Can smartphone wireless ECGs be used to accurately assess ECG intervals in pediatrics? A comparison of mobile health monitoring to standard 12-lead ECG

BACKGROUND:Arrhythmias in children are often paroxysmal, complicating the ability to capture the abnormal rhythm on routine ECG during an outpatient visit. The Alivecor Kardia Mobile (KM) device is a wireless mobile health (mHealth) device that generates a single lead ECG tracing with a FDA-approved algorithm for detection of atrial fibrillation in adults. OBJECTIVE:The goal of this study is to assess the accuracy of interval measurements on KM tracings by directly comparing to standard 12-lead ECGs in pediatric patients. METHODS:This single center, prospective study enrolled pediatric outpatients, age 20ms with 4/9 (44%) having a conduction disorder and 2/9 (22%) having marked sinus arrhythmia. Bland-Altman method of agreement demonstrated strong agreement for QRSd and QTc. The AF algorithm reported 4/30 (13%) false positive "possible AF" diagnoses (rhythm over-read on KM demonstrated n = 3 marked sinus arrhythmia, n = 1 sinus rhythm with aberrated PACs) resulting in a specificity of 87%. CONCLUSION:The Alivecor Kardia device produces accurate single lead ECG tracings in both healthy children and children with cardiac disease or rhythm abnormalities across the pediatric spectrum. This mHealth application provides an accurate, non-invasive, real-time approach for ambulatory ECG monitoring in children and adolescents

Force‐sensing catheters during pediatric radiofrequency ablation: The FEDERATION Study

Background Based on data from studies of atrial fibrillation ablations, optimal parameters for the TactiCath (TC; St. Jude Medical, Inc) force‐sensing ablation catheter are a contact force of 20 g and a force‐time integral of 400 g·s for the creation of transmural lesions. We aimed to evaluate TC in pediatric and congenital heart disease patients undergoing ablation. Methods and Results Comprehensive chart and case reviews were performed from June 2015 to March 2016. Of the 102 patients undergoing electrophysiology study plus ablation, 58 (57%) underwent ablation initially with a force‐sensing catheter. Patients had an average age of 14 (2.4–23) years and weight of 58 (18–195) kg with 15 patients having abnormal cardiac anatomy. Electrophysiology diagnoses for the + TC group included 30 accessory pathway–mediated tachycardia, 24 atrioventricular nodal reentrant tachycardia, and 7 other. Baseline generator settings included a power of 20 W, temperature of 40°, and 6 cc/min flow during lesion creation with 11 patients (19%) having alterations to parameters. Seventeen patients (30%) converted to an alternate ablation source. A total of 516 lesions were performed using the TC with a median contact force of 6 g, force‐time integral of 149 g·s, and lesion size index of 3.3. Median‐term follow‐up demonstrated 5 (10%) recurrences with no acute or median‐term complications. Conclusions TactiCath can be effectively employed in the treatment of pediatric patients with congenital heart disease with lower forces than previously described in the atrial fibrillation literature. Patients with atrioventricular nodal reentrant tachycardia or atrioventricular reciprocating tachycardia may not require transmural lesions and the TC may provide surrogate markers for success during slow pathway ablation. </jats:sec

Percutaneous pulmonary valve implantation alters electrophysiologic substrate

BACKGROUND: Percutaneous pulmonary valve implantation (PPVI) is first‐line therapy for some congenital heart disease patients with right ventricular outflow tract dysfunction. The hemodynamics improvements after PPVI are well documented, but little is known about its effects on the electrophysiologic substrate. The objective of this study is to assess the short‐ and medium‐term electrophysiologic substrate changes and elucidate postprocedure arrhythmias. METHODS AND RESULTS: A retrospective chart review of patients undergoing PPVI from May 2010 to April 2015 was performed. A total of 106 patients underwent PPVI; most commonly these patients had tetralogy of Fallot (n=59, 55%) and pulmonary insufficiency (n=60, 57%). The median follow‐up time was 28 months (7‐63 months). Pre‐PPVI, 25 patients (24%) had documented arrhythmias: nonsustained ventricular tachycardia (NSVT) (n=9, 8%), frequent premature ventricular contractions (PVCs) (n=6, 6%), and atrial fibrillation/flutter (AF/AFL) (n=10, 9%). Post‐PPVI, arrhythmias resolved in 4 patients who had NSVT (44%) and 5 patients who had PVCs (83%). New arrhythmias were seen in 16 patients (15%): 7 NSVT, 8 PVCs, and 1 AF/AFL. There was resolution at medium‐term follow‐up in 6 (86%) patients with new‐onset NSVT and 7 (88%) patients with new‐onset PVCs. There was no difference in QRS duration pre‐PPVI, post‐PPVI, and at medium‐term follow‐up (P=0.6). The median corrected QT lengthened immediately post‐PPVI but shortened significantly at midterm follow‐up (P<0.01). CONCLUSIONS: PPVI reduced the prevalence of NSVT. The majority of postimplant arrhythmias resolve by 6 months of follow‐up

The experience of non-epileptic attack disorder (NEAD) : a repertory grid study examining NEAD patients' construal of their disorder

Non-epileptic attack disorder (NEAD) is a disorder resembling epilepsy, but is caused by psychological processes rather than neurological disturbance. Approximately 15-30% of patients referred to specialist epilepsy centres have NEAD as opposed to epilepsy. Research into NEAD has largely focused on the differential diagnosis of NEAD and identifying risk factors, such as abuse and psychopathology. Whilst this is important, there remains a paucity of research exploring the processes involved in the development and maintenance of NEAD, which contributes to the lack of research investigating treatment effectiveness and prognosis. Furthermore, there remains a paucity of research investigating patient perceptions and experiences, despite such factors influencing prognosis. Subsequently, the current study used repertory grid methodology to explore the largely overlooked domain of how individuals with NEAD construe their world (i.e. how they perceive themselves, others and their disorder). Twelve individuals with a diagnosis of NEAD were recruited from a clinical neuropsychology department within North-West England. This study was an exploratory, cross-sectional study using the repertory grid technique to explore the participants' construals of themselves and others, including construals of their ideal self and self before NEAD. Based on personal construct theory, this method aimed to overcome some of the methodological limitations inherent within NEAD research, by minimising researcher bias, exploring implicit and explicit perceptions and exploring both individual and group perceptions.A case series of grids was presented. Individual and multiple analyses were used to explore participants' construct systems. A data driven approach enabled hypotheses to be developed from the individual grids, which were explored via a composite grid and SocioNet analysis. Despite some themes being identified, the findings revealed the uniqueness of the participants' ways of construing, including a lack of shared understanding amongst the participants. The participants were unhappy with their current self and no longer construed themselves to be the person they were before the onset of NEAD. They also construed themselves as being distinct and/or alienated from others, although some participants construed positive consequences as a result of their NEAD. Whilst most participants agreed with their NEAD diagnosis 'label', they were less accepting of the psychological factors that characterise the diagnosis. Finally, physical health difficulties were construed as being preferable to experiencing mental health difficulties. The findings were discussed in relation to previous research and theoretical implications were highlighted. Clinical implications were highlighted, particularly how the current diagnostic and treatment system for individuals with NEAD may threaten their self-identity. Methodological considerations and recommendations for future research were also suggested. The repertory grid technique was found to be a useful and effective method to investigate the subjective perceptions of individuals with NEAD.EThOS - Electronic Theses Online ServiceLisa MacRae, 3.53 Simon Building, The University of Manchester, Brunswick Street, Manchester, M13 9PLGBUnited Kingdo

Oxygen-Driven Tumour Growth Model : A Pathology-Relevant Mathematical Approach

We acknowledge Lucas Dias Fernandes and Dr Nicolas Rubido from the University of Aberdeen and Dr Neil Evans from the University of Warwick for the broad discussions on the mathematics.Peer reviewedPublisher PD

Implantable loop recorder monitoring for refining management of children with inherited arrhythmia syndromes

BACKGROUND: Implantable loop recorders (ILRs) are conventionally utilized to elucidate the mechanism of atypical syncope. The objective of this study was to assess the impact of these devices on management of pediatric patients with known or suspected inherited arrhythmia syndromes. METHODS AND RESULTS: A retrospective chart review was undertaken of all pediatric patients with known or suspected inherited arrhythmia syndromes in whom an ILR was implanted from 2008 to 2015. Captured data included categorization of diagnosis, treatment, transmitted tracings, and the impact of ILR tracings on management. Transmissions were categorized as symptomatic, autotriggered, or routine. Actionable transmissions were abnormal tracings that directly resulted in a change of medical or device therapy. A total of 20 patients met the stated inclusion criteria (long QT syndrome, n=8, catecholaminergic polymorphic ventricular tachycardia,n=9, Brugada syndrome, n=1, arrhythmogenic right ventricular cardiomyopathy, n=2), with 60% of patients being genotype positive. Primary indication for implantation of ILR included ongoing monitoring +/− symptoms (n=15, 75%), suspicion of noncompliance (n=1, 5%), and liberalization of recommended activity restrictions (n=4, 25%). A total of 172 transmissions were received in patients with inherited arrhythmia syndromes, with 7% yielding actionable data. The majority (52%) of symptom events were documented in the long QT syndrome population, with only 1 tracing (5%) yielding actionable data. Automatic transmissions were mostly seen in the catecholaminergic polymorphic ventricular tachycardia cohort (81%), with 21% yielding actionable data. There was no actionable data in routine transmissions. CONCLUSIONS: ILRs in patients with suspected or confirmed inherited arrhythmia syndromes may be useful for guiding management. Findings escalated therapies in 30% of subjects. As importantly, in this high‐risk population, the majority of symptom events represented normal or benign rhythms, reassuring patients and physicians that no further intervention was required

Persistent Teaching Practices After Geospatial Technology Professional Development

This case study described teachers with varying technology skills who were implementing the use of geospatial technology (GST) within project-based instruction (PBI) at varying grade levels and contexts 1 to 2 years following professional development. The sample consisted of 10 fifth- to ninth-grade teachers. Data sources included artifacts, observations, interviews, and a GST performance assessment and were analyzed using a constant comparative approach. Teachers’ teaching actions, beliefs, context, and technology skills were categorized. Results indicated that all of the teachers had high beliefs, but their context and level of technology skills strongly influenced their teaching actions. Two types of teachers persisting in practices from professional development were identified: innovators and adapters. Persistence of practice and implementation of the integration of GST within PBI must continue after professional development ends, or the sustainability of the positive results experienced during the professional development will not persist

Persistent Teaching Practices After Geospatial Technology Professional Development

This case study described teachers with varying technology skills who were implementing the use of geospatial technology (GST) within project-based instruction (PBI) at varying grade levels and contexts 1 to 2 years following professional development. The sample consisted of 10 fifth- to ninth-grade teachers. Data sources included artifacts, observations, interviews, and a GST performance assessment and were analyzed using a constant comparative approach. Teachers’ teaching actions, beliefs, context, and technology skills were categorized. Results indicated that all of the teachers had high beliefs, but their context and level of technology skills strongly influenced their teaching actions. Two types of teachers persisting in practices from professional development were identified: innovators and adapters. Persistence of practice and implementation of the integration of GST within PBI must continue after professional development ends, or the sustainability of the positive results experienced during the professional development will not persist

Implementation and early experience of a pediatric electrophysiology telehealth program

BACKGROUND: Telehealth (TH) visits have been growing with exponential increased utilization during the COVID-19 pandemic. The aim of this manuscript is to describe the implementation and early experience of a pediatric electrophysiology (EP) TH program implemented during the pandemic, assessing patient satisfaction, patient equity and inclusion (measured by geographical outreach), and sustainability. METHODS: A retrospective chart review study was performed and data were collected from the medical record, including demographic, testing, and billing data from scheduled TH encounters between March and August 2020 of a single pediatric EP group in the Midwest. Patients were called to complete satisfaction surveys. RESULTS: Patients with diverse pathologies were seen in TH, with supraventricular/atrial tachycardias (n = 41, 35%) and inherited arrhythmia syndromes (n = 23, 20%) being most common. The mean distance from clinic was 95 miles (range 2.8-320 miles), with 43% of patients living more than 100 miles away from clinic. A total of 172 tests were performed previsit (n = 102, 59%), during the visit (n = 17, 10%), or postvisit (n = 53, 31%), including 15 EP studies. Time-based Current Procedural Terminology codes were predominantly used for billing purposes (n = 92, 78%). There was generation of work relative value units (wRVU) for visits (220.5 wRVU) and testing (325.1 wRVU). Survey data demonstrated that 98% of patients were satisfied with their telehealth appointment and 99% had a clear understanding of their diagnosis. CONCLUSION: Pediatric EP TH clinics can provide care for a geographically and pathologically heterogeneous group of patients who had positive attitudes toward TH. Our study shows significant downstream testing and subsequent wRVU generation, suggesting financial sustainability