Management of Pediatric Tachyarrhythmias on Mechanical Support

• Published in: Circulation. Arrhythmia and electrophysiology Vol. 7; no. 4; pp. 658 - 663
• Main Authors: Silva, Jennifer N.A, Erickson, Christopher C, Carter, Christopher D, Greene, E Anne, Kantoch, Michal, Collins, Kathryn K, Miyake, Christina Y, Carboni, Michael P, Rhee, Edward K, Papez, Andrew, Anand, Vijay, Bowman, Tammy M, Van Hare, George F
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.08.2014
• Subjects: Age Factors; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - therapeutic use; Arrhythmias, Cardiac - complications; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - mortality; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - therapy; Canada; Catheter Ablation - adverse effects; Catheter Ablation - mortality; Cryosurgery - adverse effects; Cryosurgery - mortality; Electrophysiologic Techniques, Cardiac; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - mortality; Heart-Assist Devices - adverse effects; Humans; Infant; Retrospective Studies; Risk Factors; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - therapy; Time Factors; Treatment Outcome; United States; Canada; United States; heart-assist device; antiarrhythmic drugs; ablation techniques; pediatrics
• ISSN: 1941-3149; 1941-3084
• DOI: 10.1161/CIRCEP.113.000973

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.