Search

The Florida Children's Medical Services (CMS) has a long-standing history of ensuring that providers of multiple paediatric subspecialties abide by the highest standards. The cardiac sub-committee has written quality standard documents that participating programmes must meet or exceed. These standards oversee paediatric cardiology services including surgery, catheterisations, and outpatient services. On April, 2012, the cardiac sub-committee decided to develop similar standards in paediatric electrophysiology. A task force was created and began this process. These standards include a catalogue of required and optional equipment, as well as staff and physician credentials. We sought to establish expectations of procedural numbers by practitioner and facility. The task force surveyed the members of the Pediatric and Congenital Electrophysiology Society. Finding no consensus, the task force is committed to generate the data by requiring that the CMS participating programmes enrol and submit data to the Multicenter Pediatric and Adult Congenital EP Quality (MAP-IT™) Initiative. This manuscript details the work of the Florida CMS Paediatric Electrophysiology Task Force.

The article discusses a review of prospectively gathered data in children undergoing radiofrequency ablation at Stereotaxis Inc. in Saint Louis, Missouri since the institution's installation of magnetic navigation (MN) in March 2009. It compares the efficacy and safety between an MN-guided approach and standard manual techniques for mapping and ablation of accessory pathway (AP)-mediated tachycardia. The safety and efficacy of MN to ablate AP-mediated tachycardia in children is also cited.

Abstract: Background: Few data exist on prevalence, morbidity, and mortality of pediatric heart failure hospitalizations. We tested the hypotheses that pediatric heart failure–related hospitalizations increased over time but that mortality decreased. Factors associated with mortality and length of stay were also assessed. Methods and Results: A retrospective analysis of the Healthcare Cost and Utilization Project Kids'' Inpatient Database was performed for pediatric (age ≤18 years) heart failure–related hospitalizations for the years 1997, 2000, 2003, and 2006. Hospitalizations did not significantly increase over time, ranging from 11,153 (95% confidence interval [CI] 8,898–13,409) in 2003 to 13,892 (95% CI 11,528–16,256) in 2006. Hospital length of stay increased from 1997 (mean 13.8 days, 95% CI 12.5–15.2) to 2006 (mean 19.4 days, 95% CI 18.2 to 20.6). Hospital mortality was 7.3% (95% CI 6.9–8.0) and did not vary significantly between years; however, risk-adjusted mortality was less in 2006 (odds ratio 0.70, 95% CI 0.61 to 0.80). The greatest risk of mortality occurred with extracorporeal membrane oxygenation, acute renal failure, and sepsis. Conclusions: Heart failure–related hospitalizations occur in 11,000–14,000 children annually in the United States, with an overall mortality of 7%. Many comorbid conditions influenced hospital mortality. [Copyright &y& Elsevier]

Background: Dilated cardiomyopathy (DCM) is a well-recognized sequela of muscular dystrophy (MD). Early identification of cardiac involvement with timely therapy can favorably impact outcome. We hypothesize that electrocardiography (ECG) can be a useful adjunct in the identification of DCM in MD. Objective: This study sought to assess the utility of electrocardiography in patients with MD. Methods: A retrospective review of patients with MD was performed. ECGs and Holter monitor results were analyzed to assess for association between abnormalities and the development of DCM. Results: This study identified 150 patients. In 43% of patients (64 of 150) DCM developed. ECG abnormalities were found in 65% of patients and correlated well with the presence of DCM, with 60 of 64 (94%) with DCM having an abnormal ECG vs. 38 of 86 (44%) without DCM (P < .001). Only 4 of 52 (8%) of patients with normal ECGs had DCM. The presence of ECG abnormalities was highly sensitive (95.8%) but not specific (40.1%) to the presence of DCM. ECG abnormalities often preceded the development of DCM by a significant period of time (3.7 ± 2.6 years). Arrhythmias were common, with 17 of 150 (11%) of the cohort being affected. Those with DCM were significantly more likely to have an arrhythmia, with 16 of 64 (25%) of that group being affected (P < .01). The presence of VT was a poor prognostic indicator, with 6 of 11 patients dying within 0.68 ± 0.41 years. Conclusion: ECG abnormalities are strongly associated with DCM in patients with MD and frequently precede cardiac dysfunction by several years. Arrhythmias are common, and periodic ECG and Holter evaluations are warranted as they may predict early cardiac involvement. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to review outcomes of pediatric isolated hypertrophic cardiomyopathy (HCM) managed uniformly at a single institution and assess whether reported adult risk factors for sudden death are predictive in pediatric HCM. Background: Cardiac death in HCM occurs suddenly (SCD) or may be nonsudden (non-SCD). Little data exists on non-SCD in children. Risk factors for SCD in adult HCM are characterized and consensus management strategies detailed. Their application to children is uncertain and treatment strategies vary. Methods: A retrospective cohort study of children with HCM was performed. Primary end points were cardiac death and transplantation. Frequency and outcomes of known adult risk factors were assessed. Outcomes analysis was performed using Kaplan-Meier curves and Cox regression analysis. Results: Ninety-six patients were included. The average age at diagnosis was 10.6 ± 5.4 years, and mean follow-up was 6.4 ± 5.2 years. Primary end points occurred in 11 patients over the 20-year follow-up (11%), 4 underwent cardiac transplant and 7 died (3 suddenly). Extreme left ventricular hypertrophy (z-score: >6) and an abnormal blood pressure response to exercise were predictive of non-SCD (p < 0.02 and p < 0.03, respectively). Kaplan-Meier survival analysis predicts an 82% survival over a 20-year period. Conclusions: In children with isolated HCM managed primarily with exercise restriction and medication, cardiac death occurred infrequently. Non-SCD or transplant was at least as common as SCD. Extreme left ventricular hypertrophy and blunted blood pressure response to exercise were associated with an increased risk of non-SCD. [Copyright &y& Elsevier]

Background: Heart transplantation remains a resource-intensive therapy for children. However, data regarding change in costs over time are scarce. We tested the hypothesis that hospital charges for pediatric heart transplant hospitalizations would increase from 1997 to 2006 and assessed factors associated with hospital charges. Methods: A retrospective analysis of the Healthcare Cost and Utilization Project Kids'' Inpatient Database was performed on admissions surrounding heart transplantation for the years 1997, 2000, 2003, and 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates. Results: There were 353 (95% confidence interval, 201–505) pediatric heart transplants in 1997 and 355 (95% confidence interval, 226–485) in 2006. Mean hospital charges increased from $279,399 in 1997 to $451,738 in 2006 (p < 0.001). This increase was similar to that observed for other pediatric surgical diseases. Increases also occurred in morbidities, including pulmonary hypertension (p = 0.04) and sepsis (p = 0.04), and in the use of extracorporeal membrane oxygenation (p = 0.03). On multivariable analysis, greater hospital charges were associated with later calendar year (p = 0.001), stroke (p = 0.03), sepsis (p = 0.001), renal failure (p = 0.008), arrhythmia (p = 0.03), and use of extracorporeal membrane oxygenation (p < 0.001) and ventricular assist device (p < 0.001). Conclusions: From 1997 to 2006, mean charges for pediatric heart transplant hospitalizations increased by > $170,000 (160%). Although greater morbidities in the later years of the study potentially contributed to increased charges, later calendar year was independently associated with increased charges. The changes in charges for heart transplant are similar to the increases seen in other surgical procedures. Ongoing study of management strategies is needed to determine cost-effective therapies for this complex group of patients. [Copyright &y& Elsevier]