Spontaneous resolution of ventricular tachycardia with right bundle branch block morphology: a case report

Ventricular tachycardia is rare in children. In the absence of structural heart disease, ventricular tachycardia is known as idiopathic ventricular tachycardia and carries a good prognosis. We report a 14-month-old male child with right bundle branch block incessant ventricular tachycardia without structural heart disease. In this patient ventricular tachycardia was controlled by amiodarone and disappeared during follow-up. We want to stress the benign nature of this tachycardia if the previous treatment protocol had been appropriate

Sinus node dysfunction in children and adolescents: treatment by implantation of a permanent pacemaker in 26 patients

Sinus node dysfunction has been reported rarely in pediatric patients with structurally normal hearts. It has been diagnosed with increasing frequency in children and young adult patients with congenital heart defect, especially in patients who have undergone corrective cardiac surgery related with atrial tissue. Between 1984-1999, 26 patients who were under 22 years of age underwent implantation of a permanent pacemaker for treatment of sinus node dysfunction at our medical center. This subset of patients represents 18.5% of all patients who required permanent pacemakers during this time. The mean age of the 17 male and 9 female patients at initial implantation was 9.2+/-6 years (range, 0.5 to 22 years). Of the 26 patients, 18 (69%) had associated cardiovascular disease and in 11 (34.6%) patients, sinus node dysfunction developed after a cardiac operation. The patients were followed up for a total 1,227 (47+/-45, range 2-176, median 34) pacing months. All symptomatic patients noted a resolution of symptoms after pacing had been performed, and they remained free of symptoms at the latest follow-up examination. Mean acute pacing thresholds and mean latest pacing thresholds for the endocardial atrial and ventricular leads, mean acute impedance and mean latest impedance for the endocardial atrial and ventricular leads and mean acute p wave voltage and the latest p wave voltage did not differ significantly. In this report, we review our experience in children who required implantation of a permanent pacemaker for treatment of sinus node dysfunction during a 15-year period

Incidence of dysrhythmias in congenitally corrected transposition of the great arteries

We reviewed hospital records of 45 children with corrected transposition of the great arteries (c-TGA) to determine the incidence and outcome of congenital and postoperative dysrhythmias seen in this congenital anomaly. Our study comprised 45 patients (12 girls, 33 boys). The mean age of the patients at initial evaluation was 3.4 +/- 3.7 years, and they were followed for a mean period of 3.5 +/- 4 years. Forty-three patients (95%) with c-TGA had associated intracardiac defects. Two patients (5%) did not have any cardiac defects. In 31 (69%) of the 45 patients, ventricular septal defect (VSD) was present, while the remaining 14 patients (31%) had intact ventricular septum. VSD repair was done in 17 of 31 patients. Different types of dysrhythmias were detected in 19 of 45 patients. Six patients (13%) presented initially with congenital complete atrioventricular block (AVB) and five patients with postoperative complete ve AVB. Pacemaker implantation was required for 11 patients with complete AVB. In eight patients, ventricular and supraventricular ectopic beats, left bundle-branch block (LBBB) and first-degree AVB were determined but therapy was not required. TWenty-five (58%) of 43 patients with intracardiac defects underwent different surgical procedures. Permanent pacemaker implantation was required for five patients (29%) after VSD repair (17 patients) due to postoperative complete AVB. The incidence of congenital AVB in 14 patients with intact ventricular septum was found to be high (29%) in comparison to the group with VSD (6%). Patients diagnosed as c-TGA with or without cardiac defects should be followed carefully during their clinical course to identify and treat different types of dysrhythmias that can appear at any time

Complications and outcome in left-sided endocarditis in children

We retrospectively assessed the clinical course and outcome of left-sided endocarditis in pediatric patients to find out the prognostic significance of the presence and size of echocardiographically detected vegetations. Among the children admitted to our institution with endocarditis between January 1987 and October 1999, 16 patients (mean age 9.03 +/- 4.95 years) who met the Duke criteria for the diagnosis of infective endocarditis (IE) were included in this study. Rheumatic valvular disease was the most frequent underlying heart disease (10 patients: 62.5%). Five patients were operated at a mean of 13.9 months before endocarditis, and all had residual defects. Vegetation was detected in 11 cases (69%). Ten patients had major complications (within 2 weeks in 6 patients). Three patients developed congestive heart failure (CHF), six had intracranial and one had lower extremity emboli. Among them four were operated because of complications (CHF: 3 cases, intracranial emboli: 1 case). All the operated cases are doing well. The association between intracranial embolic events and echocardiographically detected vegetations was determined by calculating specificity (40%), sensitivity (100%), positive predictive value (50%), and negative predictive value (100%). No intracranial embolism occurred in patients without vegetations. All vegetations were < or = 6 mm in patients with systemic embolism. There were four deaths, three of which were because of intracranial embolism. This study suggests that intracranial emboli have a major risk of mortality in left-sided endocarditis. The larger size of the vegetation is not a predictor of complications; furthermore, the absence of vegetations predicts that the patient is safe from embolic events. Therefore all patients with left-sided IE should be considered for earlier surgical intervention