Leadless pacemaker implantation for pediatric patients through internal jugular vein approach: A case series of under 30 kg.

BACKGROUND: We demonstrate a case series of 8 pediatric patients, all under 30 kg, who had leadless pacemaker implants via the internal jugular vein. METHODS: A retrospective review of pediatric leadless pacing placement via the internal jugular vein at the University of Minnesota Masonic Children's Hospital and UC Davis Medical Center from 2018 through 2021 was performed. Rationales for pacing, demographics of patients, pacing thresholds, and longevity of devices were recorded. RESULTS: Eight internal jugular pacemaker insertions were performed successfully in patients weighing between 10.9 kg and 29 kg. Five patients had Micra implantation via the right internal jugular vein, whereas 3 patients had insertion via the left internal jugular vein. No surgical cut-downs were performed. No venous complications occurred. Up to 3 years of follow-up were noted. CONCLUSION: Leadless pacemaker implantation, via left or right internal jugular veins, is feasible without surgical cutdown in patients <30 kg.

Pediatric Micra leadless pacemaker implantation via internal jugular and femoral veins: experience with 11 patients.

In pediatrics, conventional transvenous and epicardial pacemaker systems carry complications, such as lead distortion due to growth and activity, in addition to lead and pocket complications. A retrospective review of pediatric leadless pacing at the University of Minnesota Masonic Children's Hospital (MN, USA) from 2018 through 2021 was performed. Diagnoses, rationale for pacing, demographics, pacing thresholds and longevity of devices were recorded. Twelve leadless pacemaker insertions and one removal were performed successfully in patients weighing 19-90 kg. Six patients had Micra implantation via the internal jugular vein without surgical cut-down. Up to 3 years of follow-up were noted, with median follow-up of 22 months. No late complications occurred. Leadless pacemaker implantation and early retrieval were feasible in pediatric patients.

Pacemaker placement has been the standard of care for patients when the top and bottom chambers of the heart are not communicating electrically. Patients can either be born with this, or it can happen after heart surgery. Traditional pacemaker technique involves placing wires (leads) through veins to the heart and surgically implanting a generator in the body. This carries a risk of complications, mainly lead dislocation and fracture with growth and activity. The Micra leadless pacemaker mitigates this risk and can be implanted into the muscle of the right ventricle. There are currently only small case series and reports in the literature on Micra pacemaker implantation in pediatric patients with congenital heart disease. We implanted 12 such devices in 11 pediatric patients weighing 19­90 kg. Six of these implantations were deployed using the internal jugular vein and were successful. One patient had a pericardial effusion at the time of implantation. Overall, leadless pacemaker implantation in the pediatric population with congenital heart disease is feasible, but further data are needed to assess long-term safety.

Long Term Outcomes of Tetralogy of Fallot With Absent Pulmonary Valve (from the Pediatric Cardiac Care Consortium).

Tetralogy of Fallot with absent pulmonary valve (TOF-APV) is a rare form of tetralogy with unique challenges due to the combination of pulmonary annular stenosis, severe pulmonary regurgitation, and airway compression secondary to aneurysmal dilatation of the pulmonary arteries. Data on the long-term outcomes of repaired TOF-APV are scarce. We used the Pediatric Cardiac Care Consortium (PCCC), a large US-based registry, to describe the postrepair transplant-free survival of patients with TOF-APV. We queried the PCCC for patients operated for TOF-APV between 1982 and 2003. Death or transplant events were ascertained from the PCCC and by linkage with the US National Death Index and the Organ Procurement Transplantation Network through December 2019. A total of 126 patients were identified with TOF-APV repair (primary n = 119, staged n = 7). The majority of them were repaired with a right ventricular to pulmonary artery conduit (n = 80, 64%) and 43 (34%) with transannular patch. In-hospital mortality occurred in 31 patients (25%); post discharge and over a median period of 19 years (IQR 0.37 to 23.7 years), 5 patients died and 2 underwent heart transplant, one of whom subsequently died. The 25-year transplant-free survival post discharge after TOF-APV repair was 92%, which was similar with the outcome of patients with simple TOF undergoing non-valve sparing procedures (94% log-rank test p = 0.455; aHR 1.37; 95% CI: 0.63 to 2.97, p = 0.432). In conclusion, early in-hospital mortality is high for TOF-APV; however, once repaired and survived to discharge, long term survival is similar to simple TOF with non-valve sparing procedures.

Pediatric Micra leadless pacemaker implantation via the internal jugular and femoral vein: a single-center, US experience.

Background: In the pediatric population, conventional transvenous and epicardial pacemaker systems carry complications such as lead distortion due to growth/activity, in addition to other lead/pocket complications. Materials & methods: A retrospective review of pediatric leadless pacing at the University of Minnesota Masonic Children's Hospital from 2018 to 2020 was performed. Rationale for pacing, demographics of patients, thresholds and longevity of devices were recorded. Results: Seven leadless pacemaker insertions and one removal were performed successfully, in patients weighing between 19 kg and 58 kg. Three patients had Micra implantation via internal jugular vein. One pericardial effusion occurred perioperatively in a 19 kg patient with baseline thrombocytopenia, sideroblastic anemia and Pearson Marrow Pancreas syndrome. Conclusion: Leadless pacemaker implantation/early retrieval is feasible in pediatric patients.

AVNRT captured by Apple Watch Series 4: Can the Apple watch be used as an event monitor?

Wrist-worn devices are popular for heart rate monitoring, including use of photoplethysmography. The Apple Watch series 4 can identify atrial fibrillation. We describe a case of identification re-entrant supraventricular tachycardia not identified by outpatient rhythm monitoring, however, was identified by the Apple Watch series 4, which lead to electrophysiology study and successful ablation of atrioventricular nodal re-entrant tachycardia.

Cardiac Rehabilitation for Adults and Adolescents With Congenital Heart Disease: EXTENDING BEYOND THE TYPICAL PATIENT POPULATION.

PURPOSE: Cardiac rehabilitation (CR) effectively decreases morbidity and mortality in adults after cardiovascular events. Cardiac rehabilitation has been underutilized for patients with congenital heart disease (CHD). The primary objective was to evaluate the inclusion of adolescents and adults with CHD in a CR program by analyzing data from our single-center CR program. The secondary objectives were to evaluate the efficacy and safety of CR as well as referral barriers. METHODS: This was a retrospective study of patients aged ≥15 yr who were referred to regional CR centers. Data on efficacy and safety were collected. RESULTS: Over a 4-yr period, 36 patients were referred to 23 regional centers: 23 patients completed CR, 12 are currently enrolled or in the referral process, and 1 died before initiation. The median age was 22 yr (range: 15-55). The primary indication was post-surgical (61%), followed by chronic heart failure (30%), and post-transplant (9%). After CR, metabolic equivalent tasks increased by 1.6 (P < .001), maximal heart rate increased by 13 beats/min (P = .026), exercise time increased by 1.35 min (P = .047), and treadmill speed increased by 0.7 mph (P = .007). There were no serious adverse events. All patients who completed CR remain alive at a median follow-up of 17 mo (range: 5-45). Common barriers to CR included accessibility, social circumstances, and cost for phase III CR. CONCLUSION: In our cohort, CR was effective and safe for adolescents and adults with CHD.

Prevention of cardiotoxicity among survivors of childhood cancer.

LINKED ARTICLES: This article is part of a joint Themed section with the British Journal of Pharmacology on Cardiotoxicity. The rest of the Themed section will appear in a future issue of BJP and will be available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1476-5381 The number of survivors of childhood cancers has increased exponentially over the past few decades. However, these survivors are also at substantially increased long-term risk of morbidity and mortality, especially from treatment-related cardiotoxicity. Preventing these risks is now a priority when treating children and adolescents with cancer. Dexrazoxane reduces the risk of anthracycline-induced cardiotoxicity among adults and children with cancer without reducing its antineoplastic effects or event-free survival. Thus, it should be strongly considered as a part of therapy for children and adolescents treated with anthracyclines.