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Dominic Abrams, MD, Sam Asirvatham, MD, Yaniv Bar-Cohen, MD, FAAP, FACC, FHRS, Andrew D. Blaufox, MD, FHRS, FACC, Bryan Cannon, MD, FHRS, John Clark, MD, Macdonald Dick, MD, FHRS, FACC, Anne Freter, MSN, FHRS, Naomi J. Kertesz, MD, FACC, FHRS, Joel A. Kirsh, MD, FRCP(C), FHRS, CEPS, John Kugler, MD, FAAC, FAAP, FAHA, Martin LaPage, MD, MS, FAAP, FHRS, CCDS, CEPS, Francis X. McGowan, MD, FAAP, Christina Y. Miyake, MD, Aruna Nathan, MBBS, FRCA, John Papagiannis, MD, FHRS, CEPS, Thomas Paul, MD, FHRS, FACC, Andreas Pflaumer, MD, FRACP, FCSANZ, CEPS, Allan C. Skanes, MD, FRCPC, William G. Stevenson, MD, FAHA, FHRS, FACC, Nicholas Von Bergen, Frank Zimmerman, MD, FAHA, FHRS

In general, the prognosis is poor for pediatric patients who experience out-of-hospital (OOH) cardiac arrest, with survival rates of 12% to 29%.The purpose of this study was to describe the causes and outcomes of pediatric patients with documented ventricular fibrillation (VF) at resuscitation from OOH cardiac arrest with sustained return of spontaneous circulation after defibrillation and survival to hospital admission.Retrospective analysis of OOH-VF patients19 years of age evaluated between 2004 and 2016 was performed. Primary outcome measures included demographics, arrest and resuscitation parameters, cardiac diagnoses, survival, and neurologic outcome.Forty-five patients fulfilled study criteria (median age 12 years; range 2 months to 18 years). Cardiac arrest occurred in public in 68% of cases, with bystander cardiopulmonary resuscitation in 42% before arrival of emergency medical services. All patients underwent defibrillation (1-6 shocks) with return of spontaneous circulation and survival to hospital admission. Underlying etiologies were primary electrical disease (33%), cardiomyopathy (27%), congenital heart disease (11%), other (13%), and unknown (16%). Before arrest, 40% of patients had a cardiac diagnosis and 26% had symptoms. Ultimately, 40 of 45 patients (89%) survived resuscitation to hospital discharge. During 72 ± 37 months of follow-up, 38% of survivors had a normal neurologic outcome, whereas 32% had mild neurologic impairment and 30% had moderate-to-severe neurologic impairment.In pediatric patients resuscitated from OOH-VF, a cardiovascular cause was identified in80%. Regardless of cause, survival and neurologic prognosis appear improved compared to patients with asystole or pulseless electrical activity. These findings support early rhythm assessment and advanced cardiopulmonary resuscitation protocols in pediatric cardiac arrest victims.

A Report from the Training and Credentialing Committee of the Pediatric and CongenitalElectrophysiology SocietyEndorsed by the Heart Rhythm SocietyCOMMITTEE MEMBERSEdward P. Walsh, MD, FHRS, ChairYaniv Bar-Cohen, MDAnjan S. Batra, MD, FHRS*Macdonald Dick II, MD, FHRSChristopher Erickson, MDFrank Fish, MDRobert M. Hamilton, MD

The use of pacemakers and implantable cardioverter-defibrillators (ICDs) in infants, children, and patients with congenital heart disease presents unique challenges and considerations. They include uncommon indications for device implantation, innovative approaches to lead implantation and configuration, and age-dependent and disease-specific aspects of device programming. In this review, the current indications for pacemaker and ICD implantation in young patients are discussed, followed by consideration of the approaches to lead and device placement in very small patients and those with complex congenital heart disease, in whom unique problems may be encountered. The limitations of programmability of current pacemakers and ICDs when used in young patients are discussed, followed by an analysis of long-term device follow-up and potential late complications.

Background Cryoablation may offer advantages over radiofrequency (RF) ablation for certain arrhythmia substrates, such as septal accessory pathways (APs). Data for young patients, especially regarding recurrence risk, require expansion. Objectives The purpose of this study was to study institutional outcomes for cryoablation of APs located in potentially difficult septal regions for children and young adults. Methods Cryoablation was attempted in 35 young patients (mean age 15.6 years) with 37 APs that were either close to normal conduction tissues or inside the coronary venous system. Outcomes were compared with previously published institutional data for RF ablation at these same locations. Results Acute cryoablation success was achieved for 29 (78%) of 37 APs. Apart from permanent PR prolongation in one case and right bundle branch block in one other, there were no detrimental effects on normal conduction. At median follow-up of 207 days (range 2–695 days), AP conduction recurred for 13 (45%) of 29 ablated APs. Younger patient age and midseptal AP location correlated with higher likelihood of recurrence. Acute success rates for cryoablation were similar to RF ablation in our laboratory, but recurrence rates were significantly higher ( P Conclusion Cryoablation yields acute success rates comparable with RF ablation for difficult septal APs in young patients. The risk of AP recurrence appears higher after cryoablation, although safety benefits may provide suitable compensation for this deficiency. Methods for creating more effective cryoablation lesions need to be explored.

Yaniv Bar-Cohen, MD, FHRS, Gerald E. Loeb, MD, Jay D. Pruetz, MD, Michael J. Silka, MD, Catalina Guerra, DVM, Adriana N. Vest, BE, Li Zhou, MS, Ramen H. Chmait, MD From the Division of Cardiology, Children’s Hospital Los Angeles; and Keck School of Medicine, University of Southern California, Los Angeles, CA, Department of Biomedical Engineering, University of Southern California, Los Angeles, California, C.W. Steers Biological Resources Center, Los Angeles Biomedical Research Institute, Harbor–University of California, Los Angeles, Torrance, California, and Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.

Age, Size, and Lead Factors. Background: Venous occlusion is a recognized complication of transvenous pacing, and lead cross-sectional area indexed to body surface area (BSA) has been used to predict venous obstruction in children. Objective: The aim of this study was to identify the risk factors and incidence of angiographic venous obstruction after transvenous lead implantation in both children and young adults. Methods: Contrast venography was obtained in 85 of 90 consecutive patients undergoing repeat pacemaker or ICD procedures from 2002 to 2004 at a single cardiac center. Venograms were graded as complete venous obstruction, significant partial obstruction (>70% with collaterals), or patent. Results: The cohort had a median age of 15.0 years at implant and was divided into two age groups: 3-12 years (n = 35) and 13 years and over (n = 50). After a median interval of 6.5 years, complete obstruction was seen in 11 of 85 patients (13%) and partial obstruction in another 10 patients (12%). No significant differences were seen in the incidence of obstruction between the two age groups although younger patients had a larger lead indexed to BSA ratio (6.82 vs 5.05, P = 0.005). There were no significant differences between obstructed and nonobstructed patients in relation to age, size, growth, or lead factors. Conclusion: Transvenous lead systems implanted in young children have a similar incidence of venous occlusion compared to older patients. Furthermore, patient age, body size, and lead characteristics at implant do not clearly predict venous occlusion.