79 results on '"Yaniv Bar-Cohen"'
Search Results
2. Pediatric Electrophysiology Device Needs: A Survey from the Pediatric and Congenital Electrophysiology Society Taskforce on Pediatric-Specific Devices
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Anne M. Dubin, Yaniv Bar‐Cohen, Charles I. Berul, Bryan C. Cannon, Elizabeth V. Saarel, Maully J. Shah, and John K. Triedman
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Heart Defects, Congenital ,Electrophysiology ,United States Food and Drug Administration ,Surveys and Questionnaires ,Humans ,Arrhythmias, Cardiac ,Cardiology and Cardiovascular Medicine ,Child ,United States - Abstract
Background There are few US Food and Drug Administration (FDA)–approved devices specifically aimed at the pediatric patient with arrhythmia. This has led to a high off‐label utilization of devices in this vulnerable population. The Pediatric and Congenital Electrophysiology Society (PACES), the international organization representing pediatric and congenital heart disease arrhythmia specialists, developed a task force to comprehensively address device development issues relevant to pediatric patients with congenital arrhythmia. Methods and Results As a first step, the taskforce developed a 26‐question survey for the pediatric arrhythmia community to assess providers’ understanding of the FDA approval process, specifically in regard to pediatric labeling. There were 92/211 respondents (44%) with a >90% completion rate. The vast majority of respondents believed there was a paucity of devices available for children (96%). More than 60% of respondents stated that they did not understand the FDA regulatory process and were not aware of whether the devices they used were labeled for pediatric use. Conclusions Pediatric electrophysiologists are keenly aware of the deficit of available pediatric devices for their patients. The majority do not understand the FDA approval process and could benefit from additional educational resources regarding this. A collaborative forum including PACES, FDA, patients and their families, and Industry would be an important next step in clarifying opportunities and priorities to serve this vulnerable population.
- Published
- 2022
3. Third Trimester Fetal Heart Rates in Antibody-Mediated Complete Heart Block Predict Need for Neonatal Pacemaker Placement
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John C. Wood, Michael J. Silka, Justin Pick, Mark Shwayder, Jay D. Pruetz, Yaniv Bar-Cohen, and Allison C. Hill
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Bradycardia ,medicine.medical_specialty ,medicine.diagnostic_test ,Heart block ,business.industry ,Birth weight ,Gestational age ,Prenatal diagnosis ,medicine.disease ,Cardiac surgery ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Cardiology ,Pacemaker Placement ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Fetal echocardiography - Abstract
Congenital complete heart block (CCHB) affects 1 in 20,000 newborns. This study evaluates fetal and neonatal risk factors predictive of neonatal pacemaker placement in antibody-mediated complete heart block. The Children’s Hospital Los Angeles institutional fetal, pacemaker, and medical record databases were queried for confirmed SSA/SSB cases of CCHB between January 2004 and July 2019. Cases excluded were those with a diagnosis beyond the neonatal period, diagnosis of a channelopathy, or if maternal antibody status was unknown. We recorded the gestational age (GA), birth weight (BW), fetal heart rates (FHRs) of the last echocardiogram before delivery, specific neonatal ECG and echocardiogram findings, age at pacemaker placement, and mortality. Of 43 neonates identified with CCHB, 27 had confirmed maternal antibody exposure. Variables associated with neonatal pacemaker implantation were FHRs
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- 2021
4. A Global Look to the Future of Pediatric Electrophysiology
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Mitchell I. Cohen, Anne M. Dubin, Gregory Webster, Yaniv Bar-Cohen, Kara S. Motonaga, Thomas Kriebel, Shubhayan Sanatani, Eric Rosenthal, Jose Moltedo, Jun Yoshimoto, Andrew Davis, George F. Van Hare, and Susan P. Etheridge
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- 2022
5. PO-03-150 INCIDENCE OF HEART BLOCK IN PEDIATRIC PATIENTS WITH L-TRANSPOSITION OF THE GREAT ARTERIES UNDERGOING CARDIAC SURGERY
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Jonathan Uniat, Mark H. Shwayder, Yaniv Bar-Cohen, Michael J. Silka, Luke Wiggins, and Allison C. Hill
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
6. Utility of Surveillance Ambulatory Rhythm Monitoring in the Pediatric Fontan Population
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Neil D. Patel, Allison C. Hill, Yaniv Bar-Cohen, Taylor Saley, and Michael J. Silka
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Fontan procedure ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Internal medicine ,medicine ,cardiovascular diseases ,education ,education.field_of_study ,business.industry ,medicine.disease ,Cardiac surgery ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Ambulatory ,cardiovascular system ,Cardiology ,Supraventricular tachycardia ,Cardiology and Cardiovascular Medicine ,business ,Atrioventricular block ,Junctional rhythm - Abstract
Our institution established a Fontan surveillance plan, which included ambulatory rhythm monitoring (ARM) at 6, 10, 13, 16 and 19 years old, for early detection of Fontan-associated complications. We conducted a retrospective chart review of Fontan patients followed at our institution 2014–2018 to determine the utility of surveillance ARMs. 139 ARMs from 83 patients were included. ARMs with supraventricular tachycardia, sinus node dysfunction, accelerated junctional rhythm, > 1st degree atrioventricular block, and complex ventricular ectopy were classified as positive for arrhythmia. Arrhythmias were occult if detected on surveillance ARM. The ARM indication was surveillance in 78 (56%) and clinically indicated in 61 (44%). 52 (37%) ARMs in 27 (33%) patients had an arrhythmia. There was no difference in the age of patients with and without arrhythmias [median 10.9 (6.5, 17.1 years) vs. 8.8 (7, 13.6 years), p = 0.5]. Clinically indicated ARMs more frequently demonstrated arrhythmias than surveillance ARMs (52% vs. 26%, p
- Published
- 2021
7. Ectopic Atrial Tachycardia in Infants Following Congenital Heart Disease Surgery
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Jonathan Uniat, Allison C. Hill, Mark Shwayder, Michael J. Silka, and Yaniv Bar-Cohen
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Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine - Abstract
Although ectopic atrial tachycardia (EAT) is common following surgery for congenital heart disease (CHD), there are limited data regarding this arrhythmia. This study assessed risk factors and outcomes for patients less than one year of age with post-operative EAT. This was a retrospective analysis of infants undergoing CHD surgery from 2007 to 2020. Patients and surgeries with EAT were compared to controls without EAT. Out of 5372 infant CHD surgeries, EAT developed in 129 (2.5%). Compared to controls, the EAT cohort was younger (median 7 vs 85 days, p 0.01), weighed less at time of surgery (3.3 vs 4.2 kg, p 0.01), and was more likely to have DiGeorge syndrome (7.7% vs 3.0%, p 0.01). Multivariate analysis revealed total anomalous venous connection (TAPVC) repair (odds ratio [OR] 2.8; 95% confidence interval 1.5-5.2), DiGeorge syndrome (OR 2.4; 1.1-5.2), Society of Thoracic Surgeons-European Association for Cardio-Thoracic surgery (STAT) category ≥ 4 (OR 2.1; 1.0-4.4), and longer cardiopulmonary bypass times (OR 1.1; 1.0-1.2) as independent risk factors for EAT. The onset of EAT occurred a median of 9 days (IQR 5-14 days) after CHD surgery. Antiarrhythmic treatment was initiated in 109/129 patients (84%) with propranolol (71%) and amiodarone (24%) the most commonly used medications. Although 15 (11.6%) patients did not survive to hospital discharge, EAT was not directly implicated in any deaths. EAT occurred after 2.5% of infant CHD surgeries. In addition to TAPVC repair, longer and more complex surgeries were associated with an increased the risk for the development of post-operative EAT.
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- 2022
8. Characteristics of antegrade-only accessory pathways in children and adolescents
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Yaniv Bar-Cohen, Allison C. Hill, Michael J. Silka, and Minh B. Nguyen
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Adult ,Tachycardia ,medicine.medical_specialty ,Adolescent ,Accessory pathway ,030204 cardiovascular system & hematology ,Chest pain ,Electrocardiography ,Young Adult ,03 medical and health sciences ,Electrophysiology study ,0302 clinical medicine ,Internal medicine ,Tachycardia, Supraventricular ,medicine ,Palpitations ,Humans ,030212 general & internal medicine ,Child ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Effective refractory period ,General Medicine ,medicine.disease ,Atrioventricular node ,Accessory Atrioventricular Bundle ,Electrophysiology ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Atrioventricular Node ,Catheter Ablation ,Cardiology ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
There is minimal data regarding antegrade-only accessory pathways in young patients. Given evolving recommendations and treatments, retrospective analysis of the clinical and electrophysiologic properties of antegrade-only pathways in patients
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- 2021
9. Pediatric Medical Device Development and Regulation: Current State, Barriers, and Opportunities
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Juan, Espinoza, Payal, Shah, Gautam, Nagendra, Yaniv, Bar-Cohen, and Frances, Richmond
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Adult ,United States Food and Drug Administration ,Health Personnel ,Pediatrics, Perinatology and Child Health ,Device Approval ,Humans ,Product Labeling ,Child ,Delivery of Health Care ,Pediatrics ,United States - Abstract
Few medical devices are designed and marketed specifically for children. Instead, adult devices are often repurposed and used off-label in pediatrics. The innovation gap between pediatric and adult devices is complex and multifactorial. This review aims to summarize the medical device landscape, describe barriers to pediatric device development, and provide an update on current strategies to help overcome these limitations. Medical devices are regulated by the Food and Drug Administration. They are registered, cleared, or approved on the basis of a 3-tier risk classification system and a differentiated set of regulatory pathways. This includes some for products that receive special designations on the basis of specific aspects that warrant more rapid review and approval. Pediatric devices number only one-quarter of those developed for adults for multiple reasons. Clinically, innovators must adjust their products to address the smaller sizes, growth, and longer duration of use in children. Smaller sample sizes and population heterogeneity also challenge the ability to obtain sufficient safety data for regulatory submissions. Financial concerns stem from lower pediatric reimbursement rates coupled with a lack of nationally standardized coverage. There are a number of promising initiatives, including the Pediatric Device Consortia Program, Early Feasibility Studies, and the new System of Hospitals for Innovation in Pediatrics – Medical Devices. However, the gap will likely not be narrowed without broad cooperation across stakeholders from industry, academia, patient advocacy groups, health care providers, investors, payors, regulators, and Congress.
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- 2022
10. Technical Refinements for Catheter Ablation in Young/Small Children
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Michael J. Silka and Yaniv Bar-Cohen
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- 2021
11. Third Trimester Fetal Heart Rates in Antibody-Mediated Complete Heart Block Predict Need for Neonatal Pacemaker Placement
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Justin, Pick, Michael J, Silka, Yaniv, Bar-Cohen, Allison, Hill, Mark, Shwayder, John, Wood, and Jay D, Pruetz
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Pacemaker, Artificial ,Pregnancy ,Pregnancy Trimester, Third ,Infant, Newborn ,Humans ,Female ,Prenatal Care ,Heart Rate, Fetal ,Atrioventricular Block ,Child - Abstract
Congenital complete heart block (CCHB) affects 1 in 20,000 newborns. This study evaluates fetal and neonatal risk factors predictive of neonatal pacemaker placement in antibody-mediated complete heart block. The Children's Hospital Los Angeles institutional fetal, pacemaker, and medical record databases were queried for confirmed SSA/SSB cases of CCHB between January 2004 and July 2019. Cases excluded were those with a diagnosis beyond the neonatal period, diagnosis of a channelopathy, or if maternal antibody status was unknown. We recorded the gestational age (GA), birth weight (BW), fetal heart rates (FHRs) of the last echocardiogram before delivery, specific neonatal ECG and echocardiogram findings, age at pacemaker placement, and mortality. Of 43 neonates identified with CCHB, 27 had confirmed maternal antibody exposure. Variables associated with neonatal pacemaker implantation were FHRs 50 bpm (p = 0.005), neonatal heart rates 52 bpm (p = 0.015), and neonatal left ventricular fractional shortening (FS) percentages 34% (p = 0.03). On multivariate analysis, FHR remained significant (p = 0.03) and demonstrated an increased risk of neonatal pacemaker placement by an odds ratio of 12.5 (95% CI 1.3-116, p = 0.05). The median GA at which the FHR was obtained was 34 weeks (IQR 26-35 weeks). Neonatal pacemaker placement was highly associated with a FHR 50 bpm, neonatal HR 52 bpm, and neonatal FS 34%. FHRs at 34 weeks GA (IQR 26-35 weeks) correlated well with postnatal heart rates and were predictive of neonatal pacemaker placement.
- Published
- 2021
12. Utility of Surveillance Ambulatory Rhythm Monitoring in the Pediatric Fontan Population
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Taylor P, Saley, Neil D, Patel, Yaniv, Bar-Cohen, Michael J, Silka, and Allison C, Hill
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Heart Defects, Congenital ,Male ,Young Adult ,Adolescent ,Risk Factors ,Child, Preschool ,Electrocardiography, Ambulatory ,Humans ,Female ,Child ,Fontan Procedure ,Retrospective Studies - Abstract
Our institution established a Fontan surveillance plan, which included ambulatory rhythm monitoring (ARM) at 6, 10, 13, 16 and 19 years old, for early detection of Fontan-associated complications. We conducted a retrospective chart review of Fontan patients followed at our institution 2014-2018 to determine the utility of surveillance ARMs. 139 ARMs from 83 patients were included. ARMs with supraventricular tachycardia, sinus node dysfunction, accelerated junctional rhythm, 1st degree atrioventricular block, and complex ventricular ectopy were classified as positive for arrhythmia. Arrhythmias were occult if detected on surveillance ARM. The ARM indication was surveillance in 78 (56%) and clinically indicated in 61 (44%). 52 (37%) ARMs in 27 (33%) patients had an arrhythmia. There was no difference in the age of patients with and without arrhythmias [median 10.9 (6.5, 17.1 years) vs. 8.8 (7, 13.6 years), p = 0.5]. Clinically indicated ARMs more frequently demonstrated arrhythmias than surveillance ARMs (52% vs. 26%, p 0.01). Compared to patients without arrhythmias, those with arrhythmias were more likely to be female (48% vs. 23%, p = 0.02), have a single right ventricle (46% vs. 19%, p 0.01) and longer QRS duration on ECG [100 (91, 116 ms) vs. 94 (84, 104 ms), p = 0.046]. Patients with occult arrhythmias were less likely to have moderate to severe atrioventricular valvar regurgitation (0% vs. 46%; p = 0.04) or ventricular dysfunction (0% vs. 46%; p = 0.04) than those with clinical arrhythmia(s). Arrhythmia findings resulted in change in management for 16/52 (31%) ARMs. The findings suggest the frequent presence of arrhythmias on periodic ARMs in patients following the Fontan procedure regardless of symptomatic status.
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- 2020
13. Correction to: Life-threatening cardiac arrhythmias in congenital central hypoventilation syndrome
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Iris A Perez, Eric Laifman, Thomas G. Keens, and Yaniv Bar-Cohen
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Pediatrics ,medicine.medical_specialty ,Mathematics::Commutative Algebra ,business.industry ,Pediatrics, Perinatology and Child Health ,Medicine ,Presentation (obstetrics) ,Congenital central hypoventilation syndrome ,business ,medicine.disease - Abstract
The publisher regrets that in the original published version of this article, one of the author’s name was incorrectly presented as “Yaniv Bar Cohen”. The correct presentation should have been “Yaniv Bar-Cohen” and is now presented correctly in this article.
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- 2020
14. SARS-CoV-2 infection presenting as sustained atrial flutter and advanced ventricular dysfunction
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Michael J. Silka, Molly Weisert, Jondavid Menteer, Jennifer A. Su, and Yaniv Bar-Cohen
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medicine.medical_specialty ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Internal medicine ,medicine ,Cardiology ,General Medicine ,medicine.disease ,business ,Atrial flutter - Published
- 2020
15. Innovation in Pediatric Medical Devices: Proceedings From The West Coast Consortium for Technology & Innovation in Pediatrics 2019 Annual Stakeholder Summit (Preprint)
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Juan Espinoza, Kathryne Cooper, Nadine Afari, Payal Shah, Sriharinarayana Batchu, and Yaniv Bar-Cohen
- Abstract
UNSTRUCTURED Pediatric medical devices cover a broad array of indications and risk profiles, and have helped to reduce disease burden and improve quality of life for numerous children. However, many of the devices used in pediatrics are not intended for or tested on children. Several barriers have been identified that pose difficulties in bringing pediatric medical devices to the market. These include a small market and small sample size; unique design considerations; regulatory complexities; lack of infrastructure for research, development, and evaluation; and low return on investment. In 2007, the Food and Drug Administration (FDA) created the Pediatric Device Consortia (PDC) Grants Program under the administration of the Office of Orphan Products Development. In 2018, the FDA awarded over US $30 million to five new PDCs. The West Coast Consortium for Technology & Innovation in Pediatrics (CTIP) is one of these PDCs and is centered at the Children’s Hospital Los Angeles. In February 2019, CTIP convened its primary stakeholders to discuss its priorities and activities for the new grant cycle. In this paper, we have presented a report of the summit proceedings to raise awareness and advocate for patients and pediatric medical device innovators as well as to inform the activities and priorities of other organizations and agencies engaged in pediatric medical device development.
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- 2019
16. Life-threatening cardiac arrhythmias in congenital central hypoventilation syndrome
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Thomas G. Keens, Yaniv Bar-Cohen, Eric Laifman, and Iris A Perez
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Sinus bradycardia ,medicine.medical_treatment ,Congenital central hypoventilation syndrome ,Chest pain ,Risk Assessment ,Cardiac pacemaker ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,medicine ,Palpitations ,Humans ,030212 general & internal medicine ,Asystole ,Child ,Retrospective Studies ,Homeodomain Proteins ,business.industry ,Arrhythmias, Cardiac ,Hypoventilation ,medicine.disease ,Sleep Apnea, Central ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Ambulatory ,Cohort ,Mutation ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,business ,Transcription Factors - Abstract
Congenital central hypoventilation syndrome (CCHS) patients are at risk for life-threatening cardiac arrhythmias, and presentation is dependent on their PHOX2B gene mutation. We describe the presentation of life-threatening arrhythmias in our cohort of CCHS patients. We reviewed the records of 72 CCHS patients seen at CHLA from 2004 to 2018. Data collected included demographics, PHOX2B genotype, ventilatory support, clinical symptoms, ambulatory cardiac monitoring results, and presence of cardiac pacemaker. Sixteen of 72 patients had evidence of potential life-threatening cardiac arrhythmias. PHOX2B genotypes were 20/25 polyalanine repeat expansion mutation (PARM), 20/26 PARM, 20/27 PARM, 20/32 PARM, and c.245C T non-polyalanine repeat mutation. 11/16 patients were ventilated during sleep only. Symptoms included syncope, dizziness, chest pain, tingling in the left arm, and palpitations. 15/16 patients had recorded ambulatory cardiac monitoring. 5/16 patients were symptomatic without significant sinus pauses. 12/16 patients had implantation of cardiac pacemakers. 9/12 had significant sinus pauses on ambulatory monitoring, and 7/12 patients were symptomatic.Conclusion: CCHS patients have potential life-threatening arrhythmias requiring cardiac pacemaker implantation. Many of these patients are symptomatic with significant sinus pauses on ambulatory monitoring. However, some symptomatic patients with no significant pauses on ambulatory monitoring may still require cardiac pacemaker implantation.What is Known:• CCHS patients are at risk for life-threatening sinus pauses and require cardiac pacemaker implantation.What is New:• CCHS patients regardless of PHOX2B genotype are at risk for significant sinus pauses. Many CCHS patients with significant sinus pause on ambulatory cardiac monitoring are symptomatic and most present with syncope. Some symptomatic patients do not have significant sinus pauses but may still require cardiac pacemaker implantation.
- Published
- 2019
17. Assessment of echocardiographic parameters in children with permanent ventricular pacing
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John C. Wood, Yaniv Bar-Cohen, Michael J. Silka, Allison C. Hill, and Eyal Sagiv
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medicine.medical_specialty ,Ejection fraction ,Ventricular function ,business.industry ,Heart block ,Cardiac anatomy ,Cardiomyopathy ,Diastole ,Fractional shortening ,Ventricular pacing ,medicine.disease ,Internal medicine ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Echocardiography is important in the follow-up of children with permanent pacemakers due to the risk for cardiomyopathy. However, the value of standard measurements is unclear in the setting of expected dyssynchrony caused by ventricular pacing. Objectives The study sought to assess and compare echocardiographic parameters of ventricular function in children with chronic ventricular pacing. Methods Echocardiographic studies of patients with normal cardiac anatomy and ventricular pacing for heart block were retrospectively evaluated for routine measurements of systolic and diastolic ventricular function. Results In 60 echocardiograms that were analyzed, fractional shortening (FS) had moderate correlation with ejection fraction (EF; R = 0.64, p Conclusions FS and EF are moderately correlated to each other and may both be appropriate in the evaluation of systolic function in chronically paced children. TDI values may be misleading, measuring low diastolic function despite normal LA area.
- Published
- 2021
18. Design and Testing of a Transcutaneous RF Recharging System for a Fetal Micropacemaker
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Yaniv Bar-Cohen, Li Zhou, Xuechen Huang, Ramen H. Chmait, Adriana Nicholson Vest, Viktoria Norekyan, and Gerald E. Loeb
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Battery (electricity) ,Pacemaker, Artificial ,Engineering ,0206 medical engineering ,Biomedical Engineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,Electric Power Supplies ,Fetus ,0302 clinical medicine ,Fetal anatomy ,Electronic engineering ,Animals ,Humans ,Electrical and Electronic Engineering ,Fetal Therapies ,Sheep ,business.industry ,Fetal Bradycardia ,020601 biomedical engineering ,Electrodes, Implanted ,Small form factor ,Patient population ,Fetal lamb ,business - Abstract
We have developed a rechargeable fetal micropacemaker in order to treat severe fetal bradycardia with comorbid hydrops fetalis. The necessarily small form factor of the device, small patient population, and fetal anatomy put unique constraints on the design of the recharging system. To overcome these constraints, a custom high power field generator was built and the recharging process was controlled by utilizing pacing rate as a measure of battery state, a feature of the relaxation oscillator used to generate stimuli. The design and in vitro and in vivo verification of the recharging system is presented here, showing successful generation of recharging current in a fetal lamb model.
- Published
- 2017
19. The clinical and genetic spectrum of catecholaminergic polymorphic ventricular tachycardia: findings from an international multicentre registry
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Zhiguang Yuchi, Martin J. LaPage, Anjan S. Batra, Shubhayan Sanatani, Michal J. Kantoch, Sally H.J. Choi, Susan P. Etheridge, Chris Anderson, Thomas M. Roston, Yung R. Lau, Maria Miszczak-Knecht, Jeffrey M. Vinocur, Roman Gebauer, Christopher L. Johnsrude, Michel Cabrera Ortega, Ming-Lon Young, Saira Mohammed, Robert M. Hamilton, Jack C. Salerno, James E. Potts, Kathryn K. Collins, Ronald J. Kanter, Peter Kubuš, Julie Hathaway, Filip Van Petegem, Andreas Pflaumer, Lynn Kimlicka, Prince J. Kannankeril, Joel Temple, Vincent C. Thomas, Anne Fournier, Mitchell I. Cohen, Christopher C. Erickson, Yaniv Bar-Cohen, Kathleen R. Maginot, and Gabriele Hessling
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Male ,Models, Molecular ,0301 basic medicine ,Tachycardia ,Heredity ,Protein Conformation ,DNA Mutational Analysis ,030204 cardiovascular system & hematology ,Cardiovascular ,Ventricular tachycardia ,Ryanodine receptor 2 ,0302 clinical medicine ,Models ,Risk Factors ,2.1 Biological and endogenous factors ,Registries ,Aetiology ,Child ,Pediatric ,medicine.diagnostic_test ,RyR2 ,Prognosis ,Sudden unexpected death ,Pedigree ,Death ,Heart Disease ,Phenotype ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Cardiac ,Arrhythmia ,Genetic Markers ,medicine.medical_specialty ,Adolescent ,Clinical Sciences ,Catecholaminergic polymorphic ventricular tachycardia ,Sudden death ,Structure-Activity Relationship ,03 medical and health sciences ,Channelopathy ,Clinical Research ,Physiology (medical) ,Internal medicine ,Genetics ,medicine ,Calsequestrin ,Humans ,Genetic Predisposition to Disease ,Retrospective Studies ,Genetic testing ,Catecholaminergic polymorphic ,business.industry ,Ventricular ,Molecular ,Cardiac arrhythmia ,Ryanodine Receptor Calcium Release Channel ,medicine.disease ,Sudden ,Death, Sudden, Cardiac ,030104 developmental biology ,Cardiovascular System & Hematology ,Mutation ,Tachycardia, Ventricular ,business - Abstract
AIMS: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an ion channelopathy characterized by ventricular arrhythmia during exertion or stress. Mutations in RYR2-coded Ryanodine Receptor-2 (RyR2) and CASQ2-coded Calsequestrin-2 (CASQ2) genes underlie CPVT1 and CPVT2, respectively. However, prognostic markers are scarce. We sought to better characterize the phenotypic and genotypic spectrum of CPVT, and utilize molecular modelling to help account for clinical phenotypes. METHODS AND RESULTS: This is a Pediatric and Congenital Electrophysiology Society multicentre, retrospective cohort study of CPVT patients diagnosed at
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- 2017
20. Analytical Modeling for Computing Lead Stress in a Novel Epicardial Micropacemaker
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Michael J. Silka, Li Zhou, Brett Harwin, Giorgio V. Chirikian, Jay D. Pruetz, Yaniv Bar-Cohen, Ramen H. Chmait, Gerald E. Loeb, and Raymond A. Peck
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Pacemaker, Artificial ,Swine ,Computer science ,0206 medical engineering ,Biomedical Engineering ,02 engineering and technology ,Bending ,030204 cardiovascular system & hematology ,Biplane ,Article ,Stress (mechanics) ,03 medical and health sciences ,0302 clinical medicine ,Cardiac motion ,medicine ,Animals ,Fluoroscopy ,Point (geometry) ,Lead (electronics) ,Deformation (mechanics) ,medicine.diagnostic_test ,Cardiac Pacing, Artificial ,Models, Cardiovascular ,020601 biomedical engineering ,Stress, Mechanical ,Cardiology and Cardiovascular Medicine ,Pericardium ,Biomedical engineering - Abstract
Implantation and maintenance of a permanent cardiac pacing system in children remains challenging due to small patient size, congenital heart defects and somatic growth. We are developing a novel epicardial micropacemaker for children that can be implanted on the epicardium within the pericardial space via a minimally-invasive technique. The key design configurations include a novel open-coiled lead in which living tissue replaces the usual polymeric support for the coiled conductor. To better understand and be able to predict the behavior of the implanted lead, we performed a radiographic image-based modeling study on a chronic animal test. We report a pilot study in which two mechanical dummy pacemakers with epicardial leads were implanted into an adult pig model via a minimally invasive approach. Fluoroscopy was obtained on the animal on Post-Operative Days #9, #35 and #56 (necropsy). We then constructed an analytic model to estimate the in vivo stress conditions on the open-coil lead based on the analysis of orthogonal biplane radiographic images. We obtained geometric deformation data of the implanted lead including elongation magnitudes and bending radii from sequenced films of cardiac motion cycles. The lead stress distribution was investigated on each film frame and the point of maximum stress (Mean Stress = 531.4 MPa; Alternating Stress = ± 216.4 MPa) was consistently where one of the leads exited the pericardial space, a deployment that we expected to be unfavorable. These results suggest the modeling approach can provide a basis for further design optimization. More animal tests and modeling will be needed to validate whether the novel lead design could meet the requirements to withstand ~200 million cardiac motion cycles over 5 years.
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- 2017
21. Utility of Surveillance Ambulatory Rhythm Monitoring in the Pediatric Fontan Population
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Taylor Saley, Neil D. Patel, MIchael J. Silka, Yaniv Bar-Cohen, and Allison C. Hill
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Pediatrics, Perinatology and Child Health - Published
- 2020
22. Prenatal diagnosis and management of congenital complete heart block
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Gerald E. Loeb, Jennifer Miller, Yaniv Bar-Cohen, Michael J. Silka, Ramen H. Chmait, and Jay D. Pruetz
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0301 basic medicine ,Embryology ,medicine.medical_specialty ,Cardiac output ,Myocarditis ,Health, Toxicology and Mutagenesis ,Prenatal diagnosis ,030105 genetics & heredity ,Toxicology ,Article ,03 medical and health sciences ,Fetal Heart ,Pregnancy ,Prenatal Diagnosis ,Fetal intervention ,medicine ,Humans ,Pacemaker Placement ,Intensive care medicine ,Fetus ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Prenatal Care ,medicine.disease ,030104 developmental biology ,Heart Block ,In utero ,Pediatrics, Perinatology and Child Health ,Female ,business ,Fetal echocardiography ,Developmental Biology - Abstract
Congenital complete heart block (CCHB) is a life-threatening medical condition in the unborn fetus with insufficiently validated prenatal interventions. Maternal administration of medications aimed at decreasing the immune response in the fetus and beta-agonists intended to increase fetal cardiac output have shown only marginal benefits. Anti-inflammatory therapies cannot reverse CCHB, but may decrease myocarditis and improve heart function. Advances in prenatal diagnosis and use of strict surveillance protocols for delivery timing have demonstrated small improvements in morbidity and mortality. Ambulatory surveillance programs and wearable fetal heart rate monitors may afford early identification of evolving fetal heart block allowing for emergent treatment. There is also preliminary data suggesting a roll for prevention of CCHB with hydroxychloroquine, but the efficacy and safety is still being studied. To date, intrauterine fetal pacing has not been successful due to the high-risk invasive placement techniques and potential problems with lead dislodgement. The development of a fully implantable micropacemaker via a minimally invasive approach has the potential to pace fetal patients with CCHB and thus delay delivery and allow fetal hydrops to resolve. The challenge remains to establish accepted prenatal interventions capable of successfully managing CCHB in utero until postnatal pacemaker placement is successfully achieved.
- Published
- 2019
23. Pediatric and congenital electrophysiology society initiative on device needs in pediatric electrophysiology
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Yaniv Bar-Cohen, Charles I. Berul, Bryan C. Cannon, Elizabeth V. Saarel, Maully J. Shah, Jonathan Reich, Vasum Peiris, Hetal Patel, James O. Gilkerson, Kenneth M. Stein, Robert C. Kowal, Anne M. Dubin, John K. Triedman, Mark D. Carlson, and Jessica Paulsen
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Heart Defects, Congenital ,medicine.medical_specialty ,Health Services Needs and Demand ,Technology Assessment, Biomedical ,Device Approval ,business.industry ,United States Food and Drug Administration ,Advisory Committees ,MEDLINE ,Off-Label Use ,Prostheses and Implants ,Off-label use ,United States ,Pediatric electrophysiology ,Patient safety ,Physiology (medical) ,Medicine ,Humans ,Medical physics ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business ,Child - Published
- 2018
24. A novel method to estimate safety factor of capture by a fetal micropacemaker
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Yaniv Bar-Cohen, Li Zhou, Adriana Nicholson Vest, and Gerald E. Loeb
- Subjects
Pacemaker, Artificial ,Form factor (electronics) ,Physiology ,Refractory period ,Computer science ,Hydrops Fetalis ,Interface (computing) ,0206 medical engineering ,Biomedical Engineering ,Biophysics ,Pilot Projects ,Comorbidity ,02 engineering and technology ,030204 cardiovascular system & hematology ,Article ,Electrocardiography ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Physiology (medical) ,Bradycardia ,medicine ,Animals ,Cardiac Surgical Procedures ,Sheep, Domestic ,Fetal Therapies ,Signal processing ,medicine.diagnostic_test ,Heart ,Signal Processing, Computer-Assisted ,Fetal Bradycardia ,020601 biomedical engineering ,Electrodes, Implanted ,Power (physics) ,Follow-Up Studies ,Biomedical engineering - Abstract
We have developed a rechargeable fetal micropacemaker in order to treat severe fetal bradycardia with comorbid hydrops fetalis, a life-threatening condition in pre-term non-viable fetuses for which there are no effective treatment options. The small size and minimally invasive form factor of our design limit the volume available for circuitry and a power source. The device employs a fixed-rate and fixed-amplitude relaxation oscillator and a tiny, rechargeable lithium ion power cell. For both research and clinical applications, it is valuable to monitor the electrode-myocardium interface in order to determine that adequate pacemaker output is being provided. This is typically accomplished by observing the minimal stimulus strength that achieves threshold for pacing capture. The output of our simple micropacemaker cannot be programmatically altered to determine this minimal capture threshold, but a safety factor can be inferred by determining the refractory period for ventricular capture at a given stimulus strength. This is done by measuring the minimal timing between naturally occurring QRS complexes and pacing stimuli that successfully generate a premature ventricular contraction. The method was tested in a pilot study in four fetal sheep and the data demonstrate that a relative measure of threshold is obtainable. This method provides valuable real-time information about the electrode-tissue interface.
- Published
- 2016
25. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease
- Author
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Yaniv Bar-Cohen, Naomi J. Kertesz, Macdonald Dick, Ronald J. Kanter, Joel A. Kirsh, Martin J. LaPage, John M. Clark, Christina Y. Miyake, Nicholas H. Von Bergen, Bryan C. Cannon, S Asirvatham, Francis X. McGowan, J. Philip Saul, Andreas Pflaumer, Frank Zimmerman, John D. Kugler, Andrew D. Blaufox, Anne Freter, William G. Stevenson, Allan C. Skanes, Aruna T. Nathan, Thomas Paul, John Papagiannis, and Dominic Abrams
- Subjects
medicine.medical_specialty ,Pediatrics ,business.industry ,Expert consensus ,030204 cardiovascular system & hematology ,3. Good health ,Heart Rhythm ,03 medical and health sciences ,Fascicular ventricular tachycardia ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Focal atrial tachycardia ,business - Abstract
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
- Published
- 2016
26. Minimally invasive implantable fetal micropacemaker: mechanical testing and technical refinements
- Author
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Xuechen Huang, Jay D. Pruetz, Ramen H. Chmait, Jonathan P. Sredl, Li Zhou, Yaniv Bar-Cohen, Raymond A. Peck, Michael J. Silka, Gerald E. Loeb, and Adriana Nicholson Vest
- Subjects
Pacemaker, Artificial ,Cardiac pacing ,Computer science ,0206 medical engineering ,Biomedical Engineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,Fetus ,0302 clinical medicine ,Hydrops fetalis ,medicine ,Animals ,Lead (electronics) ,Electrodes ,Mechanical Phenomena ,Sheep ,X-Rays ,Prostheses and Implants ,medicine.disease ,020601 biomedical engineering ,Computer Science Applications ,Reliability engineering ,Torque ,Heart failure ,Biomedical engineering - Abstract
This paper discusses the technical and safety requirements for cardiac pacing of a human fetus with heart failure and hydrops fetalis secondary to complete heart block. Engineering strategies to meet specific technical requirements were integrated into a systematic design and implementation consisting of a novel fetal micropacemaker, a percutaneous implantation system, and a sterile package that enables device storage and recharging maintenance in a clinical setting. We further analyzed observed problems on myocardial fixation and pacing lead fatigue previously reported in earlier preclinical trials. This paper describes the technical refinements of the implantable fetal micropacemaker to overcome these challenges. The mechanical performance has been extensively tested to verify the improvement of reliability and safety margins of the implantation system.
- Published
- 2016
27. Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease
- Author
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Yaniv Bar-Cohen and Michael J. Silka
- Subjects
Tachycardia ,medicine.medical_specialty ,Heart disease ,medicine.diagnostic_test ,business.industry ,P wave ,MEDLINE ,Atrial fibrillation ,Atrial arrhythmias ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography ,Cohort study - Published
- 2017
28. Innovation in Pediatric Medical Devices: Proceedings From The West Coast Consortium for Technology & Innovation in Pediatrics 2019 Annual Stakeholder Summit
- Author
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Juan Espinoza, Kathryne Cooper, Nadine Afari, Payal Shah, Sriharinarayana Batchu, and Yaniv Bar-Cohen
- Subjects
geography ,Pediatrics ,medicine.medical_specialty ,Summit ,geography.geographical_feature_category ,Stakeholder ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,030225 pediatrics ,Return on investment ,medicine ,West coast ,Business ,Technology innovation ,Administration (government) ,health care economics and organizations ,030217 neurology & neurosurgery ,Disease burden - Abstract
Pediatric medical devices cover a broad array of indications and risk profiles, and have helped to reduce disease burden and improve quality of life for numerous children. However, many of the devices used in pediatrics are not intended for or tested on children. Several barriers have been identified that pose difficulties in bringing pediatric medical devices to the market. These include a small market and small sample size; unique design considerations; regulatory complexities; lack of infrastructure for research, development, and evaluation; and low return on investment. In 2007, the Food and Drug Administration (FDA) created the Pediatric Device Consortia (PDC) Grants Program under the administration of the Office of Orphan Products Development. In 2018, the FDA awarded over US $30 million to five new PDCs. The West Coast Consortium for Technology & Innovation in Pediatrics (CTIP) is one of these PDCs and is centered at the Children’s Hospital Los Angeles. In February 2019, CTIP convened its primary stakeholders to discuss its priorities and activities for the new grant cycle. In this paper, we have presented a report of the summit proceedings to raise awareness and advocate for patients and pediatric medical device innovators as well as to inform the activities and priorities of other organizations and agencies engaged in pediatric medical device development.
- Published
- 2020
29. 825: Incidence of neonatal pacemaker placement in congenital complete heart block cases with confirmed antibody disease
- Author
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Yaniv Bar-Cohen, Justin Pick, Jay D. Pruetz, Michael J. Silka, and Allison C. Hill
- Subjects
medicine.medical_specialty ,biology ,business.industry ,Incidence (epidemiology) ,Obstetrics and Gynecology ,Disease ,Congenital complete heart block ,Internal medicine ,medicine ,Cardiology ,biology.protein ,Pacemaker Placement ,Antibody ,business - Published
- 2020
30. Minimally Invasive Implantation of a Micropacemaker Into the Pericardial Space
- Author
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Ramen H. Chmait, Gerald E. Loeb, Michael J. Silka, Sara M. Rabin, Li Zhou, Viktoria Norekyan, Allison C. Hill, Jay D. Pruetz, and Yaniv Bar-Cohen
- Subjects
Pacemaker, Artificial ,medicine.medical_specialty ,Percutaneous ,Heart block ,Sus scrofa ,0206 medical engineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,medicine ,Animals ,Minimally Invasive Surgical Procedures ,Pericardium ,Miniaturization ,business.industry ,Cardiac Pacing, Artificial ,Equipment Design ,Pericardial space ,medicine.disease ,020601 biomedical engineering ,Pacemaker leads ,Surgery ,medicine.anatomical_structure ,Models, Animal ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Permanent cardiac pacemakers require invasive procedures with complications often related to long pacemaker leads. We are developing a percutaneous pacemaker for implantation of an entire pacing system into the pericardial space. Methods: Percutaneous micropacemaker implantations were performed in 6 pigs (27.4–34.1 kg) using subxyphoid access to the pericardial space. Modifications in the implantation methods and hardware were made after each experiment as the insertion method was optimized. In the first 5 animals, nonfunctional pacemaker devices were studied. In the final animal, a functional pacemaker was implanted. Results: Successful placement of the entire nonfunctional pacing system into the pericardial space was demonstrated in 2 of the first 5 animals, and successful implantation and capture was achieved using a functional system in the last animal. A sheath was developed that allows retractable features to secure positioning within the pericardial space. In addition, a miniaturized camera with fiberoptic illumination allowed visualization of the implantation site before electrode insertion into myocardium. All animals studied during follow-up survived without symptoms after the initial postoperative period. Conclusions: A novel micropacemaker system allows cardiac pacing without entering the vascular space or surgical exposure of the heart. This pericardial pacemaker system may be an option for a large number of patients currently requiring transvenous pacemakers but is particularly relevant for patients with restricted vascular access, young children, or those with congenital heart disease who require epicardial access.
- Published
- 2018
31. A comparison of oral flecainide and amiodarone for the treatment of recurrent supraventricular tachycardia in children
- Author
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Allison C. Hill, Yaniv Bar-Cohen, and Michael J. Silka
- Subjects
Tachycardia ,Male ,medicine.medical_specialty ,Digoxin ,Heart disease ,Adolescent ,Administration, Oral ,Amiodarone ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,medicine ,Tachycardia, Supraventricular ,Humans ,030212 general & internal medicine ,Adverse effect ,Child ,Flecainide ,Ectopic atrial tachycardia ,business.industry ,Infant ,General Medicine ,medicine.disease ,Child, Preschool ,Cardiology ,Female ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Background Supraventricular tachycardia (SVT) in children can be difficult to treat when first-line therapies (beta-blockade or digoxin) are not effective. Both flecainide and amiodarone are used as second-line therapies. We sought to compare the efficacy and safety of flecainide and amiodarone in pediatric patients with recurrent SVT. Methods Pediatric patients treated with oral flecainide or oral amiodarone for SVT between 2006 and 2015 were studied. Tachycardia mechanisms included orthodromic reciprocating tachycardia (ORT), intra-atrial reentrant tachycardia (IART), and ectopic atrial tachycardia (EAT). Outcomes were classified as full success, partial success (requiring additional intervention), or failure. Results Seventy-four patients were included (median age 46 days, range 1 day to 19 years). Flecainide was used in 47 patients and amiodarone in 27 patients. Full success was achieved in 68% and 59%, respectively (P = 0.28). Partial success was achieved in 13% and 19%, respectively (P = 0.12). Treatment failed in 19% and 22%, respectively (P = 0.97). Ten crossover patients received the second medication after the first failed. Of five amiodarone-to-flecainide crossovers, four achieved success on flecainide alone. Of five flecainide-to-amiodarone crossovers, two achieved success. Minor adverse events occurred in 9% of flecainide and 22% of amiodarone patients (P = 0.16). No significant differences were seen by arrhythmia subtype (36 EAT, 28 ORT, 10 IART), congenital heart disease (n = 38), or age group (56 infants). Conclusions Oral flecainide and amiodarone achieved meaningful arrhythmia control in 81% and 78% of pediatric patients with recurrent SVT, respectively. Those who failed amiodarone had encouraging outcomes when changed to flecainide.
- Published
- 2018
32. A Comparison of AV Nodal Reentrant Tachycardia in Young Children and Adolescents: Electrophysiology, Ablation, and Outcomes
- Author
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Charitha D. Reddy, Michael J. Silka, and Yaniv Bar-Cohen
- Subjects
Tachycardia ,medicine.medical_specialty ,medicine.diagnostic_test ,Heart block ,business.industry ,medicine.medical_treatment ,Catheter ablation ,Cryoablation ,General Medicine ,medicine.disease ,Ablation ,Electrophysiology study ,Internal medicine ,Anesthesia ,medicine ,Cardiology ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,AV nodal reentrant tachycardia - Abstract
Background Atrioventricular nodal reentrant tachycardia (AVNRT) typically occurs in adolescents and adults with limited data regarding AVNRT in young children. Methods All patients with AVNRT who underwent electrophysiology study and ablation between 2005 and 2012 were retrospectively studied. Patients were stratified by age
- Published
- 2015
33. Current Practices in the Monitoring of Cardiac Rhythm Devices in Pediatrics and Congenital Heart Disease
- Author
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Stacey L. Boyer, Yaniv Bar-Cohen, and Michael J. Silka
- Subjects
Heart Defects, Congenital ,Male ,Pacemaker, Artificial ,medicine.medical_specialty ,Pediatrics ,Time Factors ,Adolescent ,Heart disease ,Electrocardiography ,Heart Rate ,Patient age ,medicine ,Humans ,Telemetry ,Pacemaker clinic ,Child ,business.industry ,Vascular surgery ,medicine.disease ,Independent factor ,Defibrillators, Implantable ,Telephone ,Cardiac surgery ,Treatment Outcome ,Child, Preschool ,Practice Guidelines as Topic ,Pediatrics, Perinatology and Child Health ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Although guidelines for routine follow-up of pacemakers and implantable cardioverter defibrillators (ICDs) are available for adults, minimal data supports their appropriateness in pediatrics and congenital heart disease. This study aimed to define current practices of cardiac rhythm device (CRD) follow-up among pediatric electrophysiologists. Pediatric and Congenital EP Society (PACES) members were surveyed regarding frequency of CRD in-person follow-up as well as transtelephonic monitoring (TTM) and remote monitoring (RM) practices. If home monitoring was used, the effect on in-person follow-up was also evaluated. A total of 106 PACES members responded to the survey. Uncomplicated pacemaker and ICD patients were both followed in-person at a median interval of 6 months (range 1-12 months). TTM was utilized by 67 % of responders (median interval 3 months; range 1-6 months), while RM was used by 87 % for pacemakers (median interval 3 months; range 1-6 months) and 92 % for ICDs (median interval 3 months; range 2 weeks-6 months). When TTM was used, 21 % of responders reduced their frequency of pacemaker clinic visits. In comparison, RM reduced the frequency of clinic visits for pacemakers and ICDs in 32 and 31 % of responders, respectively. Patient age was an independent factor in determining CRD follow-up for 49 % of responders. While CRD follow-up by pediatric electrophysiologists in general follows adult guidelines, individual practices widely vary. In contrast to published recommendations in adults, TTM and RM utilization does not reduce the frequency of in-person visits for the majority of pediatric electrophysiologists.
- Published
- 2014
34. Cardiac Resynchronization Therapy in Pediatrics
- Author
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Allison C. Hill, Yaniv Bar-Cohen, and Michael J. Silka
- Subjects
Pediatrics ,medicine.medical_specialty ,Heart disease ,genetic structures ,pediatrics ,medicine.medical_treatment ,Population ,Cardiac resynchronization therapy ,heart failure ,Physiology (medical) ,medicine ,cardiovascular diseases ,education ,education.field_of_study ,Ischemic cardiomyopathy ,business.industry ,Left bundle branch block ,Research Review ,medicine.disease ,Heart failure ,Etiology ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Pediatric population ,circulatory and respiratory physiology - Abstract
Cardiac resynchronization therapy (CRT) has proven to be a powerful and effective tool in the treatment of adults with severe dilated or ischemic cardiomyopathy. A substantial portion of the adult heart failure population has severely depressed systolic function, heart failure symptoms, QRS prolongation, and left bundle branch block. Indications for CRT in adults are commonly focused on these characteristics. However, pediatric patients represent a heterogeneous group with many etiologies of heart failure and anatomic variants, with most of them not fitting the typical adult CRT criteria. The heterogeneity of the pediatric population has hindered the identification of ideal candidates for CRT, but initial experience with CRT in various groups of pediatric patients has been encouraging. This article reviews indications for and outcomes of CRT in pediatric and congenital heart disease patients.
- Published
- 2017
35. Indications for permanent pacing, device, and lead selection
- Author
-
Christopher Carter, Yaniv Bar-Cohen, and Philip M. Chang
- Subjects
medicine.medical_specialty ,business.industry ,Heart block ,Internal medicine ,Long QT syndrome ,Cardiology ,Medicine ,business ,Lead (electronics) ,medicine.disease ,Selection (genetic algorithm) ,Syncope (phonology) - Published
- 2017
36. Pediatric survivors of out-of-hospital ventricular fibrillation: Etiologies and outcomes
- Author
-
Allison C. Hill, Ryan L. Kobayashi, Yaniv Bar-Cohen, and Michael J. Silka
- Subjects
Male ,Resuscitation ,medicine.medical_specialty ,Emergency Medical Services ,Adolescent ,medicine.medical_treatment ,Electric Countershock ,030204 cardiovascular system & hematology ,Return of spontaneous circulation ,Sudden death ,California ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Cardiopulmonary resuscitation ,Asystole ,Child ,Retrospective Studies ,business.industry ,Infant ,030208 emergency & critical care medicine ,Sudden cardiac arrest ,medicine.disease ,Prognosis ,Cardiopulmonary Resuscitation ,Survival Rate ,Child, Preschool ,Pulseless electrical activity ,Ventricular fibrillation ,Ventricular Fibrillation ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest - Abstract
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.
- Published
- 2017
37. Prenatal Exposure to Methyldopa Leading to Hypertensive Crisis and Cardiac Failure in a Neonate
- Author
-
William Tang, Jennifer A. Su, Niurka Rivero, and Yaniv Bar-Cohen
- Subjects
Agonist ,medicine.drug_class ,Intracardiac injection ,Pregnancy ,Humans ,Medicine ,Methyldopa ,Heart Failure ,business.industry ,Infant, Newborn ,Hypertension, Pregnancy-Induced ,Emergency department ,medicine.disease ,Hypertensive crisis ,Adrenergic Agonists ,Substance Withdrawal Syndrome ,In utero ,Prenatal Exposure Delayed Effects ,Anesthesia ,Heart failure ,Hypertension ,Pediatrics, Perinatology and Child Health ,Female ,Presentation (obstetrics) ,business ,medicine.drug - Abstract
A 2-week-old infant with normal intracardiac anatomy presented to the emergency department in a hypertensive crisis with acute cardiac failure. Despite extensive evaluation, no underlying disease was found. The patient’s hypertension and cardiac dysfunction resolved after 1 week of supportive care in the PICU, and she was discharged within 2 weeks of presentation. The patient’s history revealed transplacental exposure to the α-adrenergic agonist methyldopa for 10 weeks before delivery. Her age at presentation and the self-limited nature of cardiac sequelae with complete resolution of cardiac dysfunction suggest withdrawal effects from this exposure. Whereas the rebound hypertensive effects of α-adrenergic agonists are well established in the adult population, this report shows an unusual adverse outcome of in utero exposure to methyldopa.
- Published
- 2014
38. Characteristics of Decremental Accessory Pathways in Children
- Author
-
Allison C. Hill, Yaniv Bar-Cohen, Choo Phei Wee, and Michael J. Silka
- Subjects
Male ,Tachycardia ,medicine.medical_specialty ,Adolescent ,Beats per minute ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,Electrophysiology study ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,medicine ,Humans ,030212 general & internal medicine ,Child ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,Mean age ,medicine.disease ,Accessory Atrioventricular Bundle ,Surgery ,Treatment Outcome ,Child, Preschool ,Catheter Ablation ,Cardiology ,Female ,Supraventricular tachycardia ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Permanent junctional reciprocating tachycardia ,Orthodromic - Abstract
Background— Although retrograde decremental accessory pathways (DAPs) are thought to typically present as permanent junctional reciprocating tachycardia (permanent junctional reciprocating tachycardia), they may also be diagnosed unexpectedly during electrophysiology study. We aimed to compare the clinical and electrophysiological characteristics of patients with DAPs to an age-matched cohort with nondecremental accessory pathways. Methods and Results— We retrospectively studied pediatric patients (30 ms. Twenty-six patients with DAPs were compared with 73 controls (mean age at electrophysiology study 9.8±5.7 and 10.3±5.2 years, respectively [ P =nonsignificant]). Compared with controls, patients with DAPs had more frequent syncope (5/26 [19%] versus 3/73 [4%]; P =0.02) and ventricular dysfunction (6/26 [23%] versus 4/73 [6%]; P =0.04). Only 11 (42%) DAP patients manifested clinical permanent junctional reciprocating tachycardia, and these patients had more syncope (5/11 [45%] versus 0/15 [0%]; P P =0.001), and longer ventriculo-atrial times (mean maximum ventriculo-atrial times of 283±116 ms versus 208±42 ms; P =0.02) compared with those with DAPs without clinical permanent junctional reciprocating tachycardia. DAPs and controls had similar rates of acute ablation success (23/26 [89%] versus 67/73 [92%]; P =nonsignificant) and recurrences (1/23 [4%] versus 2/67 [3%]; P =nonsignificant). Conclusions— The majority of pediatric patients with DAPs do not present with clinical permanent junctional reciprocating tachycardia. DAPs are associated with more severe symptoms, but ablation outcomes are similar to those of age-matched controls.
- Published
- 2016
39. Catecholaminergic polymorphic ventricular tachycardia patients with multiple genetic variants in the PACES CPVT Registry
- Author
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Omid Haji-Ghassemi, Martin J. LaPage, Shubhayan Sanatani, Anjan S. Batra, Thomas M. Roston, James E. Potts, Yaniv Bar-Cohen, Filip Van Petegem, Roman Gebauer, Kathleen R. Maginot, Yung R. Lau, Susan P. Etheridge, Chris Anderson, and Song, Chunhua
- Subjects
Male ,0301 basic medicine ,Physiology ,lcsh:Medicine ,Pathogenesis ,030204 cardiovascular system & hematology ,Pathology and Laboratory Medicine ,Cardiovascular ,Biochemistry ,Ion Channels ,0302 clinical medicine ,Heart Rate ,Tachycardia ,Medicine and Health Sciences ,2.1 Biological and endogenous factors ,Registries ,Aetiology ,lcsh:Science ,Child ,Pediatric ,education.field_of_study ,Multidisciplinary ,medicine.diagnostic_test ,Physics ,Genomics ,Penetrance ,3. Good health ,Electrophysiology ,Heart Disease ,Treatment Outcome ,Child, Preschool ,Physical Sciences ,Medical genetics ,Female ,medicine.symptom ,Ion Channel Gating ,Arrhythmia ,Research Article ,medicine.medical_specialty ,Substitution Mutation ,Adolescent ,General Science & Technology ,Genetic counseling ,Population ,Biophysics ,Cardiology ,Neurophysiology ,Catecholaminergic polymorphic ventricular tachycardia ,Syncope ,03 medical and health sciences ,Signs and Symptoms ,Rare Diseases ,Genomic Medicine ,Protein Domains ,Diagnostic Medicine ,Internal medicine ,Genetics ,medicine ,Humans ,Genetic Predisposition to Disease ,Genetic Testing ,Expressivity (genetics) ,Preschool ,education ,Genetic testing ,Clinical Genetics ,business.industry ,Myocardium ,lcsh:R ,Human Genome ,Infant, Newborn ,Ventricular ,Biology and Life Sciences ,Proteins ,Infant ,Human Genetics ,Ryanodine Receptor Calcium Release Channel ,Sudden cardiac arrest ,Newborn ,medicine.disease ,030104 developmental biology ,Mutation ,Tachycardia, Ventricular ,lcsh:Q ,business ,Neuroscience - Abstract
Author(s): Roston, Thomas M; Haji-Ghassemi, Omid; LaPage, Martin J; Batra, Anjan S; Bar-Cohen, Yaniv; Anderson, Chris; Lau, Yung R; Maginot, Kathleen; Gebauer, Roman A; Etheridge, Susan P; Potts, James E; Van Petegem, Filip; Sanatani, Shubhayan | Abstract: BackgroundCatecholaminergic polymorphic ventricular tachycardia (CPVT) is often a life-threatening arrhythmia disorder with variable penetrance and expressivity. Little is known about the incidence or outcomes of CPVT patients with ≥2 variants.MethodsThe phenotypes, genotypes and outcomes of patients in the Pediatric and Congenital Electrophysiology Society CPVT Registry with ≥2 variants in genes linked to CPVT were ascertained. The American College of Medical Genetics a Genomics (ACMG) criteria and structural mapping were used to predict the pathogenicity of variants (3D model of pig RyR2 in open-state).ResultsAmong 237 CPVT subjects, 193 (81%) had genetic testing. Fifteen patients (8%) with a median age of 9 years (IQR 5-12) had ≥2 variants. Sudden cardiac arrest occurred in 11 children (73%), although none died during a median follow-up of 4.3 years (IQR 2.5-6.1). Thirteen patients (80%) had at least two RYR2 variants, while the remaining two patients had RYR2 variants plus variants in other CPVT-linked genes. Among all variants identified, re-classification of the commercial laboratory interpretation using ACMG criteria led to the upgrade from variant of unknown significance (VUS) to pathogenic/likely pathogenic (P/LP) for 5 variants, and downgrade from P/LP to VUS for 6 variants. For RYR2 variants, 3D mapping using the RyR2 model suggested that 2 VUS by ACMG criteria were P/LP, while 2 variants were downgraded to likely benign.ConclusionsThis severely affected cohort demonstrates that a minority of CPVT cases are related to ≥2 variants, which may have implications on family-based genetic counselling. While multi-variant CPVT patients were at high-risk for sudden cardiac arrest, there are insufficient data to conclude that this genetic phenomenon has prognostic implications at present. Further research is needed to determine the significance and generalizability of this observation. This study also shows that a rigorous approach to variant re-classification using the ACMG criteria and 3D mapping is important in reaching an accurate diagnosis, especially in the multi-variant population.
- Published
- 2018
40. Recommendations for Advanced Fellowship Training in Clinical Pediatric and Congenital Electrophysiology
- Author
-
Edward P. Walsh, Yaniv Bar-Cohen, Anjan S. Batra, Macdonald Dick, Christopher Erickson, Frank Fish, Robert M. Hamilton, Ronald J. Kanter, John H. Reed, George F. Van Hare, Victoria L. Vetter, and Gregory Webster
- Subjects
Heart Rhythm ,Pediatrics ,medicine.medical_specialty ,Cardiac electrophysiology ,business.industry ,Physiology (medical) ,Emergency medicine ,medicine ,%22">Fish ,Cardiology and Cardiovascular Medicine ,business ,Credentialing ,Fellowship training - Abstract
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
- Published
- 2013
41. Fascicular and Nonfascicular Left Ventricular Tachycardias in the Young: An International Multicenter Study
- Author
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Jack C. Salerno, John D. Kugler, Shubhayan Sanatani, Andrew D. Blaufox, Kathryn K. Collins, Christopher R. Anderson, Maria Knecht, Anne M. Dubin, George F. Van Hare, Ian H. Law, John H. Reed, Yaniv Bar-Cohen, Ronn E. Tanel, Thomas Paul, Elizabeth V. Saarel, John K. Triedman, Michael Schaffer, Pamela S. Ro, Anjan S. Batra, Narayanswami Sreeram, David J. Bradley, Leonardo Liberman, and Jose M. Moltedo
- Subjects
Tachycardia ,medicine.medical_specialty ,Heart malformation ,Radiofrequency ablation ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Physiology (medical) ,Internal medicine ,medicine ,030212 general & internal medicine ,Intention-to-treat analysis ,medicine.diagnostic_test ,business.industry ,Cryoablation ,medicine.disease ,3. Good health ,Anesthesia ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography - Abstract
Left Ventricular Tachycardia in PediatricsIntroduction The aim of this study was to evaluate the clinical presentation and outcomes of pediatric patients with ventricular tachycardia (VT) originating from left heart structures. Methods and Results This international multicenter retrospective study including 152 patients (age 10.0 ± 5.1 years, 62% male), divided into those with fascicular VT (85%, 129/152) and nonfascicular LV VT (15%, 23/152). All patients had a normal heart structure or only a minor cardiac abnormality. Adenosine was largely ineffective in both groups (tachycardia termination in 4/74 of fascicular VT and 0/5 of nonfascicular LV VT). In fascicular VT, calcium channel blockers were effective in 80% (74/92); however, when administered orally, there was a 21% (13/62) recurrence rate. In nonfascicular LV VT, a variety of antiarrhythmic therapies were used with no one predominating. Ablation procedures were successful in 71% (72/102) of fascicular VT and 67% (12/18) of nonfascicular LV VT on an intention to treat analysis. Major complications occurred in 5 patients with fascicular VT and 1 patient with nonfascicular LV VT. After a follow-up period of 2 years (1 day to 15 years), 72% of all patients with fascicular VT were off medications with no tachycardia recurrence. One patient died of noncardiac causes. In nonfascicular LV VT, follow-up was 3.5 years (0.5–15 years), P = 0.38. A total of 65% of these patients were free from arrhythmias. Two patients died suddenly (P < 0.01). Conclusion The clinical course and outcomes of pediatric patients with fascicular VT and nonfascicular LV VT are varied. Catheter ablation procedures can be curative.
- Published
- 2013
42. Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network
- Author
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Matthew E. Oster, Shan Chen, Nicholas Dagincourt, Yaniv Bar-Cohen, Matthew Brothers, Nicole Cain, Steven D. Colan, Richard J. Czosek, Jamie A. Decker, David G. Gamboa, Salim F. Idriss, Joel A. Kirsh, Martin J. LaPage, Richard G. Ohye, Elizabeth Radojewski, Maully Shah, Eric S. Silver, Anoop K. Singh, Joel D. Temple, John Triedman, and Jonathan R. Kaltman
- Subjects
Pulmonary and Respiratory Medicine ,Heart Defects, Congenital ,Male ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Norwood Procedures ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Internal medicine ,Junctional ectopic tachycardia ,medicine ,Humans ,cardiovascular diseases ,Registries ,Retrospective Studies ,Tricuspid valve ,business.industry ,Incidence ,Infant, Newborn ,Infant ,Atrial fibrillation ,Arrhythmias, Cardiac ,medicine.disease ,United States ,Survival Rate ,medicine.anatomical_structure ,Treatment Outcome ,030228 respiratory system ,Anesthesia ,cardiovascular system ,Cardiology ,Surgery ,Norwood procedure ,Female ,Supraventricular tachycardia ,Cardiology and Cardiovascular Medicine ,business ,Atrioventricular block ,Atrial flutter ,Follow-Up Studies - Abstract
The study objective was to determine the predictors of new-onset arrhythmia among infants with single-ventricle anomalies during the post-Norwood hospitalization and the association of those arrhythmias with postoperative outcomes (ventilator time and length of stay) and interstage mortality.After excluding patients with preoperative arrhythmias, we used data from the Pediatric Heart Network Single Ventricle Reconstruction Trial to identify risk factors for tachyarrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, junctional ectopic tachycardia, and ventricular tachycardia) and atrioventricular block (second or third degree) among 544 eligible patients. We then determined the association of arrhythmia with outcomes during the post-Norwood hospitalization and interstage period, adjusting for identified risk factors and previously published factors.Tachyarrhythmias were noted in 20% of subjects, and atrioventricular block was noted in 4% of subjects. Potentially significant risk factors for tachyarrhythmia included the presence of modified Blalock-Taussig shunt (P = .08) and age at Norwood (P = .07, with risk decreasing each day at age 8-20 days); the only significant risk factor for atrioventricular block was undergoing a concomitant procedure at the time of the Norwood (P = .001), with the greatest risk being in those undergoing a tricuspid valve procedure. Both tachyarrhythmias and atrioventricular block were associated with longer ventilation time and length of stay (P .001 for all analyses). Tachyarrhythmias were not associated with interstage mortality; atrioventricular block was associated with mortality among those without a pacemaker in the unadjusted analysis (hazard ratio, 2.3; P = .02), but not after adding covariates.Tachyarrhythmias are common after the Norwood procedure, but atrioventricular block may portend a greater risk for interstage mortality.
- Published
- 2016
43. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease: Developed in partnership with the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American Academy of Pediatrics (AAP), the American Heart Association (AHA), and the Association for European Pediatric and Congenital Cardiology (AEPC)
- Author
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J, Philip Saul, Ronald J, Kanter, Dominic, Abrams, Sam, Asirvatham, Yaniv, Bar-Cohen, Andrew D, Blaufox, Bryan, Cannon, John, Clark, Macdonald, Dick, Anne, Freter, Naomi J, Kertesz, Joel A, Kirsh, John, Kugler, Martin, LaPage, Francis X, McGowan, Christina Y, Miyake, Aruna, Nathan, John, Papagiannis, Thomas, Paul, Andreas, Pflaumer, Allan C, Skanes, William G, Stevenson, Nicholas, Von Bergen, and Frank, Zimmerman
- Subjects
Europe ,Heart Defects, Congenital ,Consensus ,International Cooperation ,Cardiology ,Catheter Ablation ,Humans ,American Heart Association ,Cardiac Electrophysiology ,Child ,Societies, Medical ,United States - Published
- 2016
44. The Study of Antiarrhythmic Medications in Infancy (SAMIS)
- Author
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Harinder R. Singh, J. Philip Saul, Susan P. Etheridge, Kenny K. Wong, Yaniv Bar-Cohen, Pamela S. Ro, James E. Potts, Karen Gibbs, Anne Fournier, Svjetlana Tisma-Dupanovic, Shubhayan Sanatani, Charles C. Anderson, Elizabeth A. Stephenson, Ronald J. Kanter, Bertrand A. Ross, Anjan S. Batra, John H. Reed, Andrew D. Blaufox, Andrew S. Mackie, and Brian W. McCrindle
- Subjects
Male ,Tachycardia ,Canada ,Digoxin ,Propranolol ,law.invention ,Double-Blind Method ,Randomized controlled trial ,Recurrence ,law ,Physiology (medical) ,Tachycardia, Supraventricular ,Clinical endpoint ,medicine ,Humans ,Adverse effect ,Proportional Hazards Models ,Chi-Square Distribution ,business.industry ,Infant, Newborn ,Infant ,medicine.disease ,United States ,Clinical trial ,Treatment Outcome ,Anesthesia ,Female ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Background— Supraventricular tachycardia (SVT) is one of the most common conditions requiring emergent cardiac care in children, yet its management has never been subjected to a randomized controlled clinical trial. The purpose of this study was to compare the efficacy and safety of the 2 most commonly used medications for antiarrhythmic prophylaxis of SVT in infants: digoxin and propranolol. Methods and Results— This was a randomized, double-blind, multicenter study of infants P =0.25). No first recurrence occurred after 110 days of treatment. The 6-month recurrence-free status was 79% for patients on digoxin and 67% for patients on propranolol ( P =0.34), and there were no first recurrences in either group between 6 and 12 months. There were no deaths and no serious adverse events related to study medication. Conclusions— There was no difference in SVT recurrence in infants treated with digoxin versus propranolol. The current standard practice may be treating infants longer than required and indicates the need for a placebo-controlled trial. Clinical Trial Registration Information— http://clinicaltrials.gov ; NCT-00390546.
- Published
- 2012
45. Design and Testing of a Percutaneously Implantable Fetal Pacemaker
- Author
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Raymond A. Peck, Anjana Krishnan, Ramen H. Chmait, Kaihui Zheng, Li Zhou, Adriana Nicholson, Gerald E. Loeb, Yaniv Bar-Cohen, Michael J. Silka, and Jay D. Pruetz
- Subjects
Pacemaker, Artificial ,medicine.medical_specialty ,Heart block ,Hydrops Fetalis ,medicine.medical_treatment ,Biomedical Engineering ,Article ,Congenital heart block ,Cardiac pacemaker ,Fetus ,Internal medicine ,Hydrops fetalis ,Materials Testing ,medicine ,Animals ,Lead (electronics) ,business.industry ,Cardiac Pacing, Artificial ,Equipment Design ,medicine.disease ,Electrodes, Implanted ,Ultrasonic imaging ,Heart Block ,Fetal movement ,Cardiology ,Rabbits ,business - Abstract
We are developing a cardiac pacemaker with a small, cylindrical shape that permits percutaneous implantation into a fetus to treat complete heart block and consequent hydrops fetalis, which can otherwise be fatal. The device uses off-the-shelf components including a rechargeable lithium cell and a highly efficient relaxation oscillator encapsulated in epoxy and glass. A corkscrew electrode made from activated iridium can be screwed into the myocardium, followed by release of the pacemaker and a short, flexible lead entirely within the chest of the fetus to avoid dislodgement from fetal movement. Acute tests in adult rabbits demonstrated the range of electrical parameters required for successful pacing and the feasibility of successfully implanting the device percutaneously under ultrasonic imaging guidance. The lithium cell can be recharged inductively as needed, as indicated by a small decline in the pulsing rate.
- Published
- 2012
46. A Contemporary Assessment of the Risk for Sudden Cardiac Death in Patients With Congenital Heart Disease
- Author
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Yaniv Bar-Cohen and Michael J. Silka
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Heart disease ,Transposition of Great Vessels ,Risk Assessment ,Sudden death ,Sudden cardiac death ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Risk factor ,Tetralogy of Fallot ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,United States ,Cardiac surgery ,Death, Sudden, Cardiac ,Aortic valve stenosis ,Heart failure ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Assessment of the risk for sudden cardiac death (SCD) after surgery for congenital heart disease (CHD) remains a difficult challenge. In the study of this problem, the focus has evolved from concern regarding late-onset heart block to a subsequent focus on ventricular and reentrant atrial arrhythmias, with the most recent emphasis on ventricular dysfunction and heart failure. Sudden cardiac death in CHD patients has been studied most extensively in tetralogy of Fallot. More than 30 risk factors have been proposed, with age at repair, QRS duration, right ventricular enlargement, and left ventricular dysfunction considered the most predictive risk factors. Additionally, SCD has been studied in patients with atrial repair for transposition of the great arteries, left heart obstructive lesions, and to a limited extent, patients with univentricular physiology. This review discusses current risk factors for SCD in CHD and the limited positive predictive value of any individual factor. The emphasis is on contemporary patients with CHD, who differ markedly from those who had repair of CHD decades earlier. This is characterized by complete repairs during the neonatal period, improved physiologic outcomes, and extended survival of patients with complex forms of CHD. Therefore, earlier data and conclusions may not be relevant to newer generations of patients with CHD. According to current perspectives, systemic ventricular dysfunction becomes a major risk factor beyond the age of 20 years. The first symptomatic arrhythmia may result in SCD, and defibrillators are increasingly implanted despite the lack of risk stratification criteria. The large number of potential risk factors and therapeutic options, in contrast to the low incidence of actual events, results in a difficult clinical challenge in the assessment of the risk for SCD in the individual patient with CHD.
- Published
- 2012
47. Tachycardia-Induced Cardiomyopathy in a 1-Month-Old Infant
- Author
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Yaniv Bar-Cohen and Joseph C. Mares
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,lcsh:RJ1-570 ,Cardiomyopathy ,lcsh:Pediatrics ,Case Report ,Dilated cardiomyopathy ,General Medicine ,medicine.disease ,New onset ,Tachycardia-induced cardiomyopathy ,Heart failure ,cardiovascular system ,medicine ,cardiovascular diseases ,Supraventricular tachycardia ,business - Abstract
Supraventricular tachycardia (SVT) is the most common arrhythmia in children and is especially common in infants. SVT is typically thought of as an acute condition; however, if unrecognized, a persistent tachyarrhythmia can progress to a state of cardiac contractile dysfunction known as tachycardia-induced cardiomyopathy. A high index of suspicion for an underlying arrhythmia is needed in the workup of any patient with new onset heart failure, and the 12-lead electrocardiogram can aid in the diagnosis. While this may be a rare cause of dilated cardiomyopathy and heart failure in children, the condition is usually reversible and should be considered in infants and young children.
- Published
- 2012
48. MULTIPLE GENETIC VARIANTS IN CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA: A CLINICAL AND MOLECULAR REPORT FROM THE PACES CPVT REGISTRY
- Author
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Christopher D. Anderson, Yung R. Lau, Yaniv Bar-Cohen, Thomas M. Roston, Anjan S. Batra, Roman Gebauer, Shubhayan Sanatani, J.E. Potts, Susan P. Etheridge, Omid Haji-Ghassemi, Martin J. LaPage, F. Van Petegem, and Kathleen R. Maginot
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Genetic variants ,Cardiology and Cardiovascular Medicine ,Catecholaminergic polymorphic ventricular tachycardia ,medicine.disease ,business - Published
- 2018
49. Permanent Atrioventricular Block After a Motor Vehicle Accident
- Author
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Yaniv Bar-Cohen and Michael J. Silka
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Thoracic Injuries ,Injury control ,business.industry ,Accidents, Traffic ,Poison control ,Human factors and ergonomics ,Wounds, Nonpenetrating ,Critical Care and Intensive Care Medicine ,medicine.disease ,Suicide prevention ,Occupational safety and health ,Vehicle accident ,Injury prevention ,Emergency medicine ,medicine ,Humans ,Surgery ,Atrioventricular Block ,business ,Atrioventricular block - Published
- 2010
50. Pediatric Nonpost-Operative Junctional Ectopic Tachycardia
- Author
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Thomas Paul, Volkan Tuzcu, Jennifer N. Avari, Christopher S. Snyder, Ian H. Law, Yaniv Bar-Cohen, Michael Schaffer, Susan P. Etheridge, Leonardo Liberman, Ronn E. Tanel, Richard T. Smith, George F. Van Hare, Robert J. Hamilton, Naomi J. Kertesz, Bahram Kakavand, Shubhayan Sanatani, Narayanswami Sreeram, Terrence Chun, Kathryn K. Collins, Charles I. Berul, Anne M. Dubin, Luis Arabia, and Anne Fournier
- Subjects
Tachycardia ,medicine.medical_specialty ,business.industry ,Radiofrequency ablation ,medicine.medical_treatment ,Catheter ablation ,Cryoablation ,030204 cardiovascular system & hematology ,Ablation ,medicine.disease ,Amiodarone ,3. Good health ,Surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Junctional ectopic tachycardia ,medicine ,030212 general & internal medicine ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine ,Junctional rhythm ,medicine.drug - Abstract
Objectives To determine the outcomes of medical management, pacing, and catheter ablation for the treatment of nonpost-operative junctional ectopic tachycardia (JET) in a pediatric population. Background Nonpost-operative JET is a rare tachyarrhythmia that is associated with a high rate of morbidity and mortality. Most reports of clinical outcomes were published before the routine use of amiodarone or ablation therapies. Methods This is an international, multicenter retrospective outcome study of pediatric patients treated for nonpost-operative JET. Results A total of 94 patients with JET and 5 patients with accelerated junctional rhythm (age 0.8 year, range fetus to 16 years) from 22 institutions were identified. JET patients presenting at age ≤6 months were more likely to have incessant JET and to have faster JET rates. Antiarrhythmic medications were utilized in a majority of JET patients (89%), and of those, amiodarone was the most commonly reported effective agent (60%). Radiofrequency ablation was conducted in 17 patients and cryoablation in 27, with comparable success rates (82% radiofrequency vs. 85% cryoablation, p = 1.0). Atrioventricular junction ablation was required in 3% and pacemaker implantation in 14%. There were 4 (4%) deaths, all in patients presenting at age ≤6 months. Conclusions Patients with nonpost-operative JET have a wide range of clinical presentations, with younger patients demonstrating higher morbidity and mortality. With current medical, ablative, and device therapies, the majority of patients have a good clinical outcome.
- Published
- 2009
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