Amiodarone in Pediatric Patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75189/1/j.1540-8167.1986.tb01730.x.pd

Transcatheter Electrical Ablation of Accessory Pathways in Children

Supraventricular tachycardia (SVT), the most common sustained symptomatic arrhythmia of childhood, is often supported hy a manifest or concealed accessory pathway. Permanent interruption of the accessory pathway usually requires surgical division. Recent experience with electrical ablation of posterior septal pathways in adults prompted us to apply the technique to children. Six children, ages 8 to 15 years, underwent a complete electrophysiological study followed by transcatheter electrical ablation. Five of the 6 children, 3 with a right posterior septal and 2 with a left posterior septal pathway, were approached with the ablation catheter at the os of the coronary sinus. In the remaining patient, a left lateral pathway was mapped with an electrode catheter in the coronary sinus and then approached with the ablation catheter through the patent foramen into the left atrium. Two patients are asymptomatic 18–24 months postabla-tion; one patient had return of anomalous conduction between 7 and 21 days after ablation. Two patients had transient interruption of anomalous conduction, whereas one patient experienced no effect. We conclude that in carefully selected patients, transcatheter electrical ablation ofers an alternative to surgery for permanent interruption of an accessory pathway. (PACE, Vol. 12, November 3989)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71986/1/j.1540-8159.1989.tb01865.x.pd

Delayed Response to Radiofrequency Ablation of Accessory Connections

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72240/1/j.1540-8159.1993.tb01019.x.pd

Ventricular tachycardia in children

Thirty-eight patients aged 1 to 20 years (mean 11.2) were evaluated because of recurrent ventricular tachycardia. The follow-up period ranged from 0.5 to 12 years (mean 6). The patients were separated into two groups according to the presence or absence of known structural heart disease. Seventeen of the 21 patients with known heart disease were symptomatic (cardiac arrest in 5, syncope in 5, dizziness in 7) compared with only 6 of the 17 patients without heart disease (syncope in 3 and dizziness in 3) (p Antiarrhythmic therapy was used in 28 of the 38 patients. Effectiveness of therapy was assessed with both 24 hour Holter monitoring and graded treadmill exercise testing. Therapy effectively abolished ventricular tachycardia and greatly decreased the number of premature ventricular complexes in the symptomatic patients but was less effective in the asymptomatic patients. Thus, this study suggests that the presence of underlying heart disease, the rate of ventricular tachycardia and the results of graded treadmill exercise tests are important in predicting the prognosis of children with ventricular tachycardia.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24390/1/0000660.pd

Doppler detection of valvular regurgitation after radiofrequency ablation of accessory connections

Radiofrequency current was used recently to ablate accessory connections in patients with supraventricular tachycardia.1-5 After locating the accessory connection by electrophysiologic mapping, ablation is achieved by positioning a 7Fr catheter (with 4 mm electrode at distal tip) within the ipsilateral cardiac chamber and adjacent to the accessory connection. Radiofrequency current is then delivered at the point of earliest electrical activation along the atrioventricular valve annulus. For a left-sided accessory connection, the catheter is usually passed retrograde across the aortic valve into the left ventricle and under the posterior mitral valve leaflet. For a right-sided accessory connection, the catheter is passed anterograde into the right atrium or ventricle.1-5 Systematic evaluation of the effects of this technique on the function of all cardiac valves has not been reported. This study evaluates the effects of catheter manipulation and radiofrequency current delivery on valve competence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29958/1/0000320.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

Ventricular Pacing in Children

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75351/1/j.1540-8159.1982.tb06565.x.pd

Use of the Pill Electrode for Transesophageal Atrial Pacing

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72094/1/j.1540-8159.1985.tb05853.x.pd

Use of a Single Coil Transvenous Electrode with an Abdominally Placed Implantable Cardioverter Defibrillator in Children

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73702/1/j.1540-8159.2000.tb00859.x.pd

Cardiac controlled release for arrhythmia therapy: Lidocaine-polyurethane matrix studies

Cardiac arrhythmias are the principal cause of sudden death due to heart disease, and current therapy is inadequate. A novel approach for formulating a lidocaine-polyurethane controlled release matrix and implanting this drug delivery system directly onto the arrhythmic epicardium is reported. Lidocaine-HCl-polyurethane matrices (28% w/w) were fabricated and studied for their in vitro drug release into physiologic buffer, and their in vivo pharmacologie effectiveness in rapidly converting ouabain-induced ventricular tachycardia in dogs to normal sinus rhythm. In vitro lidocaine release was successfully modulated as a result of variations in fabrication: compression molding, and stirring during polymer synthesis. Lidocaine release in vitro from the most rapidly releasing matrix formulation delivered more than 40% of the contained drug delivered after only 20 minutes, and the remainder slowly released over one week or more. Direct epimyocardial placement of this formulation resulted in the prompt conversion of ouabain-induced ventricular tachycardia to normal sinus rhythm in all experimental animals (n = 6) studied in 1.5 +/- 0.77 min(mean +/- standard error), while controls (n = 4) had persistent ventricular tachycardia for more than 60 min. Site-specific therapy was as rapid as intravenous administration, but with lower plasma lidocaine levels after comparable dosages. It is concluded that lidocaine-polyurethane controlled release matrices can be fabricated with a broad range of initial release profiles, and that these matrices can rapidly initiate the conversion of ouabain-induced ventricular tachycardia to normal sinus rhythm.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27025/1/0000013.pd