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Arrhythmias in children with ventricular assist devices

Published online by Cambridge University Press:  26 November 2013

W. Buck Kyle ,
Jamie Decker ,
Scott L. Macicek ,
Santiago O. Valdes ,
David Morales ,
Borah Hong ,
Jack F. Price ,
William J. Dreyer ,
Susan W. Denfield  and
Jeffrey J. Kim
W. Buck Kyle
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America
Jamie Decker
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America Department of Pediatrics, All Children’s Hospital, St. Petersburg, Florida, United States of America
Scott L. Macicek
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America Department of Pediatric Cardiology, Ochsner Health System, New Orleans, Los Angeles, United States of America
Santiago O. Valdes
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America
David Morales
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America Department of Pediatric Cardiovascular Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Borah Hong
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America
Jack F. Price
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America
William J. Dreyer
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America
Susan W. Denfield
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America
Jeffrey J. Kim*
Affiliation:
Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: Dr J. J. Kim, MD, Department of Pediatrics, Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin, MC# 19345-C, Houston, TX 77030, United States of America. Tel: 832 826 5600; 713 422 3641; Fax: 832 826 1901; E-mail: jjkim@texaschildrenshospital.org
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Abstract

Background: Children with decompensated heart failure are at high risk for arrhythmias, and ventricular assist device placement is becoming a more common treatment strategy. The impact of ventricular assist devices on arrhythmias and how arrhythmias affect the clinical course of this population are not well described. Methods and results: A single-centre retrospective analysis of children receiving a ventricular assist device between 1998 and 2011 was performed. In all, 45 patients received 56 ventricular assist devices. The median age at initial placement was 13 years (interquartile range 6–15). The median duration of support was 10 days (range 2–260). The aetiology of heart failure included cardiomyopathy, transplant rejection, myocarditis, and congenital heart disease. In all, 32 patients (71%) had an arrhythmia; 19 patients (42%) had an arrhythmia before ventricular assist device and eight patients (18%) developed new arrhythmias on ventricular assist device. Ventricular tachycardia was most common (25/32, 78%). There was no correlation between arrhythmia and risk of death or transplantation (p=0.14). Of the 15 patients who weaned from ventricular assist device, post-ventricular assist device arrhythmias occurred in nine (60%), with five (33%) having their first arrhythmia after weaning. Patients with ventricular dysfunction after ventricular assist device were more likely to have arrhythmias (p<0.02). Conclusions: Arrhythmias, especially ventricular, are common in children requiring ventricular assist device. They frequently persist for those able to wean from ventricular assist device.

Keywords

Paediatric cardiologyventricular assist devicesarrhythmiaheart failure
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 2 , February 2015 , pp. 255 - 260
Copyright
Copyright © Cambridge University Press 2013 

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References

1. Morales, DL, Zafar, F, Rossano, JW, et al. Use of ventricular assist devices in children across the United States: analysis of 7.5 million pediatric hospitalizations. Ann Thorac Surg 2010; 90: 1313–1318; discussion 8–9.Google Scholar
2. Fong, MW, Grazette, L, Cesario, D, Cao, M, Saxon, L. Treatment of ventricular tachycardia in patients with heart failure. Curr Cardiol Rep 2011; 13: 203–209.Google Scholar
3. Maskin, CS, Siskind, SJ, LeJemtel, TH. High prevalence of nonsustained ventricular tachycardia in severe congestive heart failure. Am Heart J 1984; 107 (5 Pt 1): 896–901.Google Scholar
4. Boyle, A. Arrhythmias in patients with ventricular assist devices. Curr Opin Cardiol 2012; 27: 13–18.Google Scholar
5. Pettit, SJ, Petrie, MC, Connelly, DT, et al. Use of implantable cardioverter defibrillators in patients with left ventricular assist devices. Eur J Heart Fail 2012; 14: 696–702.Google Scholar
6. Allen, SJ, Sidebotham, D. Postoperative care and complications after ventricular assist device implantation. Best Pract Res Clin Anaesthesiol 2012; 26: 231–246.Google Scholar
7. Ziv, O, Dizon, J, Thosani, A, Naka, Y, Magnano, AR, Garan, H. Effects of left ventricular assist device therapy on ventricular arrhythmias. J Am Coll Cardiol 2005; 45: 1428–1434.Google Scholar
8. Andersen, M, Videbaek, R, Boesgaard, S, Sander, K, Hansen, PB, Gustafsson, F. Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). J Heart Lung Transplant 2009; 28: 733–735.Google Scholar
9. Brenyo, A, Rao, M, Koneru, S, et al. Risk of mortality for ventricular arrhythmia in ambulatory LVAD patients. J Cardiovasc Electrophysiol 2012; 23: 515–520.Google Scholar
10. Raasch, H, Jensen, BC, Chang, PP, et al. Epidemiology, management, and outcomes of sustained ventricular arrhythmias after continuous-flow left ventricular assist device implantation. Am Heart J 2012; 164: 373–378.Google Scholar
11. Arai, H, Swartz, MT, Pennington, DG, et al. Importance of ventricular arrhythmias in bridge patients with ventricular assist devices. ASAIO Trans 1991; 37: M427–M428.Google Scholar
12. Fasseas, P, Kutalek, SP, Samuels, FL, Holmes, EC, Samuels, LE. Ventricular assist device support for management of sustained ventricular arrhythmias. Tex Heart Inst J 2002; 29: 33–36.Google Scholar
13. Tatewaki, H, Masuda, M, Nishida, T, et al. Successful treatment of tachycardia-induced cardiomyopathy with LVAD in a 12-year-old boy. Ann Thorac Surg 2005; 80: e5–e7.Google Scholar
14. Lakdawala, NK, Givertz, MM. Dilated cardiomyopathy with conduction disease and arrhythmia. Circulation 2010; 122: 527–534.CrossRefGoogle ScholarPubMed
15. Scott, CD, Dark, JH, McComb, JM. Arrhythmias after cardiac transplantation. Am J Cardiol 1992; 70: 1061–1063.CrossRefGoogle ScholarPubMed
16. Kuhl, U, Pauschinger, M, Seeberg, B, et al. Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation 2005; 112: 1965–1970.Google Scholar
17. Blauwet, LA, Cooper, LT. Myocarditis. Prog Cardiovasc Dis 2010; 52: 274–288.Google Scholar
18. Kirk, R, Naftel, D, Hoffman, TM, et al. Outcome of pediatric patients with dilated cardiomyopathy listed for transplant: a multi-institutional study. J Heart Lung Transplant 2009; 28: 1322–1328.Google Scholar
19. Gajarski, R, Naftel, DC, Pahl, E, et al. Outcomes of pediatric patients with hypertrophic cardiomyopathy listed for transplant. J Heart Lung Transplant 2009; 28: 1329–1334.Google Scholar
20. Oz, MC, Rose, EA, Slater, J, Kuiper, JJ, Catanese, KA, Levin, HR. Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices. J Am Coll Cardiol 1994; 24: 1688–1691.Google Scholar
21. Hall, JL, Fermin, DR, Birks, EJ, et al. Clinical, molecular, and genomic changes in response to a left ventricular assist device. J Am Coll Cardiol 2011; 57: 641–652.Google Scholar
22. Klotz, S, Danser, AH, Foronjy, RF, et al. The impact of angiotensin-converting enzyme inhibitor therapy on the extracellular collagen matrix during left ventricular assist device support in patients with end-stage heart failure. J Am Coll Cardiol 2007; 49: 1166–1174.Google Scholar