9 results on '"Mark, Shwayder"'
Search Results
2. Third Trimester Fetal Heart Rates in Antibody-Mediated Complete Heart Block Predict Need for Neonatal Pacemaker Placement
- Author
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John C. Wood, Michael J. Silka, Justin Pick, Mark Shwayder, Jay D. Pruetz, Yaniv Bar-Cohen, and Allison C. Hill
- Subjects
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
- Published
- 2021
3. Ectopic Atrial Tachycardia in Infants Following Congenital Heart Disease Surgery
- Author
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Jonathan Uniat, Allison C. Hill, Mark Shwayder, Michael J. Silka, and Yaniv Bar-Cohen
- Subjects
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.
- Published
- 2022
4. Difficulties with invasive risk stratification performed under anesthesia in pediatric Wolff-Parkinson-White Syndrome
- Author
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Shubhayan Sanatani, Susan P. Etheridge, Ian H. Law, Carolina A. Escudero, Brynn E. Dechert, James C. Perry, Andrew D. Blaufox, Anne M. Dubin, Mark Shwayder, and Kathryn K. Collins
- Subjects
Male ,Adolescent ,Population ,Subgroup analysis ,Accessory pathway ,030204 cardiovascular system & hematology ,Risk Assessment ,Sudden death ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Physiology (medical) ,medicine ,Humans ,Anesthesia ,030212 general & internal medicine ,Child ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Effective refractory period ,Atrial fibrillation ,Gold standard (test) ,medicine.disease ,Female ,Wolff-Parkinson-White Syndrome ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Children with Wolff-Parkinson-White Syndrome (WPW) are at risk for sudden death. The gold standard for risk stratification in this population is the shortest pre-excited RR interval during atrial fibrillation (SPERRI). Objective The purpose of this study was to determine how closely measurements made in the electrophysiology laboratory in patients with WPW compared to SPERRI obtained during an episode of clinical pre-excited atrial fibrillation (Clinical-SPERRI). Methods This was a subgroup analysis of a multicenter study of children with WPW. Subjects in our study (N = 49) were included if they had Clinical-SPERRI measured in addition to 1 or more of 3 surrogate measurements: SPERRI obtained during electrophysiological study (EP-SPERRI), accessory pathway effective refractory period (APERP), or shortest pre-excited paced cycle length with 1:1 conduction (SPPCL). Results Seventy percent of electrophysiological measurements were made with patients under general anesthesia. Clinical-SPERRI moderately correlated with EP-SPERRI (r = 0.495; P = .012). However, 24% of our patients with Clinical-SPERRI ≤250 ms would have been misclassified as having a low-risk pathway based on EP-SPERRI >250 ms. Clinical-SPERRI did not correlate with APERP or SPPCL (r .1). Mean EP-SPERRI, APERP, and SPPCL all were greater than Clinical-SPERRI. Conclusion Electrophysiology laboratory measurements of pathway characteristics made with patients under general anesthesia do not correlate well with Clinical-SPERRI. Of APERP, SPPCL, and EP-SPERRI, only EP-SPERRI had moderate correlation with Clinical-SPERRI. This study questions the predictive ability of invasive risk stratification with patients under general anesthesia, given that 24% of patients with high-risk Clinical-SPERRI (≤250 ms) had EP-SPERRI that may be considered low risk (>250 ms).
- Published
- 2020
5. Third Trimester Fetal Heart Rates in Antibody-Mediated Complete Heart Block Predict Need for Neonatal Pacemaker Placement
- Author
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Justin, Pick, Michael J, Silka, Yaniv, Bar-Cohen, Allison, Hill, Mark, Shwayder, John, Wood, and Jay D, Pruetz
- Subjects
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
6. Life-Threatening Event Risk in Children With Wolff-Parkinson-White Syndrome
- Author
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Kara S. Motonaga, Shubhayan Sanatani, Elizabeth A. Stephenson, Orhan Uzun, Peter Kubuš, Naomi J. Kertesz, Anne M. Dubin, Sara Sami, Stephen P. Seslar, Ian H. Law, Michel Cabrera, Jeremy P. Moore, Susan P. Etheridge, Shaji C. Menon, Andrew D. Blaufox, Christopher C. Erickson, Luciana Marcondes, Jennifer R. Maldonado, Scott R. Ceresnak, Jonathan R. Skinner, Bryan C. Cannon, Brynn E. Dechert-Crooks, Santiago O. Valdes, Ronn E. Tanel, Peter F. Aziz, Mitchell I. Cohen, Mark Abcede, Hiroko Asakai, Kathryn K. Collins, James C. Perry, Zebulon Z. Spector, David J. Bradley, Lu Ann Mill, Mark Shwayder, and Carolina A. Escudero
- Subjects
Tachycardia ,Pediatrics ,medicine.medical_specialty ,Multivariate analysis ,business.industry ,RR interval ,Effective refractory period ,Atrial fibrillation ,Accessory pathway ,030204 cardiovascular system & hematology ,medicine.disease ,Sudden death ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,030212 general & internal medicine ,medicine.symptom ,business ,Event risk - Abstract
Objectives This study sought to characterize risk in children with Wolff-Parkinson-White (WPW) syndrome by comparing those who had experienced a life-threatening event (LTE) with a control population. Background Children with WPW syndrome are at risk of sudden death. Methods This retrospective multicenter pediatric study identified 912 subjects ≤21 years of age with WPW syndrome, using electrophysiology (EPS) studies. Case subjects had a history of LTE: sudden death, aborted sudden death, or atrial fibrillation (shortest pre-excited RR interval in atrial fibrillation [SPERRI] of ≤250 ms or with hemodynamic compromise); whereas subjects did not. We compared clinical and EPS data between cases and subjects. Results Case subjects (n = 96) were older and less likely than subjects (n = 816) to have symptoms or documented tachycardia. Mean age at LTE was 14.1 ± 3.9 years of age. The LTE was the sentinel symptom in 65%, consisting of rapidly conducted pre-excited atrial fibrillation (49%), aborted sudden death (45%), and sudden death (6%). Three risk components were considered at EPS: SPERRI, accessory pathway effective refractory period (APERP), and shortest paced cycle length with pre-excitation during atrial pacing (SPPCL), and all were shorter in cases than in control subjects. In multivariate analysis, risk factors for LTE included male sex, Ebstein malformation, rapid anterograde conduction (APERP, SPERRI, or SPPCL ≤250 ms), multiple pathways, and inducible atrial fibrillation. Of case subjects, 60 of 86 (69%) had ≥2 EPS risk stratification components performed; 22 of 60 (37%) did not have EPS-determined high-risk characteristics, and 15 of 60 (25%) had neither concerning pathway characteristics nor inducible atrioventricular reciprocating tachycardia. Conclusions Young patients may experience LTE from WPW syndrome without prior symptoms or markers of high-risk on EPS.
- Published
- 2018
7. EP News: Pediatric and Congenital EP
- Author
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Mark Shwayder
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,Physiology (medical) ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
8. Life-Threatening Event Risk in Children With Wolff-Parkinson-White Syndrome: A Multicenter International Study
- Author
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Susan P, Etheridge, Carolina A, Escudero, Andrew D, Blaufox, Ian H, Law, Brynn E, Dechert-Crooks, Elizabeth A, Stephenson, Anne M, Dubin, Scott R, Ceresnak, Kara S, Motonaga, Jonathan R, Skinner, Luciana D, Marcondes, James C, Perry, Kathryn K, Collins, Stephen P, Seslar, Michel, Cabrera, Orhan, Uzun, Bryan C, Cannon, Peter F, Aziz, Peter, Kubuš, Ronn E, Tanel, Santiago O, Valdes, Sara, Sami, Naomi J, Kertesz, Jennifer, Maldonado, Christopher, Erickson, Jeremy P, Moore, Hiroko, Asakai, LuAnn, Mill, Mark, Abcede, Zebulon Z, Spector, Shaji, Menon, Mark, Shwayder, David J, Bradley, Mitchell I, Cohen, and Shubhayan, Sanatani
- Subjects
Male ,Death, Sudden ,Adolescent ,Risk Factors ,Atrial Fibrillation ,Humans ,Female ,Wolff-Parkinson-White Syndrome ,Child ,Retrospective Studies - Abstract
This study sought to characterize risk in children with Wolff-Parkinson-White (WPW) syndrome by comparing those who had experienced a life-threatening event (LTE) with a control population.Children with WPW syndrome are at risk of sudden death.This retrospective multicenter pediatric study identified 912 subjects ≤21 years of age with WPW syndrome, using electrophysiology (EPS) studies. Case subjects had a history of LTE: sudden death, aborted sudden death, or atrial fibrillation (shortest pre-excited RR interval in atrial fibrillation [SPERRI] of ≤250 ms or with hemodynamic compromise); whereas subjects did not. We compared clinical and EPS data between cases and subjects.Case subjects (n = 96) were older and less likely than subjects (n = 816) to have symptoms or documented tachycardia. Mean age at LTE was 14.1 ± 3.9 years of age. The LTE was the sentinel symptom in 65%, consisting of rapidly conducted pre-excited atrial fibrillation (49%), aborted sudden death (45%), and sudden death (6%). Three risk components were considered at EPS: SPERRI, accessory pathway effective refractory period (APERP), and shortest paced cycle length with pre-excitation during atrial pacing (SPPCL), and all were shorter in cases than in control subjects. In multivariate analysis, risk factors for LTE included male sex, Ebstein malformation, rapid anterograde conduction (APERP, SPERRI, or SPPCL ≤250 ms), multiple pathways, and inducible atrial fibrillation. Of case subjects, 60 of 86 (69%) had ≥2 EPS risk stratification components performed; 22 of 60 (37%) did not have EPS-determined high-risk characteristics, and 15 of 60 (25%) had neither concerning pathway characteristics nor inducible atrioventricular reciprocating tachycardia.Young patients may experience LTE from WPW syndrome without prior symptoms or markers of high-risk on EPS.
- Published
- 2017
9. PRACTICE VARIATION IN THE MANAGEMENT OF CONGENITAL AORTIC VALVE DISEASE IN NEW ENGLAND
- Author
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Scott B. Yeager and Mark Shwayder
- Subjects
Aortic valve disease ,medicine.medical_specialty ,Variation (linguistics) ,New england ,business.industry ,Internal medicine ,medicine ,Cardiology ,business ,Cardiology and Cardiovascular Medicine - Published
- 2015
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