Supraventricular tachycardia in neonates: antiarrhythmic drug choice dilemma.

Supraventricular tachycardia (SVT), being atrioventricular reentry the underlying mechanism, is the most frequently tachyarrhythmia requiring a medical treatment in infants with no cardiac disease. The acute treatment of a single episode of SVT has generally an excellent prognosis. An antiarrhythmic prophylaxis of SVT recurrences is usually recommended during the first year of life. Although many efficient drugs are available for the SVT treatment, a careful risk-benefit analysis of each single case should suggest the correct drug choice.

Counseling and informed consent: the experience in a pediatric cardiology unit. How to communicate a pathological diagnosis.

The aim of our study was to create an operative scheme for conveying a pathological diagnosis with emphasis on communication strategies. In order to check the validity of the scheme, parents of 122 of our patients were contacted by an outside observer and were asked to answer anonymously to a questionnaire concerning their experience in our unit. The questionnaire has been structured in three parts in order to verify (1) the quality of the communication of the diagnosis, (2) the team-patient relationship and (3) the comparison between our unit and the others. 87% of parents declared the language used in the communication clear and comprehensible and the time dedicated to the explanations sufficient (p<.01). They judged the quality of the information received as excellent (50%) or good (50%) (p<.01). Eightyfour % of them thought that the information given was sufficient and there was no need for any more details (p<.01). 92% perceived a comfortable atmosphere, they felt involved in the communication and encouraged to ask questions (p<.01). 91% described the behaviour of the team as helpful and warm without differences between the different figures of the unit (p<.01). In regard to the psychological support 70% of parents found it essential, 30% found it very useful (p<.05). These results show that our operative scheme is functional to the communication and to the team-patient relationship. It permits an "informed consent" as an aware choice of the parents and consequently a better way of management of the congenital heart disease.

[Arrhythmias in adult patients with congenital heart disease]. / Le aritmie nei pazienti adulti con cardiopatia congenita.

Arrhythmias are the main cause of morbidity and mortality in adult patients with congenital heart disease. Arrhythmias can be due to the primary anatomical defect or they can be a consequence of the long term effects of haemodynamical defects and surgical repairs. Atrial arrhythmias are the most frequent form and their prevalence varies between 10-60% in different congenital defects. Ventricular tachycardia are less common but they have potentially a dramatic impact on survival. When correcting the haemodynamic defect is not effective in avoiding arrhythmias complications, it is necessary to apply specific therapy. Antiarrhythmic drugs must be used very carefully, there is an increasing application for transcatheter or surgical ablation and device implantation.