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Mechanical circulatory support to control medically intractable arrhythmias in pediatric patients after cardiac surgery.

Jhang WK, Lee SC, Seo DM, Park JJ - Korean Circ J (2010)

Bottom Line: Postoperative intractable arrhythmia can result in high morbidity and mortality.This report describes our experiences using mechanical circulatory support (MCS) to control medically intractable arrhythmias in three pediatric patients with congenital heart disease (CHD), after palliative or total corrective open-heart surgery.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

ABSTRACT
Postoperative intractable arrhythmia can result in high morbidity and mortality. This report describes our experiences using mechanical circulatory support (MCS) to control medically intractable arrhythmias in three pediatric patients with congenital heart disease (CHD), after palliative or total corrective open-heart surgery.

No MeSH data available.


Related in: MedlinePlus

Tachyarrhythmia EKG of the three patients. A: EKG tracing of case 1 showing ectopic atrial tachycadia which was not terminated by transesophageal overdive atrial pacing. B: EKG from holter monitoring of case 2. Narrow QRS tachycardia with several different P waves that indicates chaotic atrial tachycardia. C: lead II from EKG tracing of case 3. Narrow QRS complex with atrioventricular dissociation that present junctional ectopic tachycardia. EKG: electrocardiogram.
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Figure 1: Tachyarrhythmia EKG of the three patients. A: EKG tracing of case 1 showing ectopic atrial tachycadia which was not terminated by transesophageal overdive atrial pacing. B: EKG from holter monitoring of case 2. Narrow QRS tachycardia with several different P waves that indicates chaotic atrial tachycardia. C: lead II from EKG tracing of case 3. Narrow QRS complex with atrioventricular dissociation that present junctional ectopic tachycardia. EKG: electrocardiogram.

Mentions: A 10-month-old boy with tetralogy of Fallot (TOF) and juxtaductal left pulmonary artery (LPA) stenosis was admitted for a total corrective operation. During the induction of anesthesia, supraventricular tachycardia (SVT) developed with a heart rate of >200 beats/min, and then spontaneously resolved. The major procedures performed were ventricle septal defect (VSD) patch closure, right ventricular outflow tract obstruction relief and LPA angioplasty. All were completed without any remarkable events. During cardiopulmonary bypass (CPB) weaning, however, SVT recurred. Initially the SVT was controlled by a single adenosine dose, but it again recurred immediately and repeatedly and was accompanied by hemodynamic compromise. These latter events could not be controlled using adenosine, electric cardioversion or body cooling. A transesophageal pacing trial revealed an ectopic atrial tachycardia which was not terminated by overdrive pacing (Fig. 1A). After loading 5 mg/kg/hr of amiodarone, 5 mg/kg/day of amiodarone was continuously infused for rate control. Following, the heart rate appeared to decrease slightly but was not completely controlled. Two days after the operation, the heart increased to a consistent rate >220 beats/min, and was accompanied by hypotension. MCS was provided using extracorporeal membrane oxygenation (ECMO, centrifugal pump, Bio-consoleĀ®560, Medtronic Inc., Minneapolis, MN, USA. All patients in this report were supported with this). After approximately 48 hours of ECMO support and without any antiarrhythmic agent, the heart rhythm converted to sinus rhythm. ECMO was weaned successfully after 4 days. Following MCS, brain magnetic resonance imaging (MRI) showed a small chronic subdural hemorrhage, however, no definite clinical neurological deficit was observed. The patient has been followed-up for 6 years, during which time there have been no arrhythmic events, and he is now a 7-year-old-boy in a good general condition.


Mechanical circulatory support to control medically intractable arrhythmias in pediatric patients after cardiac surgery.

Jhang WK, Lee SC, Seo DM, Park JJ - Korean Circ J (2010)

Tachyarrhythmia EKG of the three patients. A: EKG tracing of case 1 showing ectopic atrial tachycadia which was not terminated by transesophageal overdive atrial pacing. B: EKG from holter monitoring of case 2. Narrow QRS tachycardia with several different P waves that indicates chaotic atrial tachycardia. C: lead II from EKG tracing of case 3. Narrow QRS complex with atrioventricular dissociation that present junctional ectopic tachycardia. EKG: electrocardiogram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2957640&req=5

Figure 1: Tachyarrhythmia EKG of the three patients. A: EKG tracing of case 1 showing ectopic atrial tachycadia which was not terminated by transesophageal overdive atrial pacing. B: EKG from holter monitoring of case 2. Narrow QRS tachycardia with several different P waves that indicates chaotic atrial tachycardia. C: lead II from EKG tracing of case 3. Narrow QRS complex with atrioventricular dissociation that present junctional ectopic tachycardia. EKG: electrocardiogram.
Mentions: A 10-month-old boy with tetralogy of Fallot (TOF) and juxtaductal left pulmonary artery (LPA) stenosis was admitted for a total corrective operation. During the induction of anesthesia, supraventricular tachycardia (SVT) developed with a heart rate of >200 beats/min, and then spontaneously resolved. The major procedures performed were ventricle septal defect (VSD) patch closure, right ventricular outflow tract obstruction relief and LPA angioplasty. All were completed without any remarkable events. During cardiopulmonary bypass (CPB) weaning, however, SVT recurred. Initially the SVT was controlled by a single adenosine dose, but it again recurred immediately and repeatedly and was accompanied by hemodynamic compromise. These latter events could not be controlled using adenosine, electric cardioversion or body cooling. A transesophageal pacing trial revealed an ectopic atrial tachycardia which was not terminated by overdrive pacing (Fig. 1A). After loading 5 mg/kg/hr of amiodarone, 5 mg/kg/day of amiodarone was continuously infused for rate control. Following, the heart rate appeared to decrease slightly but was not completely controlled. Two days after the operation, the heart increased to a consistent rate >220 beats/min, and was accompanied by hypotension. MCS was provided using extracorporeal membrane oxygenation (ECMO, centrifugal pump, Bio-consoleĀ®560, Medtronic Inc., Minneapolis, MN, USA. All patients in this report were supported with this). After approximately 48 hours of ECMO support and without any antiarrhythmic agent, the heart rhythm converted to sinus rhythm. ECMO was weaned successfully after 4 days. Following MCS, brain magnetic resonance imaging (MRI) showed a small chronic subdural hemorrhage, however, no definite clinical neurological deficit was observed. The patient has been followed-up for 6 years, during which time there have been no arrhythmic events, and he is now a 7-year-old-boy in a good general condition.

Bottom Line: Postoperative intractable arrhythmia can result in high morbidity and mortality.This report describes our experiences using mechanical circulatory support (MCS) to control medically intractable arrhythmias in three pediatric patients with congenital heart disease (CHD), after palliative or total corrective open-heart surgery.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

ABSTRACT
Postoperative intractable arrhythmia can result in high morbidity and mortality. This report describes our experiences using mechanical circulatory support (MCS) to control medically intractable arrhythmias in three pediatric patients with congenital heart disease (CHD), after palliative or total corrective open-heart surgery.

No MeSH data available.


Related in: MedlinePlus