ABSTRACT
Coronary sinus (CS) catheterization is widely used during electrophysiological studies (EPS) and catheter ablation. The femoral venous (FV) approach to CS catheterization for EPS has been reported in adults but not in children. We report our experience with CS catheter placement through the FV approach in children. The charts of children with normal hearts who underwent EPS with CS cannulation were reviewed. The FV approach was attempted followed by right internal jugular (IJ) vein approach, if unsuccessful. Between 2010 and 2015, 250 patients were studied with an average of 13 ± 3 years. The FV approach to CS catheterization was attempted in 249 patients and was successful in all but 13 (95% successful). The right IJ was used as the primary approach in 1 infant aged 6 weeks and as the backup approach in 11 of the 13 in whom the FV approach failed. There was no appreciable difference between ages of patients in whom FV versus IJ approaches were successful (13 years ± 3 vs 13 years ± 3, respectively). There were no complications from FV sheath placement or from placement of the CS catheter from the FV approach. The right IJ approach was complicated by carotid artery puncture without hematoma in 2 patients (18% of attempts). In conclusion, the FV approach is a safe and effective option for CS cannulation for EPS procedures in children. The IJ and other approaches could be used as back up when the FV approach fails.
Subject(s)
Cardiac Catheterization/methods , Coronary Sinus , Heart Defects, Congenital/diagnosis , Adolescent , Child , Child, Preschool , Female , Femoral Vein , Follow-Up Studies , Humans , Male , Retrospective Studies , Ultrasonography, Interventional/methodsABSTRACT
BACKGROUND: Each encounter of asymptomatic individuals with the healthcare system presents an opportunity for improvement of cardiovascular disease (CVD) awareness and sudden cardiac death (SCD) risk assessment. ECG sign deep terminal negativity of the P wave in V1 (DTNPV1) was shown to be associated with an increased risk of SCD in the general population. OBJECTIVE: To evaluate association of DTNPV1 with all-cause mortality and newly diagnosed atrial fibrillation (AFib) in the large tertiary healthcare system patient population. METHODS: Retrospective double cohort study compared two levels of exposure (automatically measured amplitude of P-prime (Pp) in V1): DTNPV1 (Pp from -100µV to -200µV) and ZeroPpV1 (Pp=0). An entire healthcare system (2010-2014) ECG database was screened. Medical records of children and patients with previously diagnosed AFib/atrial flutter (AFl), implanted pacemaker or cardioverter-defibrillator were excluded. DTNPV1 (n=3,413) and ZeroPpV1 (n=3,405) cohorts were matched by age and sex. Primary outcome was all-cause mortality. Secondary outcomes were newly diagnosed AFib/AFl. Median follow-up was 2.5 y. RESULTS: DTNPV1 was associated with all-cause mortality (HR 1.95(1.64-2.31); P<0.0001) and newly diagnosed AFib (HR 1.29(1.04-1.59); P=0.021) after adjustment for CVD, comorbidities, other ECG parameters, medications, and index ECG referral. Index ECG referral by a cardiologist was independently associated with 34% relative risk reduction of mortality (HR 0.66(0.52-0.84); P=0.001), as compared to ECG referral by a non-cardiologist. CONCLUSION: DTNPV1 is independently associated with twice higher risk of all-cause death, as compared to patients without P prime in V1. Life-saving effect of the index ECG referral by a cardiologist requires further study.
Subject(s)
Atrial Fibrillation/diagnosis , Atrial Fibrillation/mortality , Atrial Flutter/diagnosis , Atrial Flutter/mortality , Death, Sudden, Cardiac/epidemiology , Electrocardiography , Adult , Aged , Databases, Factual , Female , Humans , Male , Middle Aged , Referral and Consultation , Retrospective StudiesABSTRACT
For proper distribution of preventative resources, a more robust method of cardiac risk stratification should be encouraged in addition to merely reduced ejection fraction. To this end, the QRS-T angle, an electrocardiogram-derived measure of the difference in mean vectors of depolarization and repolarization, has been found associated with sudden cardiac death and other mortal and morbid outcomes in multiple observational studies over the past decade. The use of both frontal and spatial QRS-T angle in the prediction of future cardiac events including sudden cardiac death, all-cause mortality, and further cardiac morbidity is reviewed here.
