PURPOSE: Radiofrequency catheter ablation (RFCA) has become an effective therapeutic modality for treating pediatric tachyarrhythmias. Using conventional RFCA catheters, ablation of parahisian accessory pathways may be difficult and have high risk for heart block. We reviewed the efficacy and complications of the RFCA in children and adolescent with arrhythmias including parahisian accessory pathways. METHODS: We studied 48 patients (aged 2 years to 20 years) who had undergone RFCA from August 2003 to March 2007. We reviewed clinical findings, electrophysiologic studies, RFCA data, complications, and follow-up results of the patients. RESULTS: Mean age of the patients was 13.1 years. Numbers and types of arrhythmias (age, acute success rate) were as follows: 19 WPW syndrome including 5 parahisian accessory pathways (13.74.6 yr, 18/19), 11 atrioventricular reentrant tachycardia with concealed bypass tract (12.35.0 yr, 10/11), 13 atrioventricular nodal reentrant tachycardia (12.64.4 yr, 13/13), 4 atrial flutter (13.07.4 yr, 3/4), and 1 ventricular tachycardia (20 yr, 1/1). Associated cardiac structural lesion was not detected in 48 patients. The recurrence rate was 6.5%, and the final success rate was 93.8%. CONCLUSION: These results suggest that RFCA is a highly effective treatment method in children and adolescent with tachyarrhythmia.
Adolescent* ; Arrhythmias, Cardiac ; Atrial Flutter ; Catheter Ablation* ; Catheters ; Child* ; Follow-Up Studies ; Heart Block ; Humans ; Recurrence ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Ventricular ; Wolff-Parkinson-White Syndrome

PURPOSE: Radiofrequency catheter ablation (RFCA) has become an effective therapeutic modality for treating pediatric tachyarrhythmias. Using conventional RFCA catheters, ablation of parahisian accessory pathways may be difficult and have high risk for heart block. We reviewed the efficacy and complications of the RFCA in children and adolescent with arrhythmias including parahisian accessory pathways. METHODS: We studied 48 patients (aged 2 years to 20 years) who had undergone RFCA from August 2003 to March 2007. We reviewed clinical findings, electrophysiologic studies, RFCA data, complications, and follow-up results of the patients. RESULTS: Mean age of the patients was 13.1 years. Numbers and types of arrhythmias (age, acute success rate) were as follows: 19 WPW syndrome including 5 parahisian accessory pathways (13.74.6 yr, 18/19), 11 atrioventricular reentrant tachycardia with concealed bypass tract (12.35.0 yr, 10/11), 13 atrioventricular nodal reentrant tachycardia (12.64.4 yr, 13/13), 4 atrial flutter (13.07.4 yr, 3/4), and 1 ventricular tachycardia (20 yr, 1/1). Associated cardiac structural lesion was not detected in 48 patients. The recurrence rate was 6.5%, and the final success rate was 93.8%. CONCLUSION: These results suggest that RFCA is a highly effective treatment method in children and adolescent with tachyarrhythmia.
Adolescent* ; Arrhythmias, Cardiac ; Atrial Flutter ; Catheter Ablation* ; Catheters ; Child* ; Follow-Up Studies ; Heart Block ; Humans ; Recurrence ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Ventricular ; Wolff-Parkinson-White Syndrome

A clinical study was made on 189 cases of various types of arrhythmia diagnosed among 1,100 patients. Incidence of arrhythmia was 17.2% of the total cases (male 58.2%, female 41.8%). Of 189 cases of arrhythmias, 78(41.3%) had bundle branch block, 42(22.2%) atrial fibrillation, 18(9.5%) atrioventricular block, 15(8%) premature ventricular contraction, 6(3.2%) sinus arrhythmia, 6(3.2%) W.P.W. syndrome, 4(2%) premature atrial contraction, 3(1.6%) atrial flutter-fibrillation, 3(1.6%) ventricular bigeminy, 3(1.6%) intraventricular conduction defect, 2(1.1%) atrial flutter, 2(1.1%) nodal bigeminy, 2(1.1%) ventricular bigeminy, 1(0.5%) paroxysmal atrial contraction and 1(0.5%) A-V nodal rhythm, 1(0.5%) nodla premature contraction, 1(0.5%) paroxysmal atrial contraction and 1(0.5%) sinus arrest. Etiological diagnoses of patients with arrhythmia were rheumatic heart disease (21.7%), hypertensive heart disease (12.7%), arteriosclerotic heart disease (12.7%), thyrotoxic heart disease (1.6%), anemic heart disease(1.6%) congenital heart disease (2.6%), cerebral vascular accident (1.6%), essential hypertension (9%) cerebral arteriosclerosis (0.53%), cor pulmonale (2.1%). chronic myocarditis (1.6%), anemia (1.6%), chronic nephritis (1.6%), acute glomerulonephritis (0.53%) chronic hepatitis (1.1%), tuberculosis (4.2%), bronchiectasis (1.1%), leprosy (0.53%), epilepsy (0.53%) intoxication (2.6%) cardiac neurosis (11.6%) and unknown (8%). The cardinal symptoms consisted of palpitation, dyspnea, headache, edema, dizziness, cough, left chest pain. gastrointestinal complaints, chest discomfort (thightness), weakness and fatigability. The incidence of arrhythmia was highest in the 4 th decade.
Anemia ; Arrhythmia, Sinus ; Arrhythmias, Cardiac* ; Atrial Fibrillation ; Atrial Flutter ; Atrial Premature Complexes ; Atrioventricular Block ; Bronchiectasis ; Bundle-Branch Block ; Chest Pain ; Cough ; Diagnosis ; Dizziness ; Dyspnea ; Edema ; Epilepsy ; Female ; Glomerulonephritis ; Headache ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Hepatitis, Chronic ; Humans ; Hypertension ; Incidence ; Intracranial Arteriosclerosis ; Leprosy ; Myocarditis ; Nephritis ; Neurocirculatory Asthenia ; Pulmonary Heart Disease ; Rheumatic Heart Disease ; Thorax ; Tuberculosis ; Ventricular Premature Complexes

Supraventricular tachycardia (SVT) refers to a heterogeneous group of arrhythmias localized within the upper part of the heart (the His bundle or above). In general, the term SVT does not include atrial fibrillation. Common forms of SVT include atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal atrial tachycardia, and atrial flutter. Other, less common arrhythmias also fall under the category of SVT, including inappropriate sinus tachycardia and junctional reentrant/ectopic tachycardia. Paroxysmal supraventricular tachycardia refers to AVNRT and AVRT. SVTs can be identified and classified by clinical manifestation/physical examination, ECG, and/or electrophysiologic analysis.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrial Flutter ; Bundle of His ; Diagnosis, Differential* ; Electrocardiography ; Heart ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Sinus ; Tachycardia, Supraventricular*

Cardiac arrhythmia which was observed during 5 years and 10 months from September 1975 to June 1981 on 11, 273 ECG records of the pediatric patients were analysed. Simple sinus arrhythmia and bundle branch blocks were excluded from this study. 602 cases of arrhythmia were seen among the 11,273 cases(5.3%). The types of arrhythmia in the order of frequency are: A-V block ectopic beat, multifocal rhythm, paroxysmal tachycardia, A-V junctional rhythm. A-V dissocation, atrial fibrillation, ventricular fibrillation and escape beat. The main underlying causes of the serious cardiac arrhythmia were congenital heart disease, open heart surgery, rhematic heart disease, cardiomyopathy and myocarditis.
Arrhythmia, Sinus ; Arrhythmias, Cardiac* ; Atrial Fibrillation ; Bundle-Branch Block ; Cardiomyopathies ; Child* ; Electrocardiography ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Infant* ; Myocarditis ; Tachycardia, Paroxysmal ; Thoracic Surgery ; United Nations ; Ventricular Fibrillation

arrhythmia.RESULTS: A total of 173 US patients (mean age, 67.6 ± 16.5 years; 107 men [61.8%]) who received an ILR after a negative conventional workup were enrolled. During a mean follow-up of 9.4 ± 11.1 months, 52 patients (30.1%) had recurrent syncope, and syncope-correlated arrhythmia was confirmed in 34 patients (19.7%). The ILR analysis showed sinus node dysfunction in 24 patients (70.6%), supraventricular tachyarrhythmia in 4 (11.8%), ventricular arrhythmia in 4 (11.8%), and sudden atrioventricular block in 2 (5.9%). Overall, ILR detected significant arrhythmia in 99 patients (57.2%) irrespective of syncope. Among patients with clinically relevant arrhythmia detected by ILR, PM implantation was performed in 60 (34.7%), an intra-cardiac defibrillator in 5 (2.9%), and catheter ablation in 4 (2.3%). In a Cox regression analysis, history of paroxysmal atrial fibrillation (PAF) (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.33–4.12; P < 0.01) and any bundle branch block (BBB) (HR, 2.52; 95% CI, 1.09–5.85; P = 0.03) were significantly associated with PM implantation.CONCLUSION: ILR is useful for detecting syncope-correlated arrhythmia in patients with US. The risk of PM is high in US patients with a history of PAF and any BBB.]]>
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrioventricular Block ; Bundle-Branch Block ; Catheter Ablation ; Defibrillators ; Follow-Up Studies ; Humans ; Korea ; Male ; Observational Study ; Retrospective Studies ; Sick Sinus Syndrome ; Syncope ; Tachycardia

Holter ECG monitoring is a continuous tape recording of a patient's electrocardiogram during ordinary activities and picks up hidden abnormalities in rate, rhythm or conduction. The authors delineated the types and incidence rates of arrhythmia in 32 normal Koreans by utilizing medical personnels and patients without evident heart diseases or symptoms, or significant systemic illness. Tracings and analysis were performed using 24 hour Holter monitoring processor(SCM 240, Fukuda, japan), auto-analyser (SCM-25), casette recorder(SM 24) and chrome tape. Results are as follows: 1) Portable 24 houre Holter ECG monitoring was performed in 32 persons(age range of 21 to 35) without cardiovascular disease, as defined by normal clinical and noninvasive cardiovascular examination. 2) During exercise, maximal heart rates ranged from 125.0+/-12.1/min and minimal rates from 96.7+/-5.8/min. During normal activity period, maximal and minimal heart rates were, respectively, 95.4+/-16.2/min and 62.6+/-6.3/min. Maximal sleep rates were 90.3+/-26.6/min and minimal sleep rates 57.4+/-12.4/min. 3) P-R interval decreased as heart rate increased. Transient first degree AV block was noted in 3 subjects(9.4%) and Wenckebach type second degree AV block in 2 subjects(6.3%). 4) Sinus tachycardia and bradycardia were observed in all subjects and sinus arrhythmia was more frequently noted during waking periods. Three subjects had episodes of sinus pause with maximum duration of 3.24 seconds. 5) In 13 persons(40.6%) having supraventricular premature beats, the frequency was 50.01+/-49.36/hr and in 14 persons having(44%) ventricular premature beats the frequency 26.33+/-18.83/hr. Transient ventricular tachycardia of 3 seconds' duration was observed in one subject under the extreme stressful environment. 6) ST segment elevation over 1mm was noted in 5 subjects(15.6%), of whom one had a nocturnal chest pain and ST segment depression over 1mm in 2 subjects. T wave inversion was also found during exercise(3.1%) and during sleep(9.4%).
Arrhythmia, Sinus ; Arrhythmias, Cardiac ; Atrioventricular Block ; Bradycardia ; Cardiac Complexes, Premature ; Cardiovascular Diseases ; Chest Pain ; Depression ; Electrocardiography* ; Electrocardiography, Ambulatory ; Heart Diseases ; Heart Rate ; Humans ; Incidence ; Tachycardia, Sinus ; Tachycardia, Ventricular ; Tape Recording

Anti-Arrhythmia Agents ; therapeutic use ; Child ; Humans ; Tachycardia, Atrioventricular Nodal Reentry ; drug therapy ; Tachycardia, Ectopic Atrial ; drug therapy ; Tachycardia, Ectopic Junctional ; drug therapy ; Tachycardia, Supraventricular ; drug therapy ; Tachycardia, Ventricular ; drug therapy

BACKGROUND AND OBJECTIVES: Prolonging of the corrected QT interval (QTc) has been reported after cardiac surgery in some studies. However, there have not been many studies on infant open cardiac surgery for ventricular septal defect (VSD) repair. This study was performed to define the changes in QTc and to find related post-surgery factors in this patient group. SUBJECTS AND METHODS: From 2008 to 2012, 154 infants underwent VSD repair at the Severance Cardiovascular Hospital. This study includes 105 of these cases. QTc was measured in these patients retrospectively. Demographic data and peri-procedural data, such as Aristotle score, cross-clamp time and bypass time, were analyzed. The exclusion criteria included multiple and small VSDs that underwent direct closure. RESULTS: Mean post-operative QTc was increased compared to the pre-operative measurements (from 413.6+/-2.3 to 444.9+/-2.5, p<0.001). In multiple linear regression, the comprehensive Aristotle score was associated with increasing QTc (p=0.047). The incidence of transient arrhythmia, such as atrial tachycardia, junctional ectopic tachycardia, premature atrial contraction, or premature ventricular contraction, was associated with QTc prolongation (p=0.005). Prolonged QTc was also associated with cross-clamp time (p=0.008) and low weight (p=0.042). Total length of stay at the intensive care unit and intubation time after surgery were not associated with QTc prolongation. CONCLUSION: Prolonged QTc could be seen after VSD repair in infants. This phenomenon was associated with peri-procedural factors such as the Aristotle score and cross-clamp time. Patients with QTc prolongation after cardiac surgery had an increased tendency towards arrhythmogenicity in the post-operative period.
Arrhythmias, Cardiac ; Atrial Premature Complexes ; Electrocardiography ; Heart Septal Defects, Ventricular* ; Humans ; Incidence ; Infant* ; Intensive Care Units ; Intubation ; Length of Stay ; Linear Models ; Retrospective Studies ; Tachycardia ; Tachycardia, Ectopic Junctional ; Thoracic Surgery ; Ventricular Premature Complexes

A statistical study was done on arrhythmia of the aged who were older than 60 during the period 1963~1972 at Seoul national University Hospital. This study included 6,511 patients among 40,000 total patients. The results were as follows. 1) Arrhythmias were observed among 3,058 patients(46.97%). Sinus irregularitis were the most frequent arrhythmia. 2) Except sinus irregularities premature beat (38.3%), atrial fibrillation (16.1%), bundle branch block (10.5%), atriovenricular block (10.5%), atrioventricular escape beat (5.1%), atrioventricular junctional rhythm (4.9%), wandering pacemaker(4.0%) and paroxysmal tachycardia(2.5%) were frequent arrhythmias. 3) Cardiovascular disease was major underlying disease. In cardiovascular disease group, the incidence of arrhythmia was 51.15% which was three times as high as non-cardiovascular and normal group. 4) Most arrhythmias were more frequently observed among the aged except bundle branch block and ventricular paroxysmal tachycardia. 5) The incidence of arrhythmia was similar among the aged except pre-excitation syndrome which was predisposed to woman. 6) Arrhythmia was most frequently observed in coronary heart disease. 7) Among sinus irregularities, simus bradycardia was more frequent in the aged. 8) There were no significant differences in frequency of arrhythmia between non-cardiovascular disease group patients and normal group.
Arrhythmias, Cardiac* ; Atrial Fibrillation ; Bradycardia ; Bundle-Branch Block ; Cardiac Complexes, Premature ; Cardiovascular Diseases ; Coronary Disease ; Female ; Humans ; Incidence ; Pre-Excitation Syndromes ; Seoul ; Statistics as Topic* ; Tachycardia, Paroxysmal ; United Nations