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Danville, PA, United States

Turner C.J.,Heart Center for Children | Stephenson E.A.,University of Toronto
Current Treatment Options in Cardiovascular Medicine | Year: 2012

The vast majority of implantable cardioverter defibrillators (ICDs) continue to be implanted in the adult population. Accordingly, manufacturers develop devices and leads primarily for the adult population. Whilst the number of ICDs implanted in children is small in comparison, the potential benefits are large to this group. It is a common frustration among pediatric cardiologists whom implant devices that impressive technological developments continue to be developed for the adult population; as the population of children with ICDs is small, robust clinical studies often lag behind. By necessity, pediatric cardiologists and cardiothoracic surgeons have developed innovative techniques utilizing adult components in unusual configurations for children with complex congenital heart disease. As in the adult population, inappropriate shocks are one of the most limiting and concerning complications in the use of ICDs. Unfortunately, as will be discussed below, children are at increased risk of inappropriate shocks when compared with adults. The true impact of inappropriate shocks is increasingly being realized, and much of the focus in management of children with ICDs surrounds the prevention of inappropriate shocks.

Turner C.J.,Heart Center for Children | Wren C.,Freeman Hospital
Journal of Paediatrics and Child Health | Year: 2013

Aim Cardiac arrhythmias are an important cause of morbidity in infants. Although the spectrum of types of arrhythmia has been reported, there has been no previous population-based study of the incidence of arrhythmias in infancy. Our aim was to define the population incidence of arrhythmia in infants. Methods We based this study on the Northern Region of England with a resident population of 3.1 million and an annual live birth rate of 33 000. We identified all clinically significant arrhythmias in infants in 1991-2010 from the regional cardiac database. All diagnoses were based on analysis of the electrocardiogram. Infants with only the substrate for arrhythmia (such as QT prolongation or ventricular pre-excitation) were excluded. Results In 20 years, there were 662 698 live births. We identified 162 cases of newly diagnosed arrhythmia of which 22 had associated structural cardiovascular malformations. The incidence of arrhythmia was 24.4 per 100 000 live births. The most common arrhythmia was atrioventricular re-entry tachycardia with an incidence of 16.3 per 100 000. Complete atrioventricular block and atrial flutter both occurred at 2.1 cases per 100 000 live births, and other arrhythmias were rare. Conclusions This study is the first to report a population incidence of arrhythmia in infants. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Philipson S.,University of New South Wales | Wakefield C.E.,University of New South Wales | Wakefield C.E.,Center for Childrens Cancer and Blood Disorders | Kasparian N.A.,University of New South Wales | Kasparian N.A.,Heart Center for Children
Journal of Women's Health | Year: 2011

Background: Use of the oral contraceptive pill (OCP) is associated with numerous health benefits as well as risks, and it is important that women take these into consideration when making informed contraceptive choices. Methods: A questionnaire assessing contraceptive practices, knowledge and beliefs about the risks and benefits of OCP use, and information needs and preferences was distributed to 1200 Australian women aged 18-50 years. Results: Of the 305 women who returned the questionnaire, 93% had used the OCP at some time in their lives, with 32% reporting current usage. Only 50% of women reported satisfaction with previously accessed information about the OCP. Less than 40% of the sample reported a high level of confidence in their knowledge of the risks, benefits, and side effects of OCP use. Factors associated with greater OCP knowledge included being married (β=1.74, 95% confidence interval [CI] 1.11-2.72), having a university education (β=2.20, 95% CI 1.49-3.24), longer duration of OCP use (β=1.06, 95% CI 1.02-1.09), and having greater confidence in one's knowledge about the OCP (β=1.70, 95% CI 1.38-2.09), whereas depressive symptoms were associated with lower knowledge (β=0.93, 95% CI 0.88-0.99). Preferred formats for the communication of OCP-related information were the internet and an information booklet. Conclusions: The findings provide an evidence base for the future development of simple and appropriate tools by which to communicate information about the health benefits and risks of OCP use to women. © 2011, Mary Ann Liebert, Inc.

Gill M.C.,Heart Center for Children | O'Shaughnessy K.,Heart Center for Children
Perfusion (United Kingdom) | Year: 2013

Background: Neonatal extracorporeal membrane oxygenation (ECMO) patients are particularly vulnerable to the effects of uncompensated insensible water loss resulting in hypernatraemia. There exists a long-standing relationship between hypernatraemia and varying degrees of cerebral dysfunction. The aim of this study is to explore the degree to which free water loss occurs across a commonly used ECMO oxygenator, the polymethylpentene (PMP) membrane Hilite® 2400LT (Medos, Medizintechnik AG, Stolberg, Germany). The secondary aim is to assess to what extent the addition of heat and/ or humidity ameliorates this water loss. Methods: An ECMO circuit consisting of a centrifugal pump and a Hilite® 2400LT oxygenator was primed with crystalloid and albumin. Each experimental trial was carried out in triplicate, with gas flow rates of 1, 3 and 4.8 L/min being investigated. Fluid loss was assessed at six time points over a 24-hour period. Results: Water loss increased significantly from 1 to 3 L/min gas flow (p=0.05) and from 3 to 4.8 L/min gas flow (p=0.025). The mean water loss differences between the differing gas flow trials per L/min gas flow were non-significant (72.4 ±3.9 ml/24hrs). The effect of heating the gas to 37°C did not significantly alter water loss, whereas heat and humidity reduced water loss significantly (p=0.009). Conclusions: Insensible water loss from a Hilite® 2400LT oxygenator is approximately 72 ml/day per L/min gas flow over 24 hrs. Heating and humidifying the gas reduces the fluid loss significantly to approximately 8 ml/L/min gas flow over 24 hrs (p=0.009). © The Author(s) 2012.

Turner C.J.,Heart Center for Children | Lau K.C.,Heart Center for Children | Sholler G.F.,University of Sydney
Cardiology in the Young | Year: 2012

Background Despite the increasing utilisation of interventional electrophysiology in adults and older children with arrhythmias, there are few data reflecting the safety and efficacy of this procedure in the age group under 2 years. Aim We describe our experience in assessing the efficacy and safety with this group of children. Methods We undertook a retrospective review of all infants under 2 years of age who underwent an interventional electrophysiology procedure between 1995 and 2009 to determine indications, procedural details, short- and long-term success, and complication rate. Results A total of 23 interventional electrophysiology procedures were performed in 17 patients initially under 2 years of age. Of these, three patients had congenital heart disease. The most common indication was arrhythmia resistant to pharmacological agents (59%), with the remaining cases being arrhythmia complicated by cardiovascular instability (41%). There was initial success in 15 patients after the first procedure, with early recurrence in four. Following six repeat procedures, there was long-term success in 15 patients (88%), with three repeat procedures being performed after 2 years of age. There was one non-procedural death related to persisting arrhythmia. There were three minor complications. In one patient, cryotherapy was used successfully. Conclusions The interventional electrophysiology procedure is a viable therapeutic option in infants under 2 years with arrhythmia resistant to other conventional medical management. © Copyright 2012 Cambridge University Press.

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