Abstract 15472: The Utility of Isoproterenol Testing in Pediatric Patients Following Atrioventricular Nodal Reentry Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tahmina Samad ◽  
Eric S Silver ◽  
Leonardo Liberman
Keyword(s):  
Catheter Ablation ◽  
Pediatric Patients ◽  
Common Mechanism ◽  
Slow Pathway ◽  
Significant Cost ◽  
Prior Use ◽  
Acute Success ◽  
Group 2 ◽  
Procedural Success ◽  
Group 1

Intro: AVNRT is a common mechanism of SVT in pediatric patients. Catecholamines such as isoproterenol (ISO) are routinely given during post ablation (ABL) testing to confirm acute success. In light of its recent significant cost increase, the aim of our study was to determine if ISO is necessary in all pediatric patients after AVNRT ablation to ensure acute procedural success. Method: Retrospective study of patients <21 years with AVNRT from 1/06-12/18 who had undergone catheter ablation. We excluded patients with congenital heart disease (CHD), prior ABL, without inducible tachycardia (presumed AVNRT), unsuccessful ABL and those who required ISO to induce tachycardia (TACHY) prior to ABL lesions. All patients were tested after ABL without ISO and if AVNRT was not induced they were retested while on ISO. Result: We identified 232 patients with AVNRT of whom 65 (28%) met the study criteria; 123 (53%) were excluded for requiring ISO to induce AVNRT prior to ABL, 23 (10%) for CHD, 12 (5%) with presumed AVNRT and 9 (4%) with an unsuccessful ABL. The average age was 14.4 yrs (±3.5) and 54% were female. All patients received anesthesia, 40/65 were intubated (62%). Evidence of slow pathway conduction (Spath) (AH jump with atrial extrastimulus testing, presence of AV nodal echo beats or PR>RR) was seen in 35/65 patients (54%). Patients were divided into 2 groups: group 1 (n= 57, 88%) consisted of patients without inducible TACHY post ABL while receiving ISO, group 2 (n = 8, 12%) of patients in whom TACHY was inducible with ISO thus required further ABL. There was no difference between the groups with regards to sex, age, intubation status, prior use of antiarrhythmic meds, or in the incidence of Spath (31/57, 54% vs. 4/8, 50%, p=1). Four of the 8 patients in group 2 with no evidence of Spath had inducible TACHY with ISO. Conclusion: We found that 12% of pediatric patients who did not require ISO to induce AVNRT prior to ABL had inducible TACHY only with ISO after AVNRT ABL. Presence of dual AV nodal physiology after ABL lesions did not predict inducibility of AVNRT on ISO, and 50% of the patients with no evidence of slow pathway conduction by conventional testing had inducible AVNRT with ISO. ISO testing is useful in all pediatric patients to test for inducibility following catheter ablation of AVNRT.

scholarly journals Minimising Radiation Exposure in Catheter Ablation of Ventricu-lar Arrhythmias

2021 ◽  
Author(s):  
Matevž Jan ◽  
David Žižek ◽  
Tine Prolič Kalinšek ◽  
Dimitrij Kuhelj ◽  
Primož Trunk ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Three Dimensional ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Complex Nature ◽  
Group 2 ◽  
Procedural Success ◽  
Procedural Outcomes ◽  
Group 1

Abstract BackgroundConventional fluoroscopy (CF) guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD).MethodsFifty-two (age 53.4±17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional (3D) electro-anatomical mapping (EAM) system and intra-cardiac echocardiography (ICE). Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed.ResultsSixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9±71.7 vs 123.6±42.2 minutes; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p= 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p= 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complications were low (3/60, 5%).ConclusionsFluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

scholarly journals Minimising radiation exposure in catheter ablation of ventricular arrhythmias

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matevž Jan ◽  
David Žižek ◽  
Tine Prolič Kalinšek ◽  
Dimitrij Kuhelj ◽  
Primož Trunk ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Ventricular Arrhythmias ◽  
Major Complication ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Complex Nature ◽  
Group 2 ◽  
Procedural Outcomes ◽  
Group 1

Abstract Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

Abstract 12571: Successful Catheter Ablation of Ventricular Tachycardia is Associated With Reduction of Mortality in Patients With Ventricular Tachycardia and Nonischemic Dilated Cardiomyopathy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Borislav Dinov ◽  
Arash Arya ◽  
Valentina Schirripa ◽  
Livio Bertagnolli ◽  
Lukas Fiedler ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Dilated Cardiomyopathy ◽  
Cardiac Mortality ◽  
Recurrence Rates ◽  
Success Group ◽  
Nonischemic Dilated Cardiomyopathy ◽  
Group 2 ◽  
Reduction Of Mortality ◽  
Group 1

Introduction: Recent publications reported on higher recurrence rates and lack of survival benefit after catheter ablation (CA) of ventricular tachycardia (VT) in nonischemic dilated cardiomyopathy (NIDCM). Methods: We aimed to investigate the VT recurrence and cardiac mortality in patients with NIDCM ablated for VT. The studied cohort was divided in 2 groups depending on procedure success: complete success (group 1), and failure or incomplete success (group 2). Success definition was based on the VT inducibility after CA. The patients were prospectively followed for cardiac mortality and VT recurrence. Results: 104 patients with NIDCM (87 males, mean age 59.65 ± 14.69 years, mean ejection fraction 33.42 ± 11.42 %) underwent VT ablation. Ventricular stimulation after CA was not attempted in 13 (12.5%) patients. Out of the rest 91, complete success was achieved in 62 (68.1%) patients (group1), and incomplete success or failure in 29 (31.9%) patients (group 2). During 2-years follow-up, VT recurrence was observed in 56.5% in group 1 vs. 82.8% in group 2. Incomplete success was associated with higher VT recurrence (HR 1.91; 95% CI 1.13-3.22; p=0.015). The 2-years mortality was 14.5% in group 1 vs 34.5% in group 2. The probability for death was 3-times higher in group 2 (adjusted HR 3.18; 95% CI 1.18-8.56; p=0.022). The primary and secondary endpoints were comparable between patients with idiopathic, post-myocarditis and secondary NIDCM. Conclusion: Procedure success, defined as complete VT noninducibility after CA of VT, was associated with reduced VT recurrence and improved survival in patients with nonischemic dilated cardiomyopathy.

scholarly journals The volume of left atrium measured by multi-detector computed tomography can predict of long term outcome in catheter ablation of atrial fibrillation

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
YR Kim
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Volume Estimation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background This study aimed to identify the volume left atrium (LA) and left atrial appendage (LAA) calculated by multidetector computed tomography (MDCT) is related to the long term out come of radiofrequency catheter ablation (RFCA) for atrial fibrillation(AF). Methods We analyzed data from 99 consecutive patients who referred for RFCA due to drug-refractory symptomatic AF (age 56 ± 10 years; 74% men; 64% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 128 channels MDCT scan for assessment for pulmonary vein  anatomy, LA and LAA volume estimation, and electro-anatomical mapping integration.  Results The volume of LA and LAA calculated by CT was 142.6 ± 32.2 mL and 14.7 ± 6.0 mL, respectively. LA volume was smaller in paroxysmal AF(PAF) than persistent AF(PeAF) (133.9 ± 29.3 mL vs. 158.0 ± 31.4 mL, p &lt; 0.0001) but  LAA volume was not significantly different between PAF and PeAF(13.9 ± 5.0 mL vs. 16.3 ± 7.3 mL, p = 0.09). Patients were classified into 2 groups by the LA volume of 160mL; group 1  (LA volume &lt; 160mL,n = 73) and group 2 (LA volume ≥160mL, n = 26). After a mean follow up 12.6 ± 5.3 months, 78.8% of the patients maintained sinus rhythm after the index ablation. AF free survival was significantly greater in group  1 than group 2 (84.9% vs. 61.5% p = 0.017). No relationship was found between LAA volume and the outcome of RFCA. Multivariate analysis showed that the LA volume &gt;160mL was an independent predictor of arrhythmia-free after ablation (Hazard ration 2.55, 95% confidential interval 1.02-6.35, p = 0.045) Conclusion Higher LA volume is independent risk factor for AF recurrence after RFCA but not LAA volume. The LA volume quickly assessed by MDCT could be a good predictor of long term recurrence after AF ablation.

P1031The impact of the duration of atrial fibrillation persistence for arrhythmia free survival in patients undergoing catheter ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Furukawa ◽  
T Yamada ◽  
T Morita ◽  
S Tamaki ◽  
M Kawasaki ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Outcome Data ◽  
Free Survival ◽  
Group 4 ◽  
Kaplan Meier ◽  
Group 3 ◽  
Group 2 ◽  
Af Recurrence ◽  
Group 1

Abstract Background Catheter ablation (CA) for atrial fibrillation (AF) is a curable treatment option. However, AF recurrence after CA remains an important problem. Although the success rate has been improved after catheter ablation (CA) in patients with paroxysmal AF (PAF), outcome data after CA for persistent AF (PeAF) are highly variable. Previous studies showed the PeAF is one of independent predictors for AF recurrence in comparison to PAF. However, there are little information available on the prognostic significance of AF duration after CA for AF. The aim of this study is to evaluate the impact of AF duration on long-term outcomes of AF ablation in patients with PeAF compared with PAF. Methods We enrolled 778 consecutive patients, who were referred our institution between August 2015 and December 2017 for undergoing the first time CA for AF. We divided 5 groups (Group 1; PAF (n=442), Group 2; PeAF duration ≤6 months (n=198), Group 3; PeAF duration of 6 months to 2 years (n=87), Group 4; PeAF duration of 2–5 years (n=30) and Group 5; PeAF duration ≥5 years (n=21)). All patients followed up for at least 1 year. Outcome data on recurrence of AF after ablation were collected. Results There were no significant differences in baseline clinical characteristics before CA among 5 groups, except for the prevalence of congestive heart failure, left atrial diameter and left ventricular ejection fraction. During a mean follow-up period of 511±298 days, 217 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (31% vs 20%, p=0.002) and in group 4 compared to group 3 (83% vs 30%, p<0.0001). However, AF recurrence was no significantly differences between groups 2 and 3 (31% vs 30%, p=0.76) and between groups 4 and 5 (83% vs 81%, p=0.45). Of 217 patients with AF recurrence, 154 patients had undergone multiple procedures. After last procedures, during a mean follow-up period of 546±279 days, 61 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (10% vs 3%, P=0.0005) and in group 4 compared with group 3 (35% vs 10%, p=0.0001). However, AF recurrence was no significantly difference between groups 2 and 3 (10% vs 10%, p=0.91) and between groups 4 and 5 (47% vs 35%, p=0.47). AF Free Survival Curve Conclusion Although patients with PeAF within 2 years had significantly higher AF recurrence compared to PAF, AF ablation might still be a good contributor as the first line approach to improve outcomes in patient with PeAF within 2 years.

scholarly journals 1552. Correlation Between Vancomycin Serum Trough Concentrations and Area Under the Curve in Pediatric Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S566-S567
Author(s):  
Krista Weaver ◽  
Madan Kumar ◽  
Allison Nelson ◽  
Palak Bhagat
Keyword(s):  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Primary Study ◽  
Pharmacokinetic Parameters ◽  
Optimal Method ◽  
Study Objective ◽  
Serum Trough ◽  
Trough Concentrations ◽  
Group 2 ◽  
Group 1

Abstract Background Despite years of experience with vancomycin (VAN), the optimal method to monitor VAN therapy in pediatric patients is still unknown. Recent pediatric data indicate serum trough concentrations lower than 10–20 mg/L or 15–20 mg/L based on indication may achieve an AUC24> 400 mg hours/L. The primary study objective was to compare AUC24 to goal VAN serum trough concentrations (STC). Methods A retrospective chart review of pediatric patients who received intravenous VAN June 1, 2018 to December 31, 2018 was completed. AUC24 was calculated using a trapezoidal method with 2 steady-state serum concentrations. A serum peak concentration was drawn 1 hour and 15 minutes following the end of infusion and an STC was drawn 30 minutes prior to infusion. Results During 25 admissions, 12 patients had a first AUC24 at goal and 13 patients had a first AUC24 below goal. Of 41 AUC24 calculations, 27 AUC24s were ≥400 mg hours/L (group 1), and 14 AUC24s were <400 mg hours/L (group 2). Median AUC24 was 561 mg hours/L for group 1 vs. 344.5 mg hours/L for group 2 (P < 0.001). Correlating Cmin and Ctrough (Ctr) for group 1 and group 2 were 12 mg/L and 13.5 mg/L vs. 6.4 mg/L and 7.3 mg/L, respectively (P < 0.001). Figure 1 shows the pharmacokinetic parameters for each group. Spearman correlation between AUC24 and Cmin was 0.87. Of the 35 subtherapeutic VAN STCs, 20 (57.1%) achieved an AUC24 ≥400 mg hours/L (P = 0.08). Subgroup analysis of AUC24 400–600 mg hours/L showed a median AUC24 of 519 mg hours/L with correlating Cmin and Ctr of 10.6 mg/L and 11.9 mg/L, respectively. The MIC was <1 in 90.9% of cases (Figure 2). The mean VAN dose required to achieve an AUC24 ≥400 mg hours/L was 77.7 mg/kg/day; dosing frequency did not appear to affect AUC24 outcome. Time to culture clearance was 2 days in group 1 and 6.5 days in group 2 (P = 0.24). No cases of nephrotoxicity were identified despite AUC24 values ranging from 265–1294 mg hours/L. Conclusion AUC24 monitoring using a 2-sample trapezoidal method was successfully implemented at this institution. The results of this study align with previous pediatric studies, supporting the use of lower serum trough concentration goals of 10–15 mg/L. Disclosures All authors: No reported disclosures.

scholarly journals P338 The road to zero-fluoroscopy catheter ablation in recurrent paroxysmal atrial fibrillation using ICE: training, learning, getting closer

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I A Minciuna ◽  
M Puiu ◽  
G Cismaru ◽  
S Istratoaie ◽  
G Simu ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Radiofrequency Catheter Ablation ◽  
Procedure Time ◽  
Total Procedure Time ◽  
The Mean ◽  
Group 2 ◽  
Total Procedure ◽  
Zero Fluoroscopy ◽  
Group 1

Abstract INTRODUCTION Catheter ablation is the treatment of choice for patients with recurrent paroxysmal atrial fibrillation (AF) in which antiarrhythmic drug therapy has failed to maintain sinus rhythm. Since its first introduction, intracardiac echocardiography (ICE) has proved to increase the efficacy and reduce complications in AF catheter ablation. One of the main advantages of ICE in the electrophysiology laboratory is the reduction of radiation exposure, for both the patient and the physician. Multiple recent studies have shown the feasibility and safety of zero or near-zero fluoroscopy AF ablation, including transseptal puncture, and outlined the importance of using ICE under the support of 3D mapping systems in reducing radiation exposure. PURPOSE The aim of this study was to show whether the use of ICE reduced the radiation exposure and total procedure time in recurrent paroxysmal AF patients undergoing radiofrequency catheter ablation. METHODS Forty patients that undergone radiofrequency catheter ablation for recurrent paroxysmal AF between January 2018 and May 2019 were included. They were divided in two groups: Group 1 – 20 patients in which ICE was performed and Group 2 – 20 patients in which ablation was performed without ICE guidance. We compared the total ablation time and fluoroscopy dose and time between the two groups. The total ablation time was defined as the time from the groin puncture until the withdrawal of all catheters. RESULTS Among the 40 patients included, 28 were men (70%) and the mean age was 57 years old. The mean procedure time was similar between the two groups (175 ± 52.0 for group 1 and 193 ± 49.9 for group 2, p = 0.33). The difference between the two groups was observed in fluoroscopy dose (9914.13 ± 5018.14 vs. 14561.43 ± 7446.1, p = 0.02) and time (26.04 ± 12.5 vs. 40.52 ± 12.6, p = 0.001). We found that in both groups higher fluoroscopy dose was correlated with higher fluoroscopy time (R = 0.74, p = 0.0001 vs. R = 0.57, p = 0.008) and higher total procedure time (R = 0.63, p = 0.002 vs. R = 0.46, p = 0.03). Furthermore, there was also a correlation between higher fluoroscopy dose and time (R = 0.59, p = 0.005 vs. R = 0.58, p = 0.006). No severe procedure-related complications were recorded. CONCLUSIONS This study shows that the use of ICE for recurrent paroxysmal AF catheter ablation reduces radiation exposure by lowering the fluoroscopy dose and the time of exposure. As a result, by increasing the training and learning curve in low-experienced centers it may finally get us closer to the ideal zero or near-zero fluoroscopy ablation. Abstract P338 Figure. ICE-guided transseptal puncture

Analysis of the Incidence and Characteristics of Venoocclusive Disease (VOD) of the Liver in Pediatric Hematopoietic Progenitor Cell Transplant (HPCT) Patients with Heparin Alone Vs. Heparin and Ursodiol Prophylaxis at the Medical College of Wisconsin.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4306-4306
Author(s):  
Julie-An Talano ◽  
Jessica Brown ◽  
Jennifer McArthur ◽  
Mollie Mulberry ◽  
Daniel Eastwood ◽  
...  
Keyword(s):  
Medical Records ◽  
Low Dose ◽  
Pediatric Patients ◽  
Hematologic Malignancy ◽  
Post Transplant ◽  
Dose Heparin ◽  
Group I ◽  
Group 2 ◽  
Low Dose Heparin ◽  
Group 1

Abstract Abstract 4306 VOD is a serious and potentially life-threatening complication of HPCT as a result of liver injury from the effect of chemotherapy and/or radiation. The reported incidence rate in pediatric HPCT patients varies widely from 5% to 40%. Previous studies have shown the beneficial effects of post-transplant pharmacological therapies such as ursodeoxyholic acid (ursodiol), heparin, and defibrotide at preventing VOD. However, the combined effect of heparin and ursodiol prophylaxis in preventing VOD in pediatric patients has yet to be determined. This study evaluated retrospectively whether there was a benefit of such combined therapy in pediatric HPCT patients. Our center adopted as standard practice for all HPCT patients the initiation of low dose heparin at 4 units/kg/hour with the commencement of conditioning for HPCT until day +28 post transplant. In 2003, we combined ursodiol 10 mg/kg TID to start with HPCT conditioning and to continue until day + 100 post transplant with low dose heparin through day + 28 for all pediatric HPCT patients. We performed a retrospective chart review and compared the characteristics and the incidence of VOD in patients who underwent transplantation from 1996-2002 and received heparin alone compared to 2003-2008 when the patients received the combination of heparin and ursodiol prophylaxis. Patients were identified through medical records with the ICD diagnosis of VOD. The medical records were reviewed and those patients who did not meet the Baltimore criteria for the diagnosis of VOD were excluded. Only patients who developed VOD with their first transplants were included. Group I = Heparin (216) Group II = Heparin + Ursodiol (220) Allogeneic 187 (86.5%) 160 (72.7%) Autologous 29 (13.5%) 60 (27.3%) Median Age 9 yrs 8 yrs Male 123 (57%) 135 (62%) Female 93 (43%) 85 (38%) Non-malignant 34 (15.7%) 50 (22.8%) Hematologic malignancy 143 (66.2%) 109 (49.5%) Non-hematologic malignancy 39 (18.1%) 61 (27.7%) # VOD 13 5 The 100 day incidence of VOD was 0.0605 (SE 0.01618) in group 1 and 0.0227 (SE 0.01002) in group 2. The difference is 0.0377 (SE 0.0190) and based on a standard normal distribution with a p = 0.0473. The estimated risk of VOD for patients receiving Heparin + Ursodiol is 0.94 (risk or hazard ratio) that of the risk with Heparin alone, with a 95% confidence interval of (0.918, 0.960). This represents about a 6% reduction in risk for those receiving Heparin + Ursodiol. The day 100 survival in the VOD patients was 6 out of 13 in group 1 and 3 out of 5 in group 2. In conclusion, low dose heparin and ursodiol prophylaxis appears to be an effective strategy in VOD prevention in pediatric patients. The combination appeared to be more effective than heparin alone. However, this study is limited in that it is retrospective in nature. Disclosures: Off Label Use: heparin and ursodiol as VOD prophylaxis.

Lumbar Plexus in Children

2004 ◽  
Vol 101 (2) ◽  
pp. 445-450 ◽  
Author(s):  
Lukas Kirchmair ◽  
Birgit Enna ◽  
Gottfried Mitterschiffthaler ◽  
Bernhard Moriggl ◽  
Manfred Greher ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Age Groups ◽  
Posterior Part ◽  
Lumbar Plexus ◽  
Ultrasound Guided ◽  
Psoas Major Muscle ◽  
Group 3 ◽  
Group 2 ◽  
Paravertebral Region ◽  
Group 1

Background Pediatric regional anesthesia has gained increasing interest over the past decades. The current study was conducted to investigate the lumbar paravertebral region and the lumbar plexus at L3-L4 and L4-L5 by means of sonography to obtain fundamentals for the performance of ultrasound-guided posterior lumbar plexus blocks. Methods Thirty-two children (12 boys, 20 girls) with American Society of Anesthesiologists physical status I or II were enrolled in the current study. The lumbar paravertebral region was visualized at L3-L4 and L4-L5 on two corresponding posterior sonograms (longitudinal, transverse). The lumbar plexus had to be delineated, and skin-plexus distances were measured. In a series of five pediatric patients undergoing inguinal herniotomy, ultrasound-guided posterior lumbar plexus blocks at L4-L5 were performed. Results The children were stratified into three age groups (group 1: &gt; 3 yr and &lt;/= 5 yr; group 2: &gt; 5 yr and &lt;/= 8 yr; group 3: &gt; 8 yr and &lt;/= 12 yr). The lumbar plexus could be delineated at L3-L4 and L4-L5 in 19 of 20 cases in group 1, in 17 of 20 cases in group 2, in 22 of 24 cases at L3-L4 in group 3, and in 16 of 24 cases at L4-L5 in group 3. In all patients, the lumbar plexus was situated within the posterior part of the psoas major muscle. Skin-plexus distances showed statistical significant differences between groups 1 and 3 and between groups 2 and 3. The strongest positive correlation existed between skin-plexus distances and the children's weight. Ultrasound guidance enabled safe und successful posterior approaches to the lumbar plexus, thus resulting in effective anesthesia and analgesia of the inguinal region. Conclusions Sonography of the lumbar plexus in children proved to be feasible. Skin-plexus distances correlated with the children's weight rather than with their age. The sonographic findings were fundamental for the performance of successful ultrasound-guided posterior approaches in a small group of pediatric patients.

scholarly journals EFFICACY OF CATHETER ABLATION FOR PERSISTENT ATRIAL FIBRILLATION IN PATIENTS WITH DIABETES MELLITUS PRESENT WITH TACHY-BRADY SYNDROME

2018 ◽  
Vol 7 (3) ◽  
pp. 24-32
Author(s):  
E. A. Archakov ◽  
R. E. Batalov ◽  
S. Yu. Usenkov ◽  
M. S. Khlynin ◽  
A. V. Smorgon ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Catheter Ablation ◽  
Antiarrhythmic Drug ◽  
Pacemaker Implantation ◽  
Diabetic Patients ◽  
Antiarrhythmic Drug Therapy ◽  
Ventricular Stimulation ◽  
Group 2 ◽  
Group 1

Aim. To estimate the efficacy of catheter ablation in patients with type 2 diabetes mellitus (T2D) present with atrial fibrillation and sick sinus syndrome (SSS) undergoing permanent pacemaker implantation.Methods. 56 patients (34 females) with persistent AF and SSS were enrolled in the study. The mean age of patients was 67.7±10.7 years. Dual chamber cardiac pacemaker with remote monitoring function were implanted in all patients. All the patients were assigned to two groups: Group 1 comprised 31 patients aged 67.3±9.6 years, and Group 2 comprised 25 patients aged 72.6±9.9 years, including 22 (39.2%) diabetic patients. 2-3 days after pacemaker implantation, group 1 patients underwent intracardiac electrophysiology study and RFA of the pulmonary vein ostia, mitral isthmus and the left atrial posterior wall. Group 2 patients received antiarrhythmic drug therapy. Results. 3 patients (9%) in Group 1 had recurrent AF within the 6-month follow-up. The efficacy of the RFA for AF was 55% (n = 17) 1 year after the indexed hospitalization. 8 patients had short paroxysmal attacks which gradually lessened and stopped after. 5 patients (21%) in Group 2 did not have any AF paroxysms within the 1-year follow-up (Х2 = 5.52, р = 0.02). All these patients received amiodarone as antiarrhythmic drug therapy, whereas the others had paroxysmal attacks. Frequent attacks in 10 patients (40%) led to a change in antiarrhythmic drug use. Hospital readmission rates for AF were 16% and 52%, respectively (Х2 = 4.15, р = 0.04). The impact of atrial and ventricular stimulation on the development of recurrent AF was statistically insignificant (atrial stimulation – X2 = 0.01, cc = 1, p = 0.90; ventricular stimulation – X2 = 0.15, cc = 1, p = 0.69). None paroxysmal attacks were recorded in 10 diabetic patients (45%) after the RFA within the 1-year follow-up.Conclusion. Catheter ablation for persistent AF and SSS treated with permanent pacemakers is highly effective and safe method. In addition, it is superior to pharmacological approach. The presence of T2D likely did not significantly affect the efficacy of RFA for persistent form of AF. 

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