Usefulness and safety of ablation in the treatment of supraventricular tachycardia in children — our own experience

Częstoskurcz nadkomorowy (SVT) jest jedną z częstszych arytmii stwierdzanych u dzieci i młodzieży. Jego występowanie ocenia się na 1 : 250–1 : 1000. Częste napady SVT, wymagające hospitalizacji i umiarawiania dożylnego, negatywnie wpływają na jakość życia młodzieży, a długotrwały częstoskurcz może być przyczyną niewydolności krążenia, zwłaszcza u najmłodszych dzieci. Dlatego tak ważne jest rozpoznanie typu częstoskurczu i wdrożenie właściwego leczenia. Częstoskurcze u dzieci różnią się od tych występujących u dorosłych obrazem klinicznym, typem, historią naturalną, rokowaniem i schematem postępowania terapeutycznego. Wobec powyższego nie można bez zastrzeżeń zastosować „dorosłych” standardów AHA/ESC dla populacji dziecięcej.Supraventricular tachycardia (SVT) is the most common arrhythmia in children with otherwise normal hearts. The incidence of SVT in general population is estimated at 1 : 250 to 1 : 1000. Though rarely lifethreating, it often causes significant symptoms leading to anxiety, hospitalization and lifestyle limitations. The infant presenting signs of the congestive heart failure and an extremely fast heart rate demands expert management by an emergency health care provider with an in-depth understanding of diagnostic subtleties. These tachycardias differ from those seen in the adult population in terms of modes of presentations, their natural history, prognosis and overall management schemes. Therefore, we should not indiscriminately apply principles of adult management (AHA/EHS guidelines) to pediatric arrhythmias

A survey study of the use of a subcutaneous implantable cardioverter-defibrillator in various clinical scenarios by expert electrophysiologists in Poland

Background: A subcutaneous implantable cardioverter-defibrillator (S-ICD) has become a recognized alternative to a traditional transvenous implantable cardioverter-defibrillator (T-ICD). Despite the growing evidence of non-inferiority of S-ICD, there are no clear clinical guidelines for selection of either of the two available systems. The aim of the study was to analyze the decisions made in predefined typical clinical scenarios by Polish cardiologists experienced in the use of both S-ICDs and T-ICDs. Methods: A group of 30 experts of cardiac electrotherapy experienced in the use of S-ICDs was recruited and invited to participate in a web-based anonymous survey. The survey questions regarded the proposed therapy in various but typical clinical scenarios. Results: From the invited 30 experts representing 18 clinical centers, 25 completed the survey. 72% of them declared that the number of S-ICDs implanted at their center during the preceding 12 months exceeded 10, and 40% — that it was over 20. Rates of responders preferring S-ICD or T-ICD in various clinical scenarios are reported and discussed in detail. Conclusions: Significant divergence of opinion exists among Polish experts regarding the use of a subcutaneous cardioverter-defibrillator. It is especially pronounced on the issue of the use of the system in middle-age patients, in case of complications of the hitherto ICD therapy, or the need of upgrading the existing cardiac implantable electronic device

Decubitus in pacemaker/cardioverter defibrillator. The problem too often missed out

Infekcje implantowanych układów stymulujących serce to jedne z najpoważniejszych powikłańelektroterapii. W artykule przedstawiono przypadek kliniczny chorego z odleżyną w lożyrozrusznika leczonego operacyjnie. Omówiono także całościowo problematykę rozpoznawaniai leczenia tego typu powikłań z uwzględnieniem roli lekarza rodzinnego w tym procesie.Cardiovascular implantable electronic devices (CIED) associated infections are one of the most serious complications of electrotherapy. The article presents a clinical case of a patient with pacemaker pocket infection treated surgically. Also discussed the whole issue of diagnosis and treatment of such complications, including the role of family physician in this process

Polish single-centre follow-up of subcutaneous implantable cardioverter-defibrillator (S-ICD) systems implanted for the prevention of sudden cardiac death

Background and aim: Subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective and modern tool used to protect patients at risk of sudden cardiac death (SCD) from potentially life-threatening ventricular arrhythmias. The first S-ICD systems were implanted in Poland in 2014, but since that time the national experience with that therapy has been limited. Our analysis summarises the single-centre experience at the Department of Cardiology and Electrotherapy of the Medical University of Gdansk with the use of S-ICD from the year 2014 to 2017. Methods and results: The S-ICD therapy was used in 12 patients (five male, seven female, mean age 57.2 ± 12.5 years), in eight of them for the secondary prevention of SCD. No surgical complications of implantation procedures were observed during the perioperative hospitalisation nor during follow-up. During the mean follow-up of 14 ± 13 months we observed the appropriate function of the systems and a ventricular fibrillation episode successfully terminated by the device in one patient, two cases of S-ICD sensing problems (one of which led to inadequate intervention of the device), and an episode of atrial fibrillation also leading to inadequate intervention in another patient. Conclusions: S-ICD, being an effective and safe method used to treat patients at risk of SCD, may be safely and successfully introduced into clinical practice in centres new to that field. The number of complications during the initial experience and introduction of that method may be kept low if the operating team is experienced enough in cardiac electrotherapy.Background and aim: Subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective and modern tool used to protect patients at risk of sudden cardiac death (SCD) from potentially life-threatening ventricular arrhythmias. The first S-ICD systems were implanted in Poland in 2014, but since that time the national experience with that therapy has been limited. Our analysis summarises the single-centre experience at the Department of Cardiology and Electrotherapy of the Medical University of Gdansk with the use of S-ICD from the year 2014 to 2017. Methods and results: The S-ICD therapy was used in 12 patients (five male, seven female, mean age 57.2 ± 12.5 years), in eight of them for the secondary prevention of SCD. No surgical complications of implantation procedures were observed during the perioperative hospitalisation nor during follow-up. During the mean follow-up of 14 ± 13 months we observed the appropriate function of the systems and a ventricular fibrillation episode successfully terminated by the device in one patient, two cases of S-ICD sensing problems (one of which led to inadequate intervention of the device), and an episode of atrial fibrillation also leading to inadequate intervention in another patient. Conclusions: S-ICD, being an effective and safe method used to treat patients at risk of SCD, may be safely and successfully introduced into clinical practice in centres new to that field. The number of complications during the initial experience and introduction of that method may be kept low if the operating team is experienced enough in cardiac electrotherapy

Eligibility of patients with temporarily paced rhythm for a subcutaneous implantable cardioverter-defibrillator

Background: A concomitant use of a pacemaker and a subcutaneous implantable cardioverter-defibrillator (S-ICD) may be required in some patients. The aim of our study was to evaluate the influence of permanent cardiac pacing on the morphology of the QRS complex in the context of S-ICD screening. Methods: One hundred patients with cardiac electronic implantable devices (CIEDs) were included, in whom S-ICD screening could be performed both during intrinsic and paced rhythm. Results: The positive result of screening during spontaneous rhythm for at least one vector (the same supine and standing) was obtained in 80%, and for 2 vectors in 59% of patients. Positive screening during paced rhythm for at least one vector was recorded in 36% of patients (78% right ventricular and 22% biventricular pacing), and for 2 vectors in 15% of patients (93% right ventricular and 7% biventricular pacing). At least one vector acceptable during both types of rhythm and in both positions was recorded in 23% of patients, and at least 2 vectors - in 8% of patients. Conclusions: The use of S-ICD in patients with paced ventricular rhythm is associated with a serious risk of inappropriate sensing, due to the different QRS morphology during intrinsic and paced rhythm, and it is particularly high in patients, in whom periods of spontaneous rhythm interchange with periods of ventricular pacing. That risk has been scarcely acknowledged in the available reports, but according to our data it is significant and therefore it should be considered during S-ICD screening

Pre-discharge defibrillation testing: Is it still justified?

Background: An implantable cardioverter-defibrillator (ICD) is routinely used to prevent sudden cardiac death. Since the introduction of that device into clinical practice, a defibrillation test (the so-called pre-discharge test [PDT]) has been an inseparable part of the ICD implantation procedure. Recently, the usefulness of PDT has been called into question. Methods: The aim of this research was to analyze ICD tests performed within two time periods: in years 1995–2001 (period I) and 2007–2010 (period II), in order to compare the results of tests and solutions to all the problems with ICD systems revealed by means of PDT. Results: During period I, 193 tests were performed, among which the ICD system malfunction was observed in 16 cases. Those included: sensing issues, specifically R-wave undersensing during ventricular fibrillation (VF) (7 patients) and T-wave oversensing (4 patients), as well as high defibrillation threshold (DFT) (2 patients) and ICD-pacemaker interaction (3 patients). During period II, among 561 tests, system malfunction was observed in 15 cases. In 1 patient it was VF undersensing, and in the remaining 14 it was high DFT. All the above problems were solved by means of appropriate ICD reprogramming, repositioning of the endocardial defibrillation lead or implantation of an additional subcutaneous defibrillation lead. Conclusions: Contemporary ICD technical solutions, compared to older systems, in most cases allow to avoid sensing problems. The key rationale behind ICD testing is the ability to confirm the efficacy of high-voltage therapy. Despite the increasing maximal defibrillation out­put of devices, and all possible adjustments to the characteristics of the impulse, there is still a group of patients that require additional procedures to ensure the appropriate defibrillation efficacy