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Arrhythmias in children with ventricular assist devices

Published online by Cambridge University Press:  26 November 2013

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

Abstract

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

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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