A decade of insertable cardiac monitors with remote monitoring in pediatric patients

Background: Remote monitoring-enabled insertable cardiac monitors (ICMs) are useful tools for arrhythmias and symptom management. This study sought to evaluate the outcome of ICM implantation in a large, heterogeneous cohort of pediatric and young adult patients. Methods: Single centre, retrospective analysis of patients who underwent ICM implantation in 2010–2019. Patients were analysed according to age, symptoms, arrhythmias and underlying heart disease. Results: A total of 200 consecutive patients (58% male), aged 11.5 ± 5.8 years at ICM implantation, were included. Follow-up was 31 ± 18 months. Electrophysiologic study (EPS) was initially performed in 123 patients and was negative in 85%. Patients had no heart disease (57.5%), congenital heart defects (21%), channelopathies (14.5%), cardiomyopathies/heart tumors (8%). The commonest symptoms were syncope/presyncope (45.5%) and palpitations (12.5%). A definite diagnosis was made in 63% of patients (positive diagnosis in 25%, negative in 38%) after 8 (2–19) months of monitoring. EPS results and the presence/absence of an arrhythmia before ICM implantation had no impact on the diagnostic yield. Symptomatic patients as well as patients without structural heart disease showed higher diagnostic yield. Patients with a positive diagnosis underwent pacemaker/implantable cardioverter-defibrillator implantation (13%), pharmacological treatment (10.5%), or catheter ablation (1.5%). Conclusions: In a large cohort of 200 children and young adults, ICMs with remote monitoring showed a high diagnostic yield (63%), especially in symptomatic patients and in patients without structural heart disease

Cabozantinib in neuroendocrine tumours: tackling drug activity and resistance mechanisms

Neuroendocrine tumors (NETs) are highly vascularized malignancies in which angiogenesis may entail cell proliferation and survival. Among the emerging compounds with antivascular properties, cabozantinib (CAB) appeared promising. We analyzed the antitumor activity of CAB against NETs utilizing in vitro and in vivo models. For cell cultures, we used BON-1, NCI-H727 and NCI-H720 cell lines. Cell viability was assessed by manual count coupled with quantification of cell death, performed through fluorescence-activated cell sorting analysis as propidium iodide exclusion assay. In addition, we investigated the modulation of the antiapoptotic myeloid cell leukemia 1 protein under CAB exposure, as a putative adaptive pro-survival mechanism, and compared the responses with sunitinib. The activity of CAB was also tested in mouse and zebrafish xenograft tumor models. Cabozantinib showed a dose-dependent and time-dependent effect on cell viability and proliferation in human NET cultures, besides a halting of cell cycle progression for endoduplication, never reported for other tyrosine kinase inhibitors. In a transplantable zebrafish model, CAB drastically inhibited NET-induced angiogenesis and migration of implanted cells through the embryo body. CAB showed encouraging activity in NETs, both in vitro and in vivo models. On this basis, we envisage future research to further investigate along these promising lines

Transseptal puncture via a superior access as an alternative to the conventional femoral route

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Initial Experience Using the Radiofrequency Needle Visualization on the Electroanatomical Mapping System for Transseptal Puncture

Introduction. Transseptal puncture (TSP) is a routine access route in patients with left-sided ablation substrates and is performed safely on fluoroscopy (+/− echocardiographic guidance). We report on our experience using a radiofrequency (RF) needle in an unselected group of patients to demonstrate safety and usefulness of direct tip visualization on the 3D electroanatomical mapping (EAM) system with specific emphasis on total radiation exposure. Methods and Results. We retrospectively reviewed 42 consecutive left-sided ablation procedures with TSP performed using an RF needle guided by fluoroscopy and/or EAM visualization by a single operator. The procedures included atrial fibrillation (n = 33), atrial tachycardia (n = 8), and ventricular tachycardia (n = 1) ablations. Fourteen of 41 patients had congenital heart disease, including 9 patients with previous septal closure. Twenty-two patients had at least one previous TSP. All TSPs were performed successfully and without complications. The overall median fluoroscopy time amounted to 3.2 min and median exposure of 199.5 µGy∗m2. In a subgroup of patients (n = 27), the RF needle was visualized on the EAM system: median radiation time was 0.88 (interquartile range: 0–3.4) min and median exposure 33.5 [0–324.8] µGy∗m2. Conclusions. TSP using an RF needle is an effective technique, also in congenital patients with artificial patch material and in normal patients with multiple previous TSPs. Moreover, the RF needle tip visualization on EAM allows a low (or even zero) fluoroscopy approach

Moderated poster - AVNRT cryoablation in children < 26 kg: efficacy and safety of electrophysiologically guided low voltage bridge strategy

Background and Aim: Recent studies have reported that the low voltage bridge (LVB) strategy is very effective in atrioventricular nodal reentrant tachycardia (AVNRT) ablation. The purpose of our study was to evaluate the efficacy and safety of AVNRT cryoablation in pediatric patients &lt; 26 Kg using the electrophysiologically guided LVB strategy both in the acute phase and in a mid-term follow up. Methods: Thirteen pediatric patients (69% males, mean age 7±1.65 years, mean weight 24.8±1.77 Kg), with previous history of AVNRT confirmed by the transesophageal atrial stimulation, underwent slow pathway cryoablation using the electrophysiologically guided LVB strategy. Results: In 12 patients a typical AVNRT was induced, while 1 patient showed both a typical and an atypical form. An AV “jump” occurred in 46% of patients. One small LVB was found in 7 patients (54%) at the M1-M2 level, in 4 (31%) at P2 or P2-M1 level, in 1(7.5%) at A2 and another 1 (7.5%) at M1 level. Acute success was 100% with an average of 5 cryoablations per patient. No peri-procedural complications occurred. All procedures were performed with near-zero fluoroscopy. No recurrence occurred during the follow up (10.58±10.23 months). Conclusion: AVNRT cryoablation using the electrophysiologically guided LVB strategy seems to be an effective and very safe procedure in small children who are the highest risk patients for this type of ablation

Tricuspid valve in congenital heart disease: multimodality imaging and electrophysiological considerations

The tricuspid valve (TV) has been neglected for many years. Only recently, new studies demonstrated the prognostic role of the tricuspid valve lesions. In addition to that, new interventional approaches offer the possibility to non-invasively treat tricuspid valve disease. In this review, our aim is to summarize the role of different imaging techniques in the assessment of tricuspid valve with particular regards to congenital heart diseases. Finally, we analyze the importance of the TV and its adjacent regions from an electrophysiological point of view, both in structurally normal hearts and in congenital heart diseases. The most relevant transthoracic echocardiography (TTE) views to visualize the TV are the "modified" parasternal long axis, the apical views and subcostal projections, such as right oblique or left oblique views. However, simultaneous visualization of the three leaflets is possible only with three-dimensional TTE, or, sometimes, in parasternal short axis and subcostal short axis views in children. 3D echocardiography (3DE) is promising in this field. Indeed, its unique projections, such as en face views from the right ventricular and atrial perspectives, are able to define the spatial relationship of the tricuspid leaflets with the surrounding structures. Moreover, multimodality imaging assessment has been recently proposed for the diagnostic assessment of the TV, especially before percutaneous intervention. Cardiac Computed Tomography (CCT) provides valuable anatomic spatial information of the TV apparatus. Cardiac Magnetic Resonance (CMR) is able to provide, non-invasively, detailed morphological and functional information of the valve

Adult congenital heart disease: Special considerations for COVID-19 and vaccine allocation/prioritization

none9sinoneSabatino, Jolanda; Di Salvo, Giovanni; Calcaterra, Giuseppe; Bassareo, Pier Paolo; Oreto, Lilia; Cazzoli, Ilaria; Calabrò, Maria Pia; Guccione, Paolo; Gatzoulis, Michael A.Sabatino, Jolanda; Di Salvo, Giovanni; Calcaterra, Giuseppe; Bassareo, Pier Paolo; Oreto, Lilia; Cazzoli, Ilaria; Calabrò, Maria Pia; Guccione, Paolo; Gatzoulis, Michael A