Factors Associated With the Occurrence and Treatment of Supraventricular Tachycardia in a Pediatric Congenital Heart Disease Cohort

Tripathi, Avnish; Black, George B.; Park, Young Jun; Jerrell, Jeanette M.

doi:10.1007/s00246-013-0784-3

Cited by 32 publications

(15 citation statements)

References 18 publications

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“…Supraventricular tachycardia (SVT) is the most common arrhythmia in infants, with an estimated incidence of 1/250 to 1/1000 among all infants and 1/10 among infants with congenital heart disease (CHD) [1–6]. Medications used to treat SVT typically fall into one of three categories: 1) abortive therapies; 2) acute management therapies used to achieve rate control or improve the likelihood of arrhythmia abortion; and 3) secondary prevention or “prophylactic” therapies used to prevent SVT recurrence [7,8].…”

Section: Introductionmentioning

confidence: 99%

Treatment of supraventricular tachycardia in infants: Analysis of a large multicenter database

Chu¹,

Hill²,

Clark³

et al. 2015

Early Human Development

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Objective Supraventricular tachycardia (SVT) is the most common arrhythmia in infants. Infants are typically treated with antiarrhythmic medications, but there is a lack of evidence guiding management, thus exposing infants to risks of both inadequate therapy and medication adverse events. We used data from a large clinical database to better understand current practices in SVT management, safety of commonly used medications, and outcomes of hospitalized infants treated for SVT. Methods This retrospective data analysis included all infants discharged from Pediatrix Medical Group neonatal intensive care units between 1998 and 2012 with a diagnosis of SVT who were treated with antiarrhythmic medications. We categorized infants by presence of congenital heart disease other than patent ductus arteriosus. Medications were categorized as abortive, acute, or secondary prevention therapies. We used descriptive statistics to describe medication use, adverse events, and outcomes including SVT recurrence and mortality. Results A total of 2848 infants with SVT were identified, of whom 367 (13%) had congenital heart disease. Overall, SVT in-hospital recurrence was high (13%), and almost one fifth of our cohort (18%) experienced an adverse event. Mortality was 2% in the overall cohort and 6% in the congenital heart disease group (p<0.001). Adenosine was the most commonly used abortive therapy, but there was significant practice variation in therapies used for acute treatment and secondary prevention of SVT. Conclusion and Practice Implication Significant variation in SVT treatment and suboptimal outcomes warrant future clinical trials to determine best practices in treating SVT in infants.

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Section: Introductionmentioning

confidence: 99%

Treatment of supraventricular tachycardia in infants: Analysis of a large multicenter database

Chu¹,

Hill²,

Clark³

et al. 2015

Early Human Development

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“…Intraatrial re-entrant tachycardia (IART) has become a common and potentially lethal complication during the follow-up of patients with CHD, with a general incidence of 25% 2 and even higher (up to 40%-50%) in more complex cardiac diseases. [3][4][5][6][7] Atrial scars related to previous cardiac surgeries, atrial fibrosis, and cardiac residual lesions leading to hemodynamic atrial overload create slow conduction areas that are the main mechanisms for re-entry. 2,3,[8][9][10][11][12][13][14][15][16] IART is more related to increased morbidity (heart failure, stroke) and mortality in patients with CHD than other potentially severe complications such as ventricular arrhythmias or heart failure.…”

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confidence: 99%

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

Roca‐Luque

Rivas-Gándara

Dos‐Subirà

et al. 2018

JAHA

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BackgroundIntra‐atrial re‐entrant tachycardia (IART) in patients with congenital heart disease (CHD) increases morbidity and mortality. Radiofrequency catheter ablation has evolved as the first‐line treatment. The aim of this study was to analyze the acute success and to identify predictors of failed IART radiofrequency catheter ablation in CHD.Methods and ResultsThe observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART at a single center from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55±14.9 years). In the first procedure, 114 IART were ablated (acute success: 74.6%; 1.21±0.41 IART per patient) with an acute success of 74.5%. Cavotricuspid isthmus–related IART was the only arrhythmia in 51%; non–cavotricuspid isthmus–related IART was the only mechanism in 27.7% and 21.3% of the patients had both types of IART. Predictors of acute radiofrequency catheter ablation failure were as follows: nonrelated cavotricuspid isthmus IART (odds ratio 7.3; confidence interval [CI], 1.9–17.9; P=0.04), previous atrial fibrillation (odds ratio 6.1; CI, 1.3–18.4; P=0.02), transposition of great arteries (odds ratio, 4.9; CI, 1.4–17.2; P=0.01) and systemic ventricle dilation (odds ratio 4.8; CI, 1.1–21.7; P=0.04) with an area under the receiver operating characteristic curve of 0.83±0.056 (CI, 0.74–0.93, P=0.001). After a mean follow‐up longer than 3.5 years, 78.3% of the patients were in sinus rhythm (33.1% of the patients required more than 1 radiofrequency catheter ablation procedure).ConclusionsAlthough ablation in CHD is a challenging procedure, acute success of 75% can be achieved in moderate–highly complex CHD patients in a referral center. Predictors of failed ablation are IART different from cavotricuspid isthmus, previous atrial fibrillation, and markers of complex CHD (transposition of great arteries, systemic ventricle dilation).

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“…These Medicaid data files are routinely cleaned to eliminate duplicate visit records, frequently updated before being made available for analysis, and have been used in the previous investigations of particular congenital heart lesions. [ 27 28 29 ] The methods involved in this study were approved by the University of South Carolina Institutional Review Board as exempt from human subject research guidelines (45 Code of Federal Regulations part 46) because deidentified, existing medical database records were used for the secondary analysis.…”

Section: Methodsmentioning

confidence: 99%

Population-based treated prevalence, risk factors, and outcomes of bicuspid aortic valve in a pediatric Medicaid cohort

2018

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Background:We investigated the treated prevalence of bicuspid aortic valve in a pediatric population with congenital heart disease and its incident complications.Materials and Methods:A 15-year retrospective data set was analyzed. Selection criteria included age ≤17 years, enrollees in the South Carolina State Medicaid program and diagnosed as having bicuspid aortic valve on one or more service visits.Results:The 15-year-treated prevalence of predominantly isolated bicuspid aortic valve was 2% (20/1000) of pediatric congenital heart disease cases, with a non-African American: African-American ratio of 3.5:1, and a male:female ratio of 1.6:1. Aortic stenosis (28.0%), ventricular septal defect (20.6%), and coarctation of the aorta (20.6%) were the most prevalent coexisting congenital heart lesions. Of the 378 bicuspid aortic valve cases examined, 10.3% received aortic valve repair/replacement, which was significantly more likely to be performed in children with diagnosed aortic stenosis (adjusted odds ratio = 12.90; 95% confidence interval = 5.66–29.44). Cohort outcomes over the study period indicated that 9.5% had diagnosed heart failure, but <1% had diagnosed supraventricular tachycardia, infective endocarditis, aneurysm, dissection, or death.Conclusions:The majority of isolated bicuspid aortic valve cases without aortic stenosis did not require surgical intervention. Outcomes for cases requiring repair/replacement were relatively benign.

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Factors Associated With the Occurrence and Treatment of Supraventricular Tachycardia in a Pediatric Congenital Heart Disease Cohort

Cited by 32 publications

References 18 publications

Treatment of supraventricular tachycardia in infants: Analysis of a large multicenter database

Treatment of supraventricular tachycardia in infants: Analysis of a large multicenter database

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation

Population-based treated prevalence, risk factors, and outcomes of bicuspid aortic valve in a pediatric Medicaid cohort

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