Embolic complications associated with radiofrequency catheter ablation. Atakr Investigator Group.

Both early and late thromboembolic events are known complications of radiofrequency catheter ablation. This review of 758 patients undergoing 830 radiofrequency ablation procedures finds that embolic complications after radiofrequency ablation in patients without other risk factors for thromboembolism are rare (<0.2%).

Sotalol for refractory arrhythmias in pediatric and young adult patients: initial efficacy and long-term outcome.

Sotalol is an antiarrhythmic medication that has properties of both a beta-blocker and a class III agent and has been used safely and effectively to treat arrhythmias of multiple mechanisms in pediatric patients. The purpose of this study was to review our institutional experience with sotalol in 45 patients with refractory arrhythmias and determine their long-term outcome. Patients responded to sotalol with 80% efficacy and a 22% incidence of adverse side effects. The mean sotalol dose was 116 mg/m2/day, and the average duration of therapy was 15.2 months. In spite of 80% efficacy, only 22% of patients remained on sotalol long-term. Sotalol was discontinued most commonly for either spontaneous resolution of disease or definitive cure by radiofrequency ablation. Other reasons for discontinuation of effective therapy included adverse side effects and arrhythmia control with either an antitachycardia pacemaker or another medication. One patient died while taking sotalol, but this case was considered a failure of treatment rather than an adverse side effect. Of the patients who still receive therapy, several have complex structural heart disease and require a combination of therapies, including sotalol, for adequate rhythm control.

Overview of pediatric arrhythmias.

Cardiac arrhythmias are being depressed with increased frequency in the pediatric population. Causes of pediatric arrhythmias in the general population include severe metabolic or electrolyte disturbances, drug toxicity, and chest trauma. Repairs of complex congenital heart disease have frequently left this population with persistent or recurrent postoperative arrhythmias. The diagnosis, evaluation, and management of pediatric arrhythmias requires nurses to be skilled in hemodynamic assessment and arrhythmia detection. The registered nurse's grasp of developmental issues and family education is vital in providing quality care to families dealing with these diagnoses.

Effects of propofol or isoflurane anesthesia on cardiac conduction in children undergoing radiofrequency catheter ablation for tachydysrhythmias.

BACKGROUND: To determine suitability for ablation procedures in children, two commonly used anesthetic agents were studied: propofol and isoflurane. METHODS: Twenty patients presenting for a radiofrequency catheter ablation procedure were included and randomly assigned to two groups. A baseline electrophysiology study was performed during anesthesia with thiopental, alfentanil, nitrous oxide, and pancuronium in all patients. At the completion of the baseline electrophysiology study (EPS), 0.8-1.2% isoflurane was administered to patients in group 1 and 2 mg/kg propofol bolus plus an infusion of 150 micrograms.kg-1.min-1 was administered to patients in group 2. Nitrous oxide and pancuronium were used throughout the procedure. After 30 min of equilibration, both groups underwent a repeat EPS. The following parameters were measured during the EPS: cycle length, atrial-His interval, His-ventricle interval, corrected sinus node recovery time, AV node effective refractory period, and atrial effective refractory period. Using paired t tests, the electrophysiologic parameters described above measured during propofol or isoflurane anesthesia were compared to those measured during baseline anesthesia. Statistical significance was accepted as P < 0.05. RESULTS: There was no statistically significant difference in the results obtained during baseline anesthesia when compared with those measured during propofol or isoflurane anesthesia. CONCLUSIONS: Neither propofol nor isoflurane anesthesia alter sinoatrial or atrioventricular node function in pediatric patients undergoing radiofrequency catheter ablation, compared to values obtained during baseline anesthesia with alfentanil and midazolam.

Variable location of accessory pathways associated with the permanent form of junctional reciprocating tachycardia and confirmation with radiofrequency ablation.

Permanent junctional reciprocating tachycardia (PJRT) occurs primarily in young patients and causes nearly incessant tachycardia that is frequently refractory to pharmacologic treatment. Previous nonpharmacologic therapy has included surgical or direct-current catheter ablation of either the His bundle or the accessory pathway. The accessory pathway in PJRT has been described as having retrograde and anterograde decremental conduction properties, and is typically identified in the posteroseptal location. This report describes radiofrequency catheter ablation of accessory pathways in 8 patients with PJRT. All ablations were successful and without adverse effects. Accessory pathway potentials were detected just before atrial activation in 6 of 8 patients. A new finding was that 5 of the 8 pathway locations, as identified by the site of successful ablation, were not in the typical posteroseptal region. In 1 patient it was located in the right posteroseptal region, 2 were in the right atrial freewall, 1 was in the right anterior septum and 1 was in the left posterior region just outside of the septal region. In conclusion, radiofrequency catheter ablation can be a highly effective and safe method for treatment of young patients with PJRT. Because the accessory pathways can be located outside of the posteroseptal region, careful mapping of both the right and left atrioventricular groove may be necessary for successful ablation.

Mechanical ventilation considerations in complex congenital heart disease.

It is the philosophy of our institution to provide primary surgical repair of complex congenital heart defects to avoid pulmonary and myocardial damage that occurs over time. Application of knowledge of the normal physiology and a clear understanding of the physiologic alterations of complex lesions are essential in understanding the effect of positive-pressure ventilation in complex CHD. The care and management of patients with CHD have a great deal to do with ventilatory management, which can be life-threatening when not fully understood but lifesaving when mastered. A dedicated team approach enhances communication and collaborative practice, which provides optimal patient management and outcome.