Management of pediatric tachyarrhythmias on mechanical support.

Published

Journal Article

BACKGROUND: Pediatric patients with persistent arrhythmias may require mechanical cardiopulmonary support. We sought to classify the population, spectrum, and success of current treatment strategies. METHODS AND RESULTS: A multicenter retrospective chart review was undertaken at 11 sites. Inclusion criteria were (1) patients <21 years, (2) initiation of mechanical support for a primary diagnosis of arrhythmias, and (3) actively treated on mechanical support. A total of 39 patients were identified with a median age of 5.5 months and median weight of 6 kg. A total of 69% of patients were cannulated for supraventricular tachycardia with a median rate of 230 beats per minute. A total of 90% of patients were supported with extracorporeal membrane oxygenation for an average of 5 days. The remaining 10% were supported with ventricular assist devices for an average of 38 (20-60) days. A total of 95% of patients were treated with antiarrhythmics, with 43% requiring >1 antiarrhythmic. Amiodarone was the most frequently used medication alone or in combination. A total of 33% patients underwent electrophysiology study/transcatheter ablation. Radiofrequency ablation was successful in 9 patients on full flow extracorporeal membrane oxygenation with 3 radiofrequency-failures/conversion to cryoablation. One patient underwent primary cryoablation. A total of 15% of complications were related to electrophysiology study/ablation. At follow-up, 23 patients were alive, 8 expired, and 8 transplanted. CONCLUSIONS: Younger patients were more likely to require support in the presented population. Most patients were treated with antiarrhythmics and one third required electrophysiology study/ablation. Radiofrequency ablation is feasible without altering extracorporeal membrane oxygenation flows. There was a low frequency of acute adverse events in patients undergoing electrophysiology study/ablation, while on extracorporeal membrane oxygenation.

Full Text

Duke Authors

Cited Authors

  • Silva, JNA; Erickson, CC; Carter, CD; Greene, EA; Kantoch, M; Collins, KK; Miyake, CY; Carboni, MP; Rhee, EK; Papez, A; Anand, V; Bowman, TM; Van Hare, GF; Participating Members of Pediatric and Congenital Electrophysiology Society (PACES),

Published Date

  • August 2014

Published In

Volume / Issue

  • 7 / 4

Start / End Page

  • 658 - 663

PubMed ID

  • 24987047

Pubmed Central ID

  • 24987047

Electronic International Standard Serial Number (EISSN)

  • 1941-3084

Digital Object Identifier (DOI)

  • 10.1161/CIRCEP.113.000973

Language

  • eng

Conference Location

  • United States