blend and Di! erent Corn Processing Methods on Finishing Beef Cattle Performance and Carcass Characteristics

A feedlot study utilizing 320 crossbred calf- fed steers (initial body weight 588 lb) compared the effect of feeding an Aspergillus additive in either dry- rolled corn or high- moisture corn finishing diets on cattle performance and carcass characteristics. Steers were fed 0 g/steer daily or 10 g/steer daily Aspergillus for both corn processing methods. # ere were no significant interactions between corn processing method and Aspergillus. Feeding finishing cattle Aspergillus did not impact performance compared to feeding none. Cattle fed dry- rolled corn had greater final body weight, dry matter intake, and gain compared to high- moisture corn diets. But cattle fed high- moisture corn had a 6.25% decrease in feed- to- gain compared to dry- rolled corn. These data suggest that feeding Aspergillus does not affect performance. The lower dry matter intake and average daily gain observed would suggest a potential acidosis problem for high- moisture corn compared to dry- rolled corn- based finishing diets

Impact of Shade in Beef Feed Yards on Performance, Body Temperature, and Heat Stress

A study using crossbred steers was conducted at a commercial feedyard in Eastern NE to determine the effects of shade on cattle performance, ear temperature, panting scores, and cattle activity. Cattle with shade had greater dry matter intake, average daily gain and lower panting scores while movement and ear temperature were not different between treatments. Over the course of the experiment three weather events were selected to be analyzed separately (two heat events and one cool event) based on wind adjusted temperature- humidity index. Providing shade during heat event 1 resulted in greater intakes and lower panting scores, while providing shade during heat event 2 resulted in lower panting scores compared to non- shaded cattle. During the cool event, greater intakes and lower panting scores were observed for shaded cattle, although panting scores were low for both treatments. Providing shade for cattle improved intakes and average daily gains while mitigating some effects of heat stress

Evaluation of Corn Distillers Solubles on Finishing Steer Performance

A finishing study was conducted to evaluate the effects of feeding 0, 8, 16, or 20% corn distillers solubles (CDS), as well as the effects of feeding a combination of 16% CDS and 20% wet distillers grains plus solubles (WDGS) to replace a blend of dry-rolled and high-moisture corn on finishing steer performance. As inclusions of CDS increased, ADG linearly increased and F:G linearly decreased. Feeding value of CDS at 20% inclusion was determined to be 147% compared to the corn blend. The addition of WDGS resulted in a decrease in DMI with similar ADG, resulting in a decrease in F:G. Feeding a combination of CDS and WDGS resulted in a feeding value of 161% compared to corn. Feeding CDS up to 20% or in combination with WDGS displaces corn in finishing diets and improves ADG and F:G