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Published on: June 12, 2021
Management of pediatric tachyarrhythmias on mechanical support
Jennifer N A Silva1, Christopher C Erickson2, Christopher D Carter2
1From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.). Silva_j@kids.wustl.edu.
Insights
Pediatric patients needing mechanical support for arrhythmias often receive antiarrhythmics and may need electrophysiology studies. Radiofrequency ablation is a feasible option during mechanical cardiopulmonary support.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Critical Care Medicine
Background:
- Persistent arrhythmias in children may necessitate mechanical cardiopulmonary support.
- Understanding treatment strategies for this population is crucial.
Purpose of the Study:
- To classify the patient population requiring mechanical support for arrhythmias.
- To evaluate the spectrum and success of current treatment strategies.
Main Methods:
- Multicenter retrospective chart review of 39 pediatric patients (<21 years) requiring mechanical support for arrhythmias.
- Analysis of demographics, support types (extracorporeal membrane oxygenation, ventricular assist devices), antiarrhythmic use, and electrophysiology study/ablation outcomes.
Main Results:
- Median age was 5.5 months; 69% had supraventricular tachycardia.
- 90% received extracorporeal membrane oxygenation (average 5 days); 95% received antiarrhythmics (Amiodarone most common).
- 33% underwent electrophysiology study/ablation; radiofrequency ablation was feasible with low adverse events.
Conclusions:
- Younger pediatric patients are more prone to requiring mechanical support for arrhythmias.
- Antiarrhythmics and electrophysiology studies are common interventions.
- Radiofrequency ablation is a safe and feasible procedure in pediatric patients on mechanical cardiopulmonary support.
Background:
Pediatric patients with persistent arrhythmias may require mechanical cardiopulmonary support. We sought to classify the population, spectrum, and success of current treatment strategies.
Methods And Results:
A multicenter retrospective chart review was undertaken at 11 sites. Inclusion criteria were (1) patients <21 years, (2) initiation of mechanical support for a primary diagnosis of arrhythmias, and (3) actively treated on mechanical support. A total of 39 patients were identified with a median age of 5.5 months and median weight of 6 kg. A total of 69% of patients were cannulated for supraventricular tachycardia with a median rate of 230 beats per minute. A total of 90% of patients were supported with extracorporeal membrane oxygenation for an average of 5 days. The remaining 10% were supported with ventricular assist devices for an average of 38 (20-60) days. A total of 95% of patients were treated with antiarrhythmics, with 43% requiring >1 antiarrhythmic. Amiodarone was the most frequently used medication alone or in combination. A total of 33% patients underwent electrophysiology study/transcatheter ablation. Radiofrequency ablation was successful in 9 patients on full flow extracorporeal membrane oxygenation with 3 radiofrequency-failures/conversion to cryoablation. One patient underwent primary cryoablation. A total of 15% of complications were related to electrophysiology study/ablation. At follow-up, 23 patients were alive, 8 expired, and 8 transplanted.
Conclusions:
Younger patients were more likely to require support in the presented population. Most patients were treated with antiarrhythmics and one third required electrophysiology study/ablation. Radiofrequency ablation is feasible without altering extracorporeal membrane oxygenation flows. There was a low frequency of acute adverse events in patients undergoing electrophysiology study/ablation, while on extracorporeal membrane oxygenation.
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