Showing papers by "Ronn E. Tanel published in 2004"

Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes.

Abstract: Introduction: A multicenter prospective study was designed and implemented to assess the short- and longer-term results and risks associated with radiofrequency (RF) ablation in children. Methods and Results: Patients recruited for the study were aged 0 to 16 years with supraventricular tachycardia due to accessory pathways or AV nodal reentrant tachycardia (AVNRT), excluding patients with nontrivial congenital heart disease. A national registry also was established, and contributing centers were encouraged to enroll all pediatric patients, aged 0 to 21 years, undergoing ablation at their center. This report summarizes acute results of these procedures. For analysis, subjects were divided into three groups: the prospective cohort (n = 481), cohort-eligible registry participants (n = 504), and not cohort eligible registry participants (n = 1,776). Prospectively enrolled cohort patients were similar to cohort-eligible patients in terms of demographic and other patient characteristics. Overall success rates for RF ablation were high (95.7%), with higher success rates for left-sided and particularly left free-wall pathways (97.8%) than right free-wall pathways (90.8%). Complications of both electrophysiologic study and RF ablation were infrequent (4.2% and 4.0%, respectively), and there were no deaths. AV block was uncommon overall (1.2%) and was limited to ablation in AVNRT (2.1%) and septal accessory pathways (3.0%). Conclusion: Despite the multicenter and prospective design, the study demonstrates high success rates and low complication rates, which are comparable to prior single-center retrospective studies. These results may serve as the current best benchmark for expected results in the pediatric population, aged 0 to 16 years, both in terms of acute success rates and the occurrence of complications. (J Cardiovasc Electrophysiol, Vol. 15, pp. 759-770, July 2004)

Capture management efficacy in children and young adults with endocardial and unipolar epicardial systems.

Abstract: Aims This prospective study characterized performance of the Kappa 700 Ventricular Capture Management� (VCM) system for monitoring ventricular pacing threshold and adapting outputs in both endocardial and unipolar epicardial pacing systems in children and young adults. VCM bears cautionary labelling against use with epicardial leads since they have not been demonstrated appropriate for use with VCM. Methods and results VCM was programmed in ''Monitor Only'' mode. Ventricular pacemaker thresholds were measured daily using VCM for a minimum of 2 months. Po- tential device longevities at nominal outputs (3.5 V, 1.0 ms) and at VCM-recommended outputs were compared. Thirty patients {median age 14.4 years (1e27 years); 15 epi- cardial/15 endocardial} completed the study. During the daily measurements, consis- tent undersensed evoked response occurred in 2 patients (Medtronic epicardial leads 4965). For the other 28 patients, programming VCM in ''Adaptive'' mode from implant would provide an additional 6.8 months (0e19 months) of battery life. Conclusion Although not an IDE (Investigation Device Exemption) study, this study showed acceptable VCM performance in ''Monitor Only'' mode in 13/15 patients with unipolar epicardial leads. A 2-month ''Monitor Only'' observation period helps screen patients who might not benefit from VCM. VCM may provide substantial energy savings

Slow pathway modification for atrioventricular nodal reentrant tachycardia

Abstract: The change in the "refractory window" was assessed as a possible indicator of successful slow pathway modification in 26 pediatric patients with persistent dual-atrioventricular node physiology. The "refractory window" was defined as the difference between the fast and slow pathway effective refractory periods. A significant decrease in the refractory window (p <0.001) after successful slow pathway modification was found.

ECGs in the ED. Vasodepressor syncope.

Abstract: CASE A 4-month-old infant girl presents to the Emergency Department (ED) for evaluation of 4 days of cough, upper respiratory symptoms, and increased respiratory effort. There has been a significantly increased work of breathing over the last 24 hours, which prompted the parents to bring her to the ED. There has been decreased oral intake and some occasional emesis. She has had some diaphoresis, especially while feeding. She has been more lethargic than usual. There has been no fever or rash. The last wet diaper was approximately 12 hours earlier. There has been normal growth and development. She was born at full term. There were no prenatal or neonatal concerns. She has had no prior illnesses or other medical problems. She takes no medications and has no known drug allergies. Her immunizations are reportedly up-to-date. The family history is noncontributory for congenital heart disease or premature sudden death. She lives with her parents and a 2-year-old sister who are all healthy. In the ED, the infant is pink and tachypneic. She has subcostal and intercostal retractions, and is grunting. The temperature is 37.2-C. The heart rate is 156 bpm, the respiratory rate is 66 per minute, and the blood pressure is 78/45. The oxygen saturation is 100% on 1 L of nasal cannula oxygen. The head and neck exam is significant for a flat anterior fontanelle, dry mucous membranes, clear tympanic membranes, and a clear oropharynx. The chest has bilateral breath sounds that are coarse. There are no rales. The cardiac exam has a hyperdynamic precordium with a normal first heart sound and a soft second heart sound. There is a gallop rhythm present. There is a II/VI systolic regurgitant murmur. There is no diastolic murmur. The pulses are diminished but equal. The abdomen is soft with the liver edge palpable 3 cm below the right costal margin. The extremities are cool with mildly delayed capillary refill. The neurologic exam is nonfocal, and the infant is appropriately responsive. An electrocardiogram was performed (Fig. 1).