Adults with Congenital Heart Disease: At Long Last, Guidelines for Arrhythmia Management

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108633/1/pace12456.pd

Optimizing resynchronization pacing in the failing systemic right ventricle

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147807/1/pace13560.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147807/2/pace13560_am.pd

Testing Efficacy in Determination of Recurrent Supraventricular Tachycardia among Subjectively Symptomatic Children Following “Successful” Ablation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108265/1/pace12373.pd

Electrocardiographic early repolarization characteristics and clinical presentations in the young: a benign finding or worrisome marker for arrhythmias

BackgroundThe early ECG repolarization QRS pattern (ERp), with J‐point elevation of 0.1 mV in two contiguous inferior and/or lateral leads, can be associated with ventricular arrhythmias among adults. The significance of an ERp in the young is unknown.ObjectiveThe purpose of this study was to assess the prevalence of ERp among young patients (pts), describe and correlate the characteristics with clinical presentations and any arrhythmias.MethodsThis was a 1 y retrospective review of ECGs obtained from patients referred specifically for documented arrhythmias, possible arrhythmia‐related symptoms or sports clearance. ECGs were analyzed for ERp (J‐point, ascending/horizontal patterns, location) and correlated with presenting complaints.ResultsOf 301 patient ECGs, an ERp was found in 177 (59%), (pts age 11.7 ± 4.3 y); 54% male; 23% Caucasian. Of these, 6 pts had a family history of sudden cardiac death. Arrhythmias (72% atrial) occurred in 22 pts. Only 3 pts had ventricular arrhythmias (1 successfully ablated). The ascending ST segment and elevated J‐point occurred in 77% and 51% of pts with and without arrhythmias respectively. In 73% of all pts, the ERp location was in inferior/lateral leads. Neither gender, ethnicity, large J‐point, lead location, nor the combination of a horizontal ST segment with large J‐point correlated with any arrhythmias.ConclusionsERp, especially the diffuse ascending pattern, is common among the young, in those of European ethnicity, found equally in both genders, and with no apparent correlation with atrial nor ventricular arrhythmias.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136329/1/chd12410.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136329/2/chd12410_am.pd

Optimizing Paced Ventricular Function in Patients with and without Repaired Congenital Heart Disease by Contractility‐Guided Lead Implant

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109944/1/pace12521.pd

Radiofrequency and Cryoablation Therapies for Supraventricular Arrhythmias in the Young: Five‐Year Review of Efficacies

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91333/1/j.1540-8159.2012.03372.x.pd

Arrhythmias and Sudden Death among Older Children and Young Adults Following Tetralogy of F allot Repair in the Current Era: Are Previously Reported Risk Factors Still Applicable?

Background Young adult patients (pts) with repaired tetralogy of F allot ( TOF ) remain at risk for arrhythmias ( A r) and sudden cardiac death ( SCD ). Based on past studies with earlier pt subsets, A r/ SCD events were associated with right ventricular ( RV ) systolic pressures >60 mm Hg, outflow tract gradients >20 mm Hg, and QRS duration >180 ms. However, there are limited recent studies to evaluate these risk factors in the current patient generation. Methods Patients with TOF followed over the past 50 years were grouped by presence of any arrhythmias (group 1), absence of arrhythmias (group 2), and presence of SCD or significant ventricular arrhythmias (group 3) and correlated with current pt age, gender, age at repair, repair types, echocardiogram, cardiac magnetic resonance imaging, electrocardiogram/ H olter, hemodynamics, and electrophysiology findings. Results Of 109 pts, 52 were male aged 17–58 years. Of these, 59 (54%) had A r, two of whom had SCD . These 59 pts were chronologically older at the time of analysis, with repair at an older age and wider QRS duration (78–240, mean 158 ms) when compared with those without A r. However, there was no correlation with surgical era, surgical repair, gender, RV pressure >60 mm Hg, right ventricular outflow tract gradient >20 mm Hg, or RV end‐diastolic volume on CMRI . Conclusions A r/ SCD risk continues to correlate with repair age and advancing pt age. QRS duration is longer in these patients but at a shorter interval (mean 158 ms) and less RV pressure (mean 43 mm Hg) than previously reported. In the current TOF patient generation, neither surgical era, type of repair, RV outflow gradient nor RV volume correlate with A r/ SCD . Electrophysiologic testing to verify and identify arrhythmias remains clinically effective.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108615/1/chd12153.pd

Comparative Chronic Valve and Venous Effects of Lumenless versus Stylet‐Delivered Pacing Leads in Patients with and Without Congenital Heart

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/115920/1/pace12728.pd

Pulmonary damage following right ventricular outflow tachycardia ablation in a child: When electroanatomical mapping isn’t good enough

A 14‐year‐old female was referred for severe pulmonary valve insufficiency after undergoing radiofrequency ablation for a right ventricular outflow tract tachycardia that originated in the proximal pulmonary artery at 10 years of age. Clinical records indicated that ablation was guided solely by electrograms and electroanatomical mapping. Due to myocardial tissue extensions, mapping failed to identify the level of the pulmonary valve annulus, which resulted in delivery of energy on the valve proper and into the pulmonary artery. She developed severe pulmonary valve insufficiency and moderate proximal pulmonary artery stenosis necessitating intravascular stent placement 4 years later with an associated transcatheter valve. Although the nonfluoroscopic approach during ablation has gained wide acceptance for use in children, this report highlights the benefits of adjunctive imaging to identify the precise location of the pulmonary valve when ablation therapy is contemplated in the right ventricle outflow tract.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144229/1/pace13236.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144229/2/pace13236_am.pd