Multicenter Results of a Novel Pediatric Pacemaker in Neonates and Infants.

Background: To address the unmet need for a smaller pacemaker for babies, a specially modified implantable pulse generator was developed containing a Medtronic Micra subassembly in a polymer header connecting to a bipolar epicardial lead. The aim of this study was to report midterm follow-up data and outcomes of patients who underwent implantation of this device.

Methods: Deidentified data were collected from 12 of 15 sites in the United States implanting the pediatric implantable pulse generator between March 2022 and February 2024.

Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design.

Importance: The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults.

Observations: We describe the protocol for the Pediatric Observational Cohort Study of the NIH's REsearching COVID to Enhance Recovery (RECOVER) Initiative.

Subcutaneous cardioverter-defibrillator implantation in an adult with congenital heart disease and left infra-mammary pacemaker.

The approach/type of an implantable cardioverter defibrillator (ICD) is determined by the underlying cardiac anatomy, venous access, and pre-existing cardiac implantable electronic devices. We describe a case of subcutaneous ICD implantation in an adult with congenital heart disease (CHD) with a pre-existing inframammary transvenous pacemaker. This was preferred over adding a defibrillator coil to existing pacing leads, extraction/replacement of pacing system, or a sternotomy/epicardial ICD placement.

Lead Management in Patients with Congenital Heart Disease.

Pediatric patients with congenital heart disease present unique challenges when it comes to cardiac implantable electronic devices. Pacing strategy is often determined by patient size/weight and operator experience. Anatomic considerations, including residual shunts, anatomic obstructions and barriers, and abnormalities in the native conduction system, will affect the type of CIED implanted.

Myocardial bridge in a child with cardiac arrest and ventricular fibrillation: a bridge over troubled water?

Resuscitated cardiac arrest in a child triggers a comprehensive workup to identify an aetiology and direct management. The presence of a myocardial bridge does not automatically imply causation. Careful determination of the haemodynamic significance of the myocardial bridge is critical to avoid an unnecessary sternotomy and to provide appropriate treatment.

Combination Therapy of Ivabradine with Procainamide for the Management of Pediatric Postoperative Junctional Ectopic Tachycardia.

Pediatric postoperative junctional ectopic tachycardia (JET), although usually self-limited, may lead to significant morbidity and mortality. Anti-arrhythmic medications are often necessary to restore atrioventricular synchrony when non-pharmacological measures fail. Multiple drugs have been described for the management of postoperative JET, with enteral ivabradine being the latest addition.

Significance of electrocardiogram abnormalities in children presenting to the emergency department with acute COVID-19 infection.

Objectives: Acute COVID-19 infection may be associated with electrocardiogram (EKG) abnormalities in pediatric patients. We have anecdotally observed EKG abnormalities in patients without MIS-C or significant cardiac disease requiring intervention or further follow-up. Our aim was to determine the incidence of abnormal EKG findings and correlate with evidence of significant cardiac pathology in pediatric patients who present to the emergency department during an acute COVID-19 infection.

Left Main Coronary Artery Ostial Stenosis in a Pediatric Patient With Sudden Cardiac Arrest.

Pediatric resuscitated sudden cardiac arrest may result from diverse conditions and, therefore, warrants a comprehensive work-up. Although rare, coronary artery abnormalities must be ruled out in these patients. We describe a case with congenital left main coronary artery ostial stenosis diagnosed using advanced imaging techniques.

Clinical risk prediction score for postoperative accelerated junctional rhythm and junctional ectopic tachycardia in children with congenital heart disease.

Background: Accelerated junctional rhythm (AJR) and junctional ectopic tachycardia (JET) are common postoperative arrhythmias associated with morbidity/mortality. Studies suggest that pre- or intraoperative treatment may improve outcomes, but patient selection remains a challenge.

Objectives: The purpose of this study was to describe contemporary outcomes of postoperative AJR/JET and develop a risk prediction score to identify patients at highest risk.

Ventricular arrhythmias after fibroma resection: Are patients still at risk?

Background: Ventricular fibromas frequently present with life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) in children. The long-term risk of sustained ventricular arrhythmias after surgical resection is unknown.

Objectives: The aims of this study were to quantify the VT/VF risk after surgical resection and to examine the results of early (during index surgical hospitalization) and late (≥3 months after surgery) postoperative ventricular stimulation (V-stim) studies.

Non-fluoroscopic Techniques for Catheter Ablation of Typical Atrioventricular Nodal Re-entry Tachycardia in a Pediatric Patient with Atypical Venous Anatomy.

Catheter ablation of the slow pathway to the atrioventricular node is generally a safe and effective treatment for atrioventricular nodal re-entry tachycardia (AVNRT). However, congenital anomalies of the inferior vena cava and superior draining veins can limit traditional catheter approaches to the right heart from femoral venous access and distort local anatomy within the triangle of Koch, necessitating alternative electrophysiology (EP) mapping and ablation strategies. Despite the widespread availability of non-fluoroscopic 3-dimensional imaging systems, many providers still rely on venography to describe unusual cardiovascular anatomy and fluoroscopy to position EP catheters when mapping and ablating the slow pathway.

Adverse Drug Event Prediction Using Noisy Literature-Derived Knowledge Graphs: Algorithm Development and Validation.

Background: Adverse drug events (ADEs) are unintended side effects of drugs that cause substantial clinical and economic burdens globally. Not all ADEs are discovered during clinical trials; therefore, postmarketing surveillance, called pharmacovigilance, is routinely conducted to find unknown ADEs. A wealth of information, which facilitates ADE discovery, lies in the growing body of biomedical literature.

Rheumatic Heart Disease in the United States: Forgotten But Not Gone: Results of a 10 Year Multicenter Review.

Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty-two US pediatric institutions participated in a 10-year review (2008-2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management.

Role of functional echocardiographic parameters in the diagnosis of bronchopulmonary dysplasia-associated pulmonary hypertension.

Echocardiogram (echo) is a commonly used noninvasive modality for the diagnosis of bronchopulmonary dysplasia associated pulmonary hypertension (BPD-PH). Though not considered the gold standard for the diagnosis of BPD-PH, it is an extremely valuable tool in the neonatal and pediatric population, especially when cardiac catheterization is not feasible. In addition to the traditional echo parameters that are used to assess the presence of BPD-PH, much attention has been recently placed on newer bedside echo measures, the so-called functional echo parameters, to aid and assist in the diagnosis.

N-terminal pro-B-type-natriuretic peptide as a screening tool for pulmonary hypertension in the paediatric population.

Background: Although cardiac catheterisation (cath) is the diagnostic test for pulmonary hypertension, it is an invasive procedure. Echocardiography (echo) is commonly used for the non-invasive diagnosis of pulmonary hypertension but maybe limited by lack of adequate signals. Therefore, emphasis has been placed on biomarkers as a potential diagnostic tool.

Application of Appropriate Use Criteria for Echocardiography in Pediatric Patients with Palpitations and Arrhythmias.

Unlabelled: Before the integration of the pediatric appropriate use criteria (AUC) for initial transthoracic echocardiography (TTE) in the outpatient setting with our electronic medical record (EMR), there was a high proportion of "rarely appropriate" TTEs (17.2%) ordered for palpitations/arrhythmias. We studied appropriateness ratings and applicability of pediatric AUC on the initial outpatient evaluation of children with palpitations/arrhythmias after EMR integration and the yield of abnormal TTEs for these indications.