Age and gender specific pediatric reference intervals for aldolase, amylase, ceruloplasmin, creatine kinase, pancreatic amylase, prealbumin, and uric acid.

BACKGROUND: Reference intervals can vary based on age and gender. Proper partitioning is necessary to classify health status in different age groups. METHODS: Seven analytes; aldolase, amylase, ceruloplasmin, creatine kinase, pancreatic amylase, prealbumin and uric acid; were assayed on Roche Modular P analyzers using serum samples from 1765 children (867 females and 898 males; age range, 6 months to 17 y). Subjects 6 months up to 7 y were undergoing minor surgical procedures. Children 7 to 17 y were apparently healthy. Subjects with significant medical history or who were taking any medications were excluded. RESULTS: Separate reference intervals for boys and girls were required for 33% of the groups. Aldolase showed gender variation in the 6-8, 12-14, and 15-17 y. Amylase was the only analyte that showed no significant gender differences within any age group. Both ceruloplasmin and uric acid had significant differences between the 12-14 and 15-17 y groups. Creatine kinase exhibited statistically significant gender differences in all age groups with the exception of 6-8 y. CONCLUSION: We verified that when establishing pediatric reference intervals, partitioning by age and gender is frequently necessary.

Imaging modalities in cardiac electrophysiology.

Cardiac imaging, both noninvasive and invasive, has become a crucial part of evaluating patients during the electrophysiology procedure experience. These anatomical data allow electrophysiologists to not only assess who is an appropriate candidate for each procedure, but also to determine the rate of success from these procedures. This article incorporates a review of the various cardiac imaging techniques available today, with a focus on atrial arrhythmias, ventricular arrhythmias and device therapy.

Atrial fibrillation ablation in patients with therapeutic international normalized ratios.

AIMS: Pulmonary vein antrum isolation (PVAI) plays a pivotal role in the comprehensive treatment of atrial fibrillation (AF). The need for effective anticoagulation bridging following PVAI is associated with significant vascular complication rates and increased costs. We investigated the safety of PVAI in patients with therapeutic international normalized ratios (INR) the day of the procedure. METHODS: A case-control analysis was performed on patients who underwent PVAI with therapeutic INR (>2). Patients with normal preprocedure INR served as controls. The incidence of major and minor hematomas, fistulas, vascular injury, and cardiac perforation or tamponade were catalogued. PVAI was performed under fluoroscopic, electro-anatomical, and intracardiac echocardiographic guidance, with an open irrigation ablation technique. RESULTS: A total of 194 patients (mean age 64 +/- 12) were included; 87 patients underwent PVAI with therapeutic INR (cases) and 107 with normal INR (controls). Persistent AF was more prevalent than paroxysmal AF in the therapeutic INR group. The mean INR for cases was 2.8 +/- 0.7 compared to 1.4 +/- 0.3 in the control group (P < 0.01). All procedures were completed without acute complications. Two major adverse events were observed, one in each arm. No significant difference in terms of minor (6.5% vs. 5.7%, P = 0.23) or major (0.93% vs. 1.15%, P = 0.49) vascular events or bleeding was detected between the therapeutic INR and the control group. The combined endpoint of major and minor complications did not differ among groups (9.35% vs. 8.05%, P = 0.19). CONCLUSION: Atrial fibrillation ablation in patients with therapeutic INR on the day of a procedure appears to be safe and feasible. Expensive outpatient anti-coagulation bridging may be safely avoided in this type of population.