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Point-of-Care Echocardiography: A Useful Tool for Assessing Complex Arrhythmias in the Pediatric Intensive Care Unit
José L Vázquez1, Corina I Márquez1, Elvira Garrido-Lestache2
1Department of Pediatric Critical Care, Ramón y Cajal University Hospital, Madrid, Spain.
Insights
Point-of-care ultrasound (POCUS) effectively assesses complex arrhythmias in pediatric congenital heart disease patients. This bedside echocardiography method aids diagnosis when advanced studies are unavailable.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiac Electrophysiology
Background:
- Complex arrhythmias are common in pediatric patients with congenital heart disease (CHD).
- Assessing these arrhythmias often requires invasive electrophysiology studies or epicardial electrocardiograms.
- Non-invasive imaging modalities are crucial for timely diagnosis and management.
Purpose of the Study:
- To evaluate point-of-care ultrasound (POCUS) as a tool for assessing cardiac asynchrony in pediatric CHD patients with complex arrhythmias.
- To determine if POCUS can provide an alternative diagnostic method when electrophysiology studies are not feasible.
Main Methods:
- A descriptive, retrospective case series was conducted in a pediatric intensive care unit.
- 12 post-surgical pediatric patients with CHD and complex arrhythmias underwent bedside echocardiography.
- Analysis focused on atrioventricular, intraventricular, and interventricular asynchrony using M-mode and Doppler mitral inflow.
Main Results:
- 14 complex arrhythmias were analyzed in 12 patients where electrocardiograms were inconclusive.
- POCUS identified various arrhythmias including atrial flutter, atrioventricular block, and pacemaker-induced asynchrony.
- Detecting motion asynchrony was key to accurate diagnosis, with full agreement from offline cardiologist analysis.
Conclusions:
- Point-of-care ultrasound (POCUS) is a valuable tool for the initial diagnosis of complex arrhythmias in pediatric intensive care settings.
- POCUS provides a crucial alternative when electrophysiology studies or epicardial electrocardiograms are unavailable for pediatric CHD patients.
Objective:
To demonstrate that the analysis of the atrioventricular, intraventricular, and interventricular asynchrony by point-of-care ultrasound (POCUS) could be an alternative tool for assessing complex arrhythmias in pediatric patients with congenital heart diseases, mainly when an epicardial register or electrophysiology study is not available.
Design:
Descriptive, retrospective case series study.
Setting:
The pediatric intensive care unit of a university-affiliated tertiary hospital in Spain.
Patients:
The authors included 12 patients with congenital heart disease younger than 18 years admitted to the authors' pediatric intensive care unit (PICU) from January 2018 to December 2019, with complex arrhythmias after surgery, managed by performing a bedside echocardiography when an electrophysiology test or epicardial auriculogram was unavailable.
Interventions:
None.
Measurements And Main Results:
The authors included a total of 14 complex arrhythmias in 12 postsurgical patients in whom a comprehensive transthoracic electrocardiogram was not conclusive. The presence of atrioventricular, intraventricular, or interventricular asynchrony was assessed in standard echo views by performing M-mode and Doppler mitral inflow analysis, checking the heart motion. The final POCUS diagnoses were atrial flutter (n = 5), postsurgical atrioventricular block (n = 4), asynchrony induced by pacemaker (n = 2), junctional ectopic tachycardia (n = 1), nodal rhythm plus ventricular extrasystole (n = 1), and supraventricular tachycardia (n = 1). In all patients, regardless of the type of arrhythmia, detecting motion asynchrony was crucial for making the correct diagnosis. Offline cardiologist analysis of the POCUS scans showed full agreement.
Conclusions:
POCUS is a useful tool for initial diagnosis and management of complex arrhythmias in the PICU, mainly when epicardial auriculogram or electrophysiology studies are unavailable.
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