How are arrhythmias managed in the paediatric population in Europe? Results of the European Heart Rhythm survey

Hernández‐Madrid, Antonio; Hocini, Mélèze; Chen, Jian; Potpara, Tatjana; Pison, Laurent; Blomström‐Lundqvist, Carina

doi:10.1093/europace/euu313

Cited by 26 publications

(36 citation statements)

References 23 publications

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“…One of the most recent reviews by Kutanzi et al highlights the need of minimizing the negative health effects of pediatric exposure to ionizing radiations [28]. On these bases and given that the most frequent arrhythmias in pediatric population are supraventricular tachycardias [3], which are most often not fatal conditions, it seems a reasonable approach a further decrease of radiation exposure [19].…”

Section: Discussionmentioning

confidence: 99%

“…Between them tachyarrhythmias occur more rarely, with an incidence of 2% [2]. Their incidence is greater in children older than 1 year and in patients with grown-up congenital heart diseases [3]. Between all arrhythmias the supraventricular tachycardias are the most common in the newborn [4].…”

Section: Introductionmentioning

confidence: 99%

“…Atrial fibrillation and atrial flutter seem to be the less frequent, being almost always associated with specific and reversible conditions or to Fontan's surgical correction of univentricular heart or congenital heart diseases involving atrial dilatation [10]. The most frequent tachyarrhythmias are the atrioventricular reentrant tachycardias (AVRT) and atrioventricular nodal reentrant tachycardias (AVNRT), reported in the 90.24% of the cases [3]. Both are due to an anatomically determined circuit.…”

Section: Introductionmentioning

confidence: 99%

“…It connects an atrium with the ventricle so that the impulse arising from sinus node reaches the ventricle and depolarizes part of it (pre-excitation) bypassing the normal pathway of the atrioventricular node (AVN). In certain circumstances (linked to the refractory periods of the structures involved) an impulse is conducted only by the AVN to the ventricle and from here returns to the atrium by the accessory pathway, originating an AVRT (the so called WolffParkinson White syndrome) [1][2][3]. AVNRT is due to the presence of two pathways in the context of the AVN: a fast pathway and a slow pathway.…”

Section: Introductionmentioning

confidence: 99%

“…AVNRT is due to the presence of two pathways in the context of the AVN: a fast pathway and a slow pathway. This situation creates conditions for an impulse to go through one of the two pathways and to return up by the second one: the circuit is totally in the AVN and both atria and ventricles are activated in parallel [1][2][3]. Although the standard 12-lead ECG maintains high diagnostic value as first line tool [11], a more invasive approach is often required in order to solve definitively both the diagnostic process and the recurrences [12].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Electroanatomical mapping systems and cardiac arrhythmias: avoiding radiations in pediatric patients

Casale¹,

Mezzetti²,

Tulino³

et al. 2017

J Neonatal Biol

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Introduction: Cardiac arrhythmias are challenging conditions in pediatric patients, especially in the case of newborns. Most of the tachyarrhythmias in children (90.24%) are atrioventricular reentrant tachycardias (AVRT) and atrioventricular nodal reentrant tachycardias (AVNRT). Although the standard 12-lead ECG maintains high diagnostic value, an invasive electrophysiological study with catheter ablation are often required. Unfortunately these procedures are burdened by the use of radiations. Materials and methods:We performed a systematic research in PubMed and Embase. We found 257 articles of interest but we selected only 36 as the most representative. Discussion:The main concerns linked to electrophysiological procedures are the need of fluoroscopy and thus the risk of malignancy as well as dermatitis, cataracts, thyroid diseases and birth defects in the patients' offspring. Children and especially newborns have a greater life expectancy so their cumulative risk is greater than adults. For this reason the guiding principle in electrophysiological procedures involving radiations in pediatric subjects is "as low as reasonably achievable" (acronym: ALARA). The development of 3-dimensional (3-D) electroanatomical mapping systems allowed a significant reduction of radiation exposure during catheter ablations. The most recent experiences demonstrated the feasibility and the safety of fluoroless ablation procedures of the most common arrhythmias in children.Conclusions: Cardiac arrhythmias could be very challenging conditions in pediatric patients. Predictors of complications are body weight <15 kg and age <4 years so it is clear that newborns are the most difficult patients. It is reasonable, because of these evidences, to approach cardiac arrhythmias pharmacologically in younger subjects. More than 20 years of experiences conducted by the electrophysiologists allow us to encourage the use of the electroanatomical mapping systems, with the objective of reducing the radiation exposure in children, especially when accessory pathways are involved. Citation: Casale M, Mezzetti M, Tulino V, Morelli M, Ciccarelli I, et al. (2017)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Electroanatomical mapping systems and cardiac arrhythmias: avoiding radiations in pediatric patients

Casale¹,

Mezzetti²,

Tulino³

et al. 2017

J Neonatal Biol

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Catheter ablation of left‐sided accessory pathways in small children

Fogelman

Birk

Dagan

et al. 2019

Journal of Arrhythmia

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Background Accessory pathways (APs) are a common reason for supraventricular tachycardia in small children. Trans‐septal puncture (TSP) approach is commonly used for the ablation of left‐sided APs, however it may be challenging in small children. The aim of this study was to assess the efficacy and safety of trans‐septal approach radiofrequency (RF) ablation of left‐sided APs in children weighing up to 30 kg. Methods Of the 658 children who underwent catheter ablation of APs since 06/2002, 86 children had left‐sided AP and weighed less than 30 kg. TSP approach guided with TEE and fluoroscopy was used for left atrium access. Results The mean age, height, and body weight were 7.6 ± 1.9 years, 122.4 ± 9.3 cm and 24.0 ± 4.2 kg, respectively. Forty‐three children (50%) were male, 46 of 86 (53%) had manifest AP, 17 of 86 (20%) weighed less than 20 kg and in 24 of 86 children (28%) a three‐dimensional system (3DS) was used to reduce fluoroscopy time. The acute success rate was 98.8% (85/86), with a recurrence rate of 2.4% (2/85) in a mean follow‐up of 66.2 ± 42.7 (9.1‐184.2) months. The mean procedure time and fluoroscopy time were significantly lower for the 3DS group compared to the standard fluoroscopy group 131 ± 41 (55‐262) and 2.4 ± 1.5 (1‐6) minutes vs 164 ± 51 (62‐249) and 27 ± 13 (8‐77) minutes, P < 0.01 and P < 0.0001, respectively. There were no ablation‐related complications. Conclusions RF ablation of left‐sided APs using TSP approach in small children had an excellent efficacy and safety profile. The use of 3DS significantly reduces the procedure and fluoroscopy time.

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The Benefit of a General, Systematic Use of Mapping Systems During Electrophysiological Procedures in Children and Teenagers: The Experience of an Adult EP Laboratory

et al. 2016

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Standard imaging during electrophysiological procedures (EPs) uses fluoroscopy. The aim of this study was to evaluate the feasibility, efficacy, safety and effect of an extended use of non-fluoroscopic mapping systems (NMSs) for imaging during paediatric EPs in an adult EP laboratory focusing on the amount of X-ray exposure. This study is a retrospective analysis that includes consecutive young patients (83 pts, aged between 8 and 18) who underwent EPs from March 2005 to February 2015. We compare the fluoroscopy data of two groups of pts: Group I, pts who underwent EPs from 2005 to 2008 using only fluoroscopy and Group II, pts who underwent EPs from 2008 to 2015 performed also using NMSs. The use of an NMS resulted in reduced fluoroscopy time in Group II {median value 0.1 min (95 % CI [0.00-1.07])} compared to Group I {median value 3.55 min (95 % CI [1.93-7.83]) (MW test, P < 0.05)}. There was a complementary reduction in the total X-ray exposure from 2.53 Gy cm(2) (95 % CI [1.51-4.66]) in Group I to 0.05 Gy cm(2) in Group II (95 % CI [0.00-1.22]) (MW test, P < 0.05). Regarding ablation procedures, the median effective dose decreased from 3.04 mSv (95 % CI [1.22-6.89]) to 0.25 mSv (95 % CI [0.00-0.60]) (MW test, P < 0.05). The use of an NMS dramatically reduces fluoroscopy time and total X-ray exposure during EPs in children and teenagers in an adult EP laboratory. In our experience, this reduction is mainly related to the systematic day-to-day use of NMSs.

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How are arrhythmias managed in the paediatric population in Europe? Results of the European Heart Rhythm survey

Cited by 26 publications

References 23 publications

Electroanatomical mapping systems and cardiac arrhythmias: avoiding radiations in pediatric patients

Electroanatomical mapping systems and cardiac arrhythmias: avoiding radiations in pediatric patients

Catheter ablation of left‐sided accessory pathways in small children

The Benefit of a General, Systematic Use of Mapping Systems During Electrophysiological Procedures in Children and Teenagers: The Experience of an Adult EP Laboratory

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