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Objective:To evaluate the strategy and safety of the radiofrequency ablation (RFA) on ventricular arrhythmias (VAs) originating from the pulmonary sinus cusp (PSC) in pediatric patients.Methods:Retrospective study.Fifteen patients with VAs originating from the PSC who were intervened by RFA in the Department of Pediatric Cardiology, Guangdong Provincial People′s Hospital between March 2014 to July 2020 were enrolled.All the patients met the indication criteria for RFA in pediatric patients.The electrocardiogram, ablation method of ablation were analyzed.Different curved catheters were selected for RFA according to the age and weight of the patients.The catheter was then inserted in a " U" or inverted " P" shape to the PSC.The long-term effect of ablation were reviewed.Results:The mean age and body weight of 15 patients with VAs originating from the PSC were (11.6±2.6) (6-15) years and (39.9±12.2) (19-65) kg, respectively.The electrocardiogram recorded during VAs originating from the PSC showed left bundle branch block and inferior axis with monomorphic R pattern, as well as a QS-wave in aVR and aVL.The electrocardiogram characteristics varied in patients with VAs originating from the PSC.The ideal excitation point was not found in the right ventricular outflow tract or the ablation was unsuccessful in all patients, and the earliest target was mapped and RFA was successful.Among the 15 patients, the successful ablation site was in the lower regions of the PSC, involving the right cusp in 11 patients(73.3%), the anterior cusp in 3 patients(20.0%), and the left cusp in 1 patient(6.7%). The earliest potential recorded at the PSC ablation site preceded the QRS complex onset by (27.3±6.0) ms.During the follow-up period for (2.7±2.0) years, no recurrence of VAs or complications were recorded.Conclusions:Under the premise of gentle catheterization procedure and appropriate radiofrequency energy, ablation was effective, safe and with low recurrence rate to eradicate VAs originating from the PSC in children.
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Objective:To explore the application of implantable cardioverter defibrillator(ICD) in the prevention of sudden cardiac death for children and adolescents, the treatment of adverse events and follow-up studies.Methods:A total of 19 pediatric patients (12 males, 7 females) were admitted in the Department of Pediatric Cardio-logy, Guangdong Provincial People′s Hospital from January 2008 to March 2019, and their previous inpatient and outpatient data including medical history, ICD implantation method, postoperative program control, the use of antiarrhythmic drugs, proper/improper discharge of ICD and management of ventricular electrical storm were collected retrospectively and follow-up study was carried out.Results:A total of 19 pediatric patients were included, all of whom had once syncope or more before ICD implantation.The age at the time of ICD implantation was (12.30±2.08) years, and the weight was (40.00±13.93) kg.Eleven patients were implanted in the subpectoralis major space, 6 cases in the subfascial space, and 2 cases in the left abdomen and left armpit, respectively.All patients received oral antiarrhythmic drugs after surgery.The follow-up period was 3.2 years(0.3-11.1 years). All the children survived without complications such as electrode fracture, dislocation, venous thrombosis, cardiac perforation, capsular hematoma, rupture, and infection.Twelve cases (63.2%) had discharge events, including 10 cases (83.3%) of appropriate recognition/treatment events, and 2 cases (16.7%) of inappropriate recognition/treatment events, while 5 cases were ventricular electrical storms.Totally, 7 ICD cases (36.8%) were equipped with remote monitoring system, and 4 cases (57.1%) were detected whit adverse reactions, which were timely handled online and offline, thus avoiding adverse consequences.Conclusions:Currently, ICD is the most effective treatment for the prevention of sudden cardiac death in children and adolescents.According to age, weight and developmental conditions, different implantation methods should be selected.Appropriate/inappropriate discharge events after implantation should be identified in time, drug treatment should be optimized, and radiofrequency ablation should be performed if necessary.
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Objective@#To analyze and summarize the diagnosis and treatment experience of common inherited cardiac arrhythmia syndrome in pediatric patients, and explore the most appropriate therapy.@*Methods@#A retrospective review identified 30 pediatric cases (19 males, 11 females) diagnosed with long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), hypertrophic cardiomyopathy (HCM), arrhythmogenc right ventricular cardiomyopathy (ARVC) from January 2008 to December 2018 in the Pediatric Cardiology Department, Guangdong Provincial People′s Hospital. Data obtained included the diagnosis, treatment and follow-up outcome.@*Results@#The most common inherited cardiac arrhythmia syndromes were LQTS (n=14) including 1 case with epilepsy, CPVT (n=5), HCM (n=7), ARVC (n=1), and BrS (n=3). Twenty-seven cases were admitted to hospital due to syncope, whereas the remaining 3 cases of BrS had not presented with syncope before admission. The average onset age of inherited arrhythmia was (10.0±3.3) years. Genetic testing was performed on 20 patients. The median follow-up time was 40 months. Among 15 patients who underwent implantable cardioverter defibrillator (ICD) and survived, 2 patients had frequent ICD discharge. One patient underwent radiofrequency ablation, and the other one received left cardiac sympathetic denervation and an increased ICD defibrillation threshold, and the number of ICD discharge was significantly reduced. Among 10 patients who received drug therapy, 4 patients including two patients who discontinued treatment without advices died. Two patients whose parents refused treatment died, 1 case diagnosed with unexplained sudden cerebral death, and the remaining 2 cases without indication for drug therapy survived without any treatment.@*Conclusions@#Mortality rate is high in pediatric patients with inherited cardiac arrhythmia and syncope. The therapeutic effect of drugs are not satisfactory, ICD implantation is the most effective treatment to prevent sudden cardiac death currently, but the postoperative frequent discharge should be brought to the forefront and handled in time.
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Objective To monitor the degradation and bio-safety features of the bioabsorbable iron-based stent planted in the pig pulmonary artery.Methods A total of 19 miniature pigs were randomly assigned into 3 groups.Three cases were assigned as the control group; ten cases were assigned as stent implantation group A with one stent implanted in the pig pulmonary artery; the other six cases were assigned as stent implantation group B with two stents implanted in the pig pulmonary artery.Follow-up studies for 24 months were conducted in all cases.Repeated measures ANOVA were used to collect and analyze statistical processing data at multiple time points of the follow-up.Results After surgery,pulmonary artery blood flow velocity and right ventricular pressure were measured by echocardiography and cardiac catheterization.There was no significant difference in pulmonary artery blood flow velocity (Fgroup×time =1.06,P =0.40) and right ventricular pressure (Fgroup ×time =0.58,P =0.86) among each group,and no vascular renarrow circumstance was indicated.Pulmonary artery diameter expansion rate between stent group and control group was statistically different (Fgroup =3.57,P =0.05 ; Ftime =12.89,P ＜ 0.001 ; Fgroup ×time =2.99,P =0.03),suggesting that the stent could maintain a good expansion of the role of vascular in the follow-up period even though in degradation.Difference in the level of serum iron concentrations among the groups was not statistically significant (Fgroup ×time =0.94,P =0.52),suggesting that there was no evidence of iron overload.All animals survived to the follow-up endpoint,and no serious side effects caused by stent implantation were found.Conclusions Bioabsorbable iron-based stent planted in the pig pulmonary artery may experience a certain degree of degradation,and it is safe and stabile in animals.