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Anne Fournier

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chongqing major

University of Santo Tomas, Phils

The University of Georgia

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University of Pittsburgh School of Medicine

St George's, University of London

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Papers by Anne Fournier

Shock to the Heart: Psychosocial Implications and Applications of Sudden Cardiac Death in the Young

Current Cardiology Reports

Purpose of Review Although rare, sudden cardiac death (SCD) in the young is a tragic event, havin... more Purpose of Review Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impact upon all involved. The psychosocial burden associated with SCD can leave friends, families, and entire communities bereft. With only limited evidence to describe the volatile emotional reactions associated with a young SCD, there is an urgent need for care providers to better understand the psychological complexities and impacts faced by both at-risk individuals and those directly affected by these tragic events. Recent Findings Current knowledge of the psychosocial implications associated with SCD in the young has recently generated interest in the cardiovascular community, with the goal of addressing prevention strategies (screening), family bereavement, and the psychological impact of at-risk or surviving individuals. With the emergence of novel strategies aimed at reducing the public health impact of SCD in the young, further discussion regarding the psychosocial impact of SCD, encompassing prevention, survivorship, and the downstream communal effects of a young death is required. Support systems and intervention could assist in the management of the associated psychosocial burden, yet there is a lack of clinical guidelines to direct this form of care. Summary There is an important need for multidisciplinary collaboration across subspecialties to provide support to grieving individuals and manage patient well-being throughout the screening process for SCD. This collaborative approach requires the integration of cardiovascular and psychological expertise where relevant.

Shock to the Heart: Psychosocial Implications and Applications of Sudden Cardiac Death in the Young

Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impac... more Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impact upon all involved. The psychosocial burden associated with SCD can leave friends, families, and entire communities bereft. With only limited evidence to describe the volatile emotional reactions associated with a young SCD, there is an urgent need for care providers to better understand the psychological complexities and impacts faced by both at-risk individuals and those directly affected by these tragic events. Current knowledge of the psychosocial implications associated with SCD in the young has recently generated interest in the cardiovascular community, with the goal of addressing prevention strategies (screening), family bereavement, and the psychological impact of at-risk or surviving individuals. With the emergence of novel strategies aimed at reducing the public health impact of SCD in the young, further discussion regarding the psychosocial impact of SCD, encompassing preven...

Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children

The Canadian journal of cardiology, 2018

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, asses... more Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hyper...

Pulse oximetry screening in newborns to enhance detection of critical congenital heart disease

Paediatrics & child health, 2017

Pulse oximetry screening is safe, noninvasive, easy to perform and proven to enhance detection of... more Pulse oximetry screening is safe, noninvasive, easy to perform and proven to enhance detection of critical congenital heart disease in newborns. However, this test has yet to be adopted as routine practice in Canada. The present practice point highlights essential details and recommendations for screening, which research has shown to be highly specific, with low false-positive rates. Optimal screening for critical congenital heart disease should include prenatal ultrasound, physical examination and pulse oximetry screening. Screening should be performed between 24 hours and 36 hours postbirth, using the infant's right hand and either foot to minimize false-positive results. Newborns with abnormal results should undergo a thorough evaluation by the most responsible health care provider. When a cardiac diagnosis cannot be excluded, referral to a paediatric cardiologist for consultation and echocardiogram is advised.

Hypertension Canada's 2017 Guidelines for the Diagnosis, Assessment, Prevention, and Treatment of Pediatric Hypertension

Canadian Journal of Cardiology, 2017

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, asses... more Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be

Incidence Rate and Epidemiological and Clinical Aspects of Kawasaki Disease in Children of Maghrebi Origin in the Province of Quebec, Canada, Compared to the Country of Origin

Global pediatric health, 2016

The incidence of Kawasaki disease in Maghreb countries is apparently low, unlike those living in ... more The incidence of Kawasaki disease in Maghreb countries is apparently low, unlike those living in the province of Quebec, Canada. This retrospective study compared Maghrebi children living in Quebec to the countries of origin, Morocco, Algeria, and Tunisia. The annualized incidence rate in Quebec (18.49/year/100 000 children under 5 years of age) was 4 to 12 times higher than in Tunisia, Morocco, and Algeria (0.95, 4.52, and 3.15, respectively). The prevalence of incomplete diagnostic criteria was higher in Quebec at 39%, Morocco 43%, and Tunisia 39% compared to Algeria at 8%, with minimal delayed diagnosis (7%) only in Quebec compared to 30%, 35%, and 62%, respectively (P < .001). The rate of coronary aneurysms was comparable however (11% in Quebec vs 4%, 10%, and 25%, in Tunisia, Morocco, and Algeria, respectively; P = .31). The higher incidence of Kawasaki disease in the Maghreb community in Quebec versus the countries of origin seems due to underdiagnosis, which represents a p...

Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease

The Canadian journal of cardiology, Feb 1, 2017

Congenital heart disease is the most common congenital malformation and approximately 3 in 1000 n... more Congenital heart disease is the most common congenital malformation and approximately 3 in 1000 newborns have critical congenital heart disease (CCHD). Timely diagnosis affects morbidity, mortality, and disability, and newborn pulse oximetry screening has been studied to enhance detection of CCHD. In this position statement we present an evaluation of the literature for pulse oximetry screening. Current detection strategies including prenatal ultrasound examination and newborn physical examination are limited by low diagnostic sensitivity. Pulse oximetry screening is safe, noninvasive, easy to perform, and widely available with a high specificity (99.9%) and moderately high sensitivity (76.5%). When an abnormal saturation is obtained, the likelihood of having CCHD is 5.5 times greater than when a normal result is obtained. The use of pulse oximetry combined with current strategies has shown sensitivities of up to 92% for detecting CCHD. False positive results can be minimized by scr...

The clinical and genetic spectrum of catecholaminergic polymorphic ventricular tachycardia: findings from an international multicentre registry

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Mar 31, 2017

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an ion channelopathy characterize... more 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. This is a Pediatric and Congenital Electrophysiology Society multicentre, retrospective cohort study of CPVT patients diagnosed at <19 years of age and their first-degree relatives. Genetic testing was undertaken in 194 of 236 subjects (82%) during 3.5 (1.4-5.3) years of follow-up. The majority (60%) had RyR2-associated CPVT1. Variant locations were predicted based on a 3D structural model of RyR2. Specific residues appear to have key structural importance, supported by an association between cardiac arres...

Importance of anatomical dominance in the evaluation of coronary dilatation in Kawasaki disease

Cardiology in the Young, 2016

Introduction In Kawasaki disease, although coronary dilatation is attributed to vasculitis, the e... more Introduction In Kawasaki disease, although coronary dilatation is attributed to vasculitis, the effect of myocardial inflammation is underestimated. Coronary dilatations are determined by Z-scores, which do not take into account dominance. The aim of the present study was to describe the impact of coronary dominance on dilatation in Kawasaki disease. Methods We performed a retrospective analysis of coronary dilatations according to angiography categorisation of dominance. Results Of 28 patients (2.6 [0.2–10.1] years), right dominance was present in 15 patients and left in 13. Early dilatation was present in all patients, of whom 11 were ipsilateral to the dominant segment and 17 contralateral. Ipsilateral dilatations were present at diagnosis (9/11 versus 6/17, p=0.02) compared with contralateral dilatations, which developed 2 weeks after diagnosis (9/11 versus 16/17, p=0.29). Coronary artery Z-scores of patients with contralateral dilatation increased at 2 weeks, before returning t...

Prenatal diagnosis and prognosis of accelerate idioventricular rhythm

Ultrasound in Obstetrics & Gynecology, 2016

Objectives As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on spe... more Objectives As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on specific electrocardiographic patterns, prenatal diagnosis of this condition is challenging and its true incidence is unknown. The objectives of this study were to evaluate the performance of prenatal ultrasonography in identifying intrauterine cardiocirculatory events linked to specific electrocardiographic signs of postnatal AIVR, including left or right ventricular origin, and to assess the prenatal prognosis of this arrhythmia. Methods We reviewed Doppler tracings from the superior vena cava/ascending aorta (SVC/Ao), ductus venosus (DV), ductus arteriosus (DA) and aortic isthmus (AoI), as well as simultaneous M-mode recordings of septal and left ventricular wall motions of fetuses diagnosed with AIVR from January 2004 to December 2014. Results Three cases of AIVR were identified among 27 912 fetuses. SVC/Ao Doppler flow recordings revealed atrioventricular dissociation (ventricular rates within 20% of atrial rates) in all three fetuses and episodes of isorhythmic atrioventricular dissociation in one, while M-mode confirmed normal left ventricular shortening fraction in all cases. Fusion beats were observed on AoI tracing in one fetus, while simultaneous recordings of AoI and DA revealed signs of right bundle branch block in one case and left bundle branch block in the other two. On DV Doppler recordings, retrograde a-waves in the presence of simultaneous atrial and ventricular contractions were observed in all three fetuses, leading to an increase in

Atrial Septal Defect Closure with Occlutech® ASD Fenestrated Device in a Child with Severe Pulmonary Hypertension

Pediatric Cardiology, 2016

We report a 5-year-old patient with severe pulmonary hypertension and a large secundum atrial sep... more We report a 5-year-old patient with severe pulmonary hypertension and a large secundum atrial septal defect who benefited from a percutaneous closure of the defect with an Occlutech(®) custom-made fenestrated device. Whereas the closure is technically identical to standard atrial defect closure, the immediate and midterm beneficial results are presented.

NT-proBNP diagnostic algorithm for Kawasaki Disease compared to AHA Algorithm

Pediatrics International, 2016

Diagnosis of Kawasaki disease (KD) can be challenging in the absence of a confirmatory test or pa... more Diagnosis of Kawasaki disease (KD) can be challenging in the absence of a confirmatory test or pathognomonic finding, especially when clinical criteria are incomplete. We recently proposed serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) as an adjunctive diagnostic test. We retrospectively tested a new algorithm to help KD diagnosis based on NT-proBNP, coronary artery dilation (CAD) at onset, and abnormal serum albumin or C-reactive protein (CRP). The goal was to assess the performance of the algorithm and compare its performance with that of the 2004 American Heart Association (AHA)/American Academy of Pediatrics (AAP) algorithm. The algorithm was tested on 124 KD patients with NT-proBNP measured on admission at the present institutions between 2007 and 2013. Age at diagnosis was 3.4 ± 3.0 years, with a median of five diagnostic criteria; and 55 of the 124 patients (44%) had incomplete KD. CA complications occurred in 64 (52%), with aneurysm in 14 (11%). Using this algorithm, 120/124 (97%) were to be treated, based on high NT-proBNP alone for 79 (64%); on onset CAD for 14 (11%); and on high CRP or low albumin for 27 (22%). Using the AHA/AAP algorithm, 22/47 (47%) of the eligible patients with incomplete KD would not have been referred for treatment, compared with 3/55 (5%) with the NT-proBNP algorithm (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). This NT-proBNP-based algorithm is efficient to identify and treat patients with KD, including those with incomplete KD. This study paves the way for a prospective validation trial of the algorithm.

Coronary Artery Dilatation in Viral Myocarditis Mimics Coronary Artery Findings in Kawasaki Disease

Pediatric Cardiology, 2016

Coronary artery (CA) dilatations are typical to Kawasaki disease (KD) in the pediatric population... more Coronary artery (CA) dilatations are typical to Kawasaki disease (KD) in the pediatric population. CA involvement is a useful feature to help establish the diagnosis of KD. Since myocarditis is omnipresent in the acute phase of KD, we sought to investigate whether viral myocarditis may cause CA dilatation. This retrospective study reviewed 14 consecutive patients diagnosed with acute myocarditis at CHU Sainte-Justine, Montreal. KD diagnosis was excluded for all patients. All echocardiography studies were reviewed by an independent experienced echocardiographer for CA size and myocardial function parameters. CA involvement was classified under three categories: definite dilatation (Z-score ≥2.5 in one or more CA), occult dilatation (Z-score variation ≥2 points for the same CA on two different echocardiograms, but maximum Z-score always &amp;amp;amp;amp;lt;2.5), and no dilatation otherwise. Demographics, laboratory values, microbial etiology testing, and diagnostic studies were collected from medical records. Mean age at presentation was 1.67 ± 3.22 years, where 11/14 (78 %) presented with acute and three with subacute myocarditis. Five (36 %) patients had normal CA measurements, six (43 %) had occult dilatation, and three (21 %) had definite dilatation. Maximal CA Z-score was within the first 8 days of presentation. Patients with viral myocarditis can present CA dilatation during the acute phase of the illness. This finding should be taken into account when KD diagnosis is being based on the CA involvement as the two illnesses may present with similar features.

Thromboprophylaxis for atrial arrhythmias in congenital heart disease: A multicenter study

International Journal of Cardiology, 2016

There is a paucity of data to guide decisions regarding thromboprophylaxis for atrial arrhythmias... more There is a paucity of data to guide decisions regarding thromboprophylaxis for atrial arrhythmias in congenital heart disease. A retrospective multicenter cohort study enrolled patients with documented sustained atrial arrhythmias and congenital heart disease from 12 North American centers to quantify thromboembolic and bleeding rates associated with antiplatelet and anticoagulation therapy, and explore associated factors. A blinded committee adjudicated all qualifying arrhythmias and outcomes. A total of 482 patients, 45.2% female, age 32.0±18.0years, were followed for 11.3±9.4years since the qualifying arrhythmia. Antiplatelet therapy was administered to 37.8%, anticoagulation to 54.4%, and neither to 7.9%. Congenital heart disease complexity was simple, moderate, and severe in 18.5%, 34.4%, and 47.1%, respectively. Freedom from thromboembolic events was 84.7±2.7% at 15years, with no difference between anticoagulation versus antiplatelet therapy (P=0.97). Congenital heart disease complexity was independently associated with thromboembolic events, with rates of 0.00%, 0.93%, and 1.95%/year in those with simple, moderate, and severe forms (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). CHADS2 and CHA2DS2-VASc scores were not predictive of thromboembolic risk. Annualized bleeding rates with antiplatelet and anticoagulation therapy were 0.66% and 1.82% (P=0.039). In multivariable analyses, anticoagulation [hazard ratio (HR) 4.76, 95% CI (1.05-21.58), P=0.043] and HAS-BLED score [HR 3.15, 95% CI (1.02, 9.78), P=0.047] were independently associated with major bleeds. Current management of atrial arrhythmias in congenital heart disease is associated with a modest rate of thromboembolic events, which is predicted by disease complexity but not CHADS2/CHA2DS2-VASc scores. HAS-BLED score is applicable to the congenital population in predicting major bleeds.

Catecholaminergic Polymorphic Ventricular Tachycardia in Children: An Analysis of Therapeutic Strategies and Outcomes from an International Multicenter Registry

Circulation Arrhythmia and Electrophysiology, Feb 24, 2015

Editorial see p 523 β-Blockers are the standard therapy in CPVT, 7,9,12 although evidence of trea... more

Hypertension Canada’s 2016 CHEP Guidelines for Blood Pressure Measurement, Diagnosis and Assessment of Risk of Pediatric Hypertension

Canadian Journal of Cardiology, 2016

We present the inaugural evidence-based Canadian recommendations for the measurement of blood pre... more We present the inaugural evidence-based Canadian recommendations for the measurement of blood pressure in children, and the diagnosis and evaluation of pediatric hypertension. Rates of pediatric hypertension are increasing concomitant with increased rates of childhood obesity. With this there is growing awareness of the need to measure blood pressure in children. Consequently, the present recommendations have been developed to address an important gap and improve the clinical care of children. For 2016 a total of 15 recommendations are presented, these are categorized in a similar fashion to the existing adult recommendations. Specifically, we present recommendations on (1) accurate measurement of blood pressure in children; (2) criteria for diagnosis of hypertension in children; (3) assessment of overall cardiovascular risk in hypertensive children; (4) routine laboratory tests for the investigation of children with hypertension; (5) ambulatory blood pressure measurement in children; and, (6) role of echocardiography. We discuss the rationale for the recommendations and present additional supporting material for the clinician, including tables with standardized techniques for blood pressure measurement and determination of normative blood pressure values for children. Hypertension Canada's CHEP Guidelines Task Force will update the recommendations annually and develop future evidence-based recommendations to guide prevention and treatment of pediatric hypertension. guide.medlive.cn

L'atteinte cardiaque dans la maladie de Kawasaki

Mtp Medecine Therapeutique Pediatrie, Sep 25, 2001

La maladie de Kawasaki est une vasculite multisystemique qui atteint principalement les enfants e... more La maladie de Kawasaki est une vasculite multisystemique qui atteint principalement les enfants et les jeunes adultes. Cette maladie a ete decrite originellement au Japon en 1967 par le docteur Tomisaku Kawasaki [1]. Depuis, la maladie a ete reconnue mondialement chez des enfants de toutes les races. A la suite de ces premieres publications, il est devenu evident que la maladie n'est pas benigne, puisqu'un nombre significatif de morts subites chez l'enfant a ete rapporte, habituellement suite aux complications cardiovasculaires [2]. En fait la maladie de Kawasaki est devenue la premiere cause de maladie cardiaque acquise chez l'enfant [3]. Epidemiologie La maladie de Kawasaki survient plus souvent chez les garcons que chez les filles, avec un ratio de 1,5 : 1 [2]. Environ 80 % des cas surviennent chez des enfants de moins de 3 ans [3]. La maladie est beaucoup plus frequente au Japon avec en moyenne 5 000 cas par an depuis 1986, ce qui correspond a une incidence annuelle de 90 par 100 000 enfants moins de 5 ans [4]. Aux Etats-Unis et au Canada, l'incidence se situe entre 7,6 et 11,3 cas par 100 000 [5]. Cette incidence est plus elevee chez les enfants d'origine asiatique, en particulier japonaise et coreenne. Le nombre de cas rapportes augmente en hiver et au printemps [6] avec des pics epidemiques. Il y a des annees ou l'incidence peut atteindre 21 a 46 cas par 100 000 [7], epidemies qui sont survenues avant 1990.

Left Atrial Inexcitability in Children With Congenital Lupus-Induced Complete Atrioventricular Block

Journal of the American Heart Association, Jan 16, 2015

Congenital atrioventricular block is a well-established immunologic complication of maternal syst... more Congenital atrioventricular block is a well-established immunologic complication of maternal systemic lupus erythematosus. We sought to further characterize the electrophysiological manifestations of maternal systemic lupus erythematosus on neonatal atria. Cases of isolated congenital atrioventricular block treated at our center over the past 41 years were identified. Data were extracted from clinical charts, pacemaker interrogations, ECGs, echocardiograms, and histopathological reports, when available. Of 31 patients with isolated congenital atrioventricular block, 18 were negative for maternal antibodies and had normal epicardial atrial sensing and pacing thresholds. In contrast, 12 of 13 patients with positive maternal antibodies had epicardial pacemakers, 5 (42%) of whom had left atrial (LA) inexcitability and/or atrial conduction delay. In 3 patients, the LA could not be captured despite high-output pacing. The fourth patient had acutely successful LA appendage and left ventric...

Effect of Dual-Chamber Pacemaker Implantation on Aortic Dilatation in Patients With Congenital Heart Block

The American Journal of Cardiology, 2014

Ascending aortic dilatation (AoD) in patients with structurally normal hearts and congenital hear... more Ascending aortic dilatation (AoD) in patients with structurally normal hearts and congenital heart block (CHB) has been previously described. The cause and management of AoD are yet to be determined. The aim of this study was to test the hypothesis that AoD in children with CHB regresses after the implantation of cardiac dual-chamber pacemakers (PMs). The secondary hypothesis was an association between the presence of maternal antibodies (SS-A or SS-B) and the degree of aortic dilatation. Clinical data with echocardiographic correlates of patients with CHB followed at a single institution were retrospectively reviewed. Comparison of the target structures diameter was based on 3 different z-score equations, with AoD defined as a z score >2. Inclusion criteria were CHB diagnosis by 12-lead electrocardiography or Holter recording and benefit from a permanent dualchamber PM. Excluded were patients with incomplete echocardiographic measurements, those with major structural heart defects, and those with syndromes or diseases known to be associated with AoD. There were 17 patients, diagnosed at a median age of 6 months (interquartile range 0 to 47.8). Maternal antibodies were positive in 6 patients and negative in 11. All patients underwent PM implantation at a median age of 4.5 years (interquartile range 1.4 to 7.9). AoD (z score >2.0 according to 3 different equations) was present in 35% to 59% of patients. There was a significant reduction of mean ascending aortic z score in patients with AoD from 4.66 to 3.67 (p [ 0.06), from 4.82 to 2.95 (p [ 0.002), and from 6.07 to 3.39 (p [ 0.006) according to the various z-score equations. Most patients with positive serology had AoD, without reaching statistical significance. In conclusion, AoD is associated with CHB, more likely in infants exposed to maternal antibodies. AoD decreases after the implantation of a PM. This is probably related to the regularization of stroke volume.

The study of antiarrhythmic medications in infancy (SAMIS): a multicenter, randomized controlled trial comparing the efficacy and safety of digoxin versus propranolol for prophylaxis of supraventricular tachycardia in infants

Circulation. Arrhythmia and electrophysiology, 2012

Supraventricular tachycardia (SVT) is one of the most common conditions requiring emergent cardia... more 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. This was a randomized, double-blind, multicenter study of infants <4 months with SVT (atrioventricular reciprocating tachycardia or atrioventricular nodal reentrant tachycardia), excluding Wolff-Parkinson-White, comparing digoxin with propranolol. The primary end point was recurrence of SVT requiring medical intervention. Time to recurrence and adverse events were secondary outcomes. Sixty-one patients completed the study, 27 randomized to digoxin and 34 to propranolol. SVT recurred in 19% of patients on digoxin and 31% of patients on propranolol (P=0.25). No first recurrence occurred after 110 days of ...

Shock to the Heart: Psychosocial Implications and Applications of Sudden Cardiac Death in the Young

Current Cardiology Reports

Purpose of Review Although rare, sudden cardiac death (SCD) in the young is a tragic event, havin... more Purpose of Review Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impact upon all involved. The psychosocial burden associated with SCD can leave friends, families, and entire communities bereft. With only limited evidence to describe the volatile emotional reactions associated with a young SCD, there is an urgent need for care providers to better understand the psychological complexities and impacts faced by both at-risk individuals and those directly affected by these tragic events. Recent Findings Current knowledge of the psychosocial implications associated with SCD in the young has recently generated interest in the cardiovascular community, with the goal of addressing prevention strategies (screening), family bereavement, and the psychological impact of at-risk or surviving individuals. With the emergence of novel strategies aimed at reducing the public health impact of SCD in the young, further discussion regarding the psychosocial impact of SCD, encompassing prevention, survivorship, and the downstream communal effects of a young death is required. Support systems and intervention could assist in the management of the associated psychosocial burden, yet there is a lack of clinical guidelines to direct this form of care. Summary There is an important need for multidisciplinary collaboration across subspecialties to provide support to grieving individuals and manage patient well-being throughout the screening process for SCD. This collaborative approach requires the integration of cardiovascular and psychological expertise where relevant.

Shock to the Heart: Psychosocial Implications and Applications of Sudden Cardiac Death in the Young

Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impac... more Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impact upon all involved. The psychosocial burden associated with SCD can leave friends, families, and entire communities bereft. With only limited evidence to describe the volatile emotional reactions associated with a young SCD, there is an urgent need for care providers to better understand the psychological complexities and impacts faced by both at-risk individuals and those directly affected by these tragic events. Current knowledge of the psychosocial implications associated with SCD in the young has recently generated interest in the cardiovascular community, with the goal of addressing prevention strategies (screening), family bereavement, and the psychological impact of at-risk or surviving individuals. With the emergence of novel strategies aimed at reducing the public health impact of SCD in the young, further discussion regarding the psychosocial impact of SCD, encompassing preven...

Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children

The Canadian journal of cardiology, 2018

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, asses... more Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hyper...

Pulse oximetry screening in newborns to enhance detection of critical congenital heart disease

Paediatrics & child health, 2017

Pulse oximetry screening is safe, noninvasive, easy to perform and proven to enhance detection of... more Pulse oximetry screening is safe, noninvasive, easy to perform and proven to enhance detection of critical congenital heart disease in newborns. However, this test has yet to be adopted as routine practice in Canada. The present practice point highlights essential details and recommendations for screening, which research has shown to be highly specific, with low false-positive rates. Optimal screening for critical congenital heart disease should include prenatal ultrasound, physical examination and pulse oximetry screening. Screening should be performed between 24 hours and 36 hours postbirth, using the infant's right hand and either foot to minimize false-positive results. Newborns with abnormal results should undergo a thorough evaluation by the most responsible health care provider. When a cardiac diagnosis cannot be excluded, referral to a paediatric cardiologist for consultation and echocardiogram is advised.

Hypertension Canada's 2017 Guidelines for the Diagnosis, Assessment, Prevention, and Treatment of Pediatric Hypertension

Canadian Journal of Cardiology, 2017

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, asses... more Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be

Incidence Rate and Epidemiological and Clinical Aspects of Kawasaki Disease in Children of Maghrebi Origin in the Province of Quebec, Canada, Compared to the Country of Origin

Global pediatric health, 2016

The incidence of Kawasaki disease in Maghreb countries is apparently low, unlike those living in ... more The incidence of Kawasaki disease in Maghreb countries is apparently low, unlike those living in the province of Quebec, Canada. This retrospective study compared Maghrebi children living in Quebec to the countries of origin, Morocco, Algeria, and Tunisia. The annualized incidence rate in Quebec (18.49/year/100 000 children under 5 years of age) was 4 to 12 times higher than in Tunisia, Morocco, and Algeria (0.95, 4.52, and 3.15, respectively). The prevalence of incomplete diagnostic criteria was higher in Quebec at 39%, Morocco 43%, and Tunisia 39% compared to Algeria at 8%, with minimal delayed diagnosis (7%) only in Quebec compared to 30%, 35%, and 62%, respectively (P < .001). The rate of coronary aneurysms was comparable however (11% in Quebec vs 4%, 10%, and 25%, in Tunisia, Morocco, and Algeria, respectively; P = .31). The higher incidence of Kawasaki disease in the Maghreb community in Quebec versus the countries of origin seems due to underdiagnosis, which represents a p...

Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease

The Canadian journal of cardiology, Feb 1, 2017

Congenital heart disease is the most common congenital malformation and approximately 3 in 1000 n... more Congenital heart disease is the most common congenital malformation and approximately 3 in 1000 newborns have critical congenital heart disease (CCHD). Timely diagnosis affects morbidity, mortality, and disability, and newborn pulse oximetry screening has been studied to enhance detection of CCHD. In this position statement we present an evaluation of the literature for pulse oximetry screening. Current detection strategies including prenatal ultrasound examination and newborn physical examination are limited by low diagnostic sensitivity. Pulse oximetry screening is safe, noninvasive, easy to perform, and widely available with a high specificity (99.9%) and moderately high sensitivity (76.5%). When an abnormal saturation is obtained, the likelihood of having CCHD is 5.5 times greater than when a normal result is obtained. The use of pulse oximetry combined with current strategies has shown sensitivities of up to 92% for detecting CCHD. False positive results can be minimized by scr...

The clinical and genetic spectrum of catecholaminergic polymorphic ventricular tachycardia: findings from an international multicentre registry

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Mar 31, 2017

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an ion channelopathy characterize... more 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. This is a Pediatric and Congenital Electrophysiology Society multicentre, retrospective cohort study of CPVT patients diagnosed at <19 years of age and their first-degree relatives. Genetic testing was undertaken in 194 of 236 subjects (82%) during 3.5 (1.4-5.3) years of follow-up. The majority (60%) had RyR2-associated CPVT1. Variant locations were predicted based on a 3D structural model of RyR2. Specific residues appear to have key structural importance, supported by an association between cardiac arres...

Importance of anatomical dominance in the evaluation of coronary dilatation in Kawasaki disease

Cardiology in the Young, 2016

Introduction In Kawasaki disease, although coronary dilatation is attributed to vasculitis, the e... more Introduction In Kawasaki disease, although coronary dilatation is attributed to vasculitis, the effect of myocardial inflammation is underestimated. Coronary dilatations are determined by Z-scores, which do not take into account dominance. The aim of the present study was to describe the impact of coronary dominance on dilatation in Kawasaki disease. Methods We performed a retrospective analysis of coronary dilatations according to angiography categorisation of dominance. Results Of 28 patients (2.6 [0.2–10.1] years), right dominance was present in 15 patients and left in 13. Early dilatation was present in all patients, of whom 11 were ipsilateral to the dominant segment and 17 contralateral. Ipsilateral dilatations were present at diagnosis (9/11 versus 6/17, p=0.02) compared with contralateral dilatations, which developed 2 weeks after diagnosis (9/11 versus 16/17, p=0.29). Coronary artery Z-scores of patients with contralateral dilatation increased at 2 weeks, before returning t...

Prenatal diagnosis and prognosis of accelerate idioventricular rhythm

Ultrasound in Obstetrics & Gynecology, 2016

Objectives As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on spe... more Objectives As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on specific electrocardiographic patterns, prenatal diagnosis of this condition is challenging and its true incidence is unknown. The objectives of this study were to evaluate the performance of prenatal ultrasonography in identifying intrauterine cardiocirculatory events linked to specific electrocardiographic signs of postnatal AIVR, including left or right ventricular origin, and to assess the prenatal prognosis of this arrhythmia. Methods We reviewed Doppler tracings from the superior vena cava/ascending aorta (SVC/Ao), ductus venosus (DV), ductus arteriosus (DA) and aortic isthmus (AoI), as well as simultaneous M-mode recordings of septal and left ventricular wall motions of fetuses diagnosed with AIVR from January 2004 to December 2014. Results Three cases of AIVR were identified among 27 912 fetuses. SVC/Ao Doppler flow recordings revealed atrioventricular dissociation (ventricular rates within 20% of atrial rates) in all three fetuses and episodes of isorhythmic atrioventricular dissociation in one, while M-mode confirmed normal left ventricular shortening fraction in all cases. Fusion beats were observed on AoI tracing in one fetus, while simultaneous recordings of AoI and DA revealed signs of right bundle branch block in one case and left bundle branch block in the other two. On DV Doppler recordings, retrograde a-waves in the presence of simultaneous atrial and ventricular contractions were observed in all three fetuses, leading to an increase in

Atrial Septal Defect Closure with Occlutech® ASD Fenestrated Device in a Child with Severe Pulmonary Hypertension

Pediatric Cardiology, 2016

We report a 5-year-old patient with severe pulmonary hypertension and a large secundum atrial sep... more We report a 5-year-old patient with severe pulmonary hypertension and a large secundum atrial septal defect who benefited from a percutaneous closure of the defect with an Occlutech(®) custom-made fenestrated device. Whereas the closure is technically identical to standard atrial defect closure, the immediate and midterm beneficial results are presented.

NT-proBNP diagnostic algorithm for Kawasaki Disease compared to AHA Algorithm

Pediatrics International, 2016

Diagnosis of Kawasaki disease (KD) can be challenging in the absence of a confirmatory test or pa... more Diagnosis of Kawasaki disease (KD) can be challenging in the absence of a confirmatory test or pathognomonic finding, especially when clinical criteria are incomplete. We recently proposed serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) as an adjunctive diagnostic test. We retrospectively tested a new algorithm to help KD diagnosis based on NT-proBNP, coronary artery dilation (CAD) at onset, and abnormal serum albumin or C-reactive protein (CRP). The goal was to assess the performance of the algorithm and compare its performance with that of the 2004 American Heart Association (AHA)/American Academy of Pediatrics (AAP) algorithm. The algorithm was tested on 124 KD patients with NT-proBNP measured on admission at the present institutions between 2007 and 2013. Age at diagnosis was 3.4 ± 3.0 years, with a median of five diagnostic criteria; and 55 of the 124 patients (44%) had incomplete KD. CA complications occurred in 64 (52%), with aneurysm in 14 (11%). Using this algorithm, 120/124 (97%) were to be treated, based on high NT-proBNP alone for 79 (64%); on onset CAD for 14 (11%); and on high CRP or low albumin for 27 (22%). Using the AHA/AAP algorithm, 22/47 (47%) of the eligible patients with incomplete KD would not have been referred for treatment, compared with 3/55 (5%) with the NT-proBNP algorithm (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). This NT-proBNP-based algorithm is efficient to identify and treat patients with KD, including those with incomplete KD. This study paves the way for a prospective validation trial of the algorithm.

Coronary Artery Dilatation in Viral Myocarditis Mimics Coronary Artery Findings in Kawasaki Disease

Pediatric Cardiology, 2016

Coronary artery (CA) dilatations are typical to Kawasaki disease (KD) in the pediatric population... more Coronary artery (CA) dilatations are typical to Kawasaki disease (KD) in the pediatric population. CA involvement is a useful feature to help establish the diagnosis of KD. Since myocarditis is omnipresent in the acute phase of KD, we sought to investigate whether viral myocarditis may cause CA dilatation. This retrospective study reviewed 14 consecutive patients diagnosed with acute myocarditis at CHU Sainte-Justine, Montreal. KD diagnosis was excluded for all patients. All echocardiography studies were reviewed by an independent experienced echocardiographer for CA size and myocardial function parameters. CA involvement was classified under three categories: definite dilatation (Z-score ≥2.5 in one or more CA), occult dilatation (Z-score variation ≥2 points for the same CA on two different echocardiograms, but maximum Z-score always &amp;amp;amp;amp;lt;2.5), and no dilatation otherwise. Demographics, laboratory values, microbial etiology testing, and diagnostic studies were collected from medical records. Mean age at presentation was 1.67 ± 3.22 years, where 11/14 (78 %) presented with acute and three with subacute myocarditis. Five (36 %) patients had normal CA measurements, six (43 %) had occult dilatation, and three (21 %) had definite dilatation. Maximal CA Z-score was within the first 8 days of presentation. Patients with viral myocarditis can present CA dilatation during the acute phase of the illness. This finding should be taken into account when KD diagnosis is being based on the CA involvement as the two illnesses may present with similar features.

Thromboprophylaxis for atrial arrhythmias in congenital heart disease: A multicenter study

International Journal of Cardiology, 2016

There is a paucity of data to guide decisions regarding thromboprophylaxis for atrial arrhythmias... more There is a paucity of data to guide decisions regarding thromboprophylaxis for atrial arrhythmias in congenital heart disease. A retrospective multicenter cohort study enrolled patients with documented sustained atrial arrhythmias and congenital heart disease from 12 North American centers to quantify thromboembolic and bleeding rates associated with antiplatelet and anticoagulation therapy, and explore associated factors. A blinded committee adjudicated all qualifying arrhythmias and outcomes. A total of 482 patients, 45.2% female, age 32.0±18.0years, were followed for 11.3±9.4years since the qualifying arrhythmia. Antiplatelet therapy was administered to 37.8%, anticoagulation to 54.4%, and neither to 7.9%. Congenital heart disease complexity was simple, moderate, and severe in 18.5%, 34.4%, and 47.1%, respectively. Freedom from thromboembolic events was 84.7±2.7% at 15years, with no difference between anticoagulation versus antiplatelet therapy (P=0.97). Congenital heart disease complexity was independently associated with thromboembolic events, with rates of 0.00%, 0.93%, and 1.95%/year in those with simple, moderate, and severe forms (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). CHADS2 and CHA2DS2-VASc scores were not predictive of thromboembolic risk. Annualized bleeding rates with antiplatelet and anticoagulation therapy were 0.66% and 1.82% (P=0.039). In multivariable analyses, anticoagulation [hazard ratio (HR) 4.76, 95% CI (1.05-21.58), P=0.043] and HAS-BLED score [HR 3.15, 95% CI (1.02, 9.78), P=0.047] were independently associated with major bleeds. Current management of atrial arrhythmias in congenital heart disease is associated with a modest rate of thromboembolic events, which is predicted by disease complexity but not CHADS2/CHA2DS2-VASc scores. HAS-BLED score is applicable to the congenital population in predicting major bleeds.

Catecholaminergic Polymorphic Ventricular Tachycardia in Children: An Analysis of Therapeutic Strategies and Outcomes from an International Multicenter Registry

Circulation Arrhythmia and Electrophysiology, Feb 24, 2015

Editorial see p 523 β-Blockers are the standard therapy in CPVT, 7,9,12 although evidence of trea... more

Hypertension Canada’s 2016 CHEP Guidelines for Blood Pressure Measurement, Diagnosis and Assessment of Risk of Pediatric Hypertension

Canadian Journal of Cardiology, 2016

We present the inaugural evidence-based Canadian recommendations for the measurement of blood pre... more We present the inaugural evidence-based Canadian recommendations for the measurement of blood pressure in children, and the diagnosis and evaluation of pediatric hypertension. Rates of pediatric hypertension are increasing concomitant with increased rates of childhood obesity. With this there is growing awareness of the need to measure blood pressure in children. Consequently, the present recommendations have been developed to address an important gap and improve the clinical care of children. For 2016 a total of 15 recommendations are presented, these are categorized in a similar fashion to the existing adult recommendations. Specifically, we present recommendations on (1) accurate measurement of blood pressure in children; (2) criteria for diagnosis of hypertension in children; (3) assessment of overall cardiovascular risk in hypertensive children; (4) routine laboratory tests for the investigation of children with hypertension; (5) ambulatory blood pressure measurement in children; and, (6) role of echocardiography. We discuss the rationale for the recommendations and present additional supporting material for the clinician, including tables with standardized techniques for blood pressure measurement and determination of normative blood pressure values for children. Hypertension Canada's CHEP Guidelines Task Force will update the recommendations annually and develop future evidence-based recommendations to guide prevention and treatment of pediatric hypertension. guide.medlive.cn

L'atteinte cardiaque dans la maladie de Kawasaki

Mtp Medecine Therapeutique Pediatrie, Sep 25, 2001

La maladie de Kawasaki est une vasculite multisystemique qui atteint principalement les enfants e... more La maladie de Kawasaki est une vasculite multisystemique qui atteint principalement les enfants et les jeunes adultes. Cette maladie a ete decrite originellement au Japon en 1967 par le docteur Tomisaku Kawasaki [1]. Depuis, la maladie a ete reconnue mondialement chez des enfants de toutes les races. A la suite de ces premieres publications, il est devenu evident que la maladie n'est pas benigne, puisqu'un nombre significatif de morts subites chez l'enfant a ete rapporte, habituellement suite aux complications cardiovasculaires [2]. En fait la maladie de Kawasaki est devenue la premiere cause de maladie cardiaque acquise chez l'enfant [3]. Epidemiologie La maladie de Kawasaki survient plus souvent chez les garcons que chez les filles, avec un ratio de 1,5 : 1 [2]. Environ 80 % des cas surviennent chez des enfants de moins de 3 ans [3]. La maladie est beaucoup plus frequente au Japon avec en moyenne 5 000 cas par an depuis 1986, ce qui correspond a une incidence annuelle de 90 par 100 000 enfants moins de 5 ans [4]. Aux Etats-Unis et au Canada, l'incidence se situe entre 7,6 et 11,3 cas par 100 000 [5]. Cette incidence est plus elevee chez les enfants d'origine asiatique, en particulier japonaise et coreenne. Le nombre de cas rapportes augmente en hiver et au printemps [6] avec des pics epidemiques. Il y a des annees ou l'incidence peut atteindre 21 a 46 cas par 100 000 [7], epidemies qui sont survenues avant 1990.

Left Atrial Inexcitability in Children With Congenital Lupus-Induced Complete Atrioventricular Block

Journal of the American Heart Association, Jan 16, 2015

Congenital atrioventricular block is a well-established immunologic complication of maternal syst... more Congenital atrioventricular block is a well-established immunologic complication of maternal systemic lupus erythematosus. We sought to further characterize the electrophysiological manifestations of maternal systemic lupus erythematosus on neonatal atria. Cases of isolated congenital atrioventricular block treated at our center over the past 41 years were identified. Data were extracted from clinical charts, pacemaker interrogations, ECGs, echocardiograms, and histopathological reports, when available. Of 31 patients with isolated congenital atrioventricular block, 18 were negative for maternal antibodies and had normal epicardial atrial sensing and pacing thresholds. In contrast, 12 of 13 patients with positive maternal antibodies had epicardial pacemakers, 5 (42%) of whom had left atrial (LA) inexcitability and/or atrial conduction delay. In 3 patients, the LA could not be captured despite high-output pacing. The fourth patient had acutely successful LA appendage and left ventric...

Effect of Dual-Chamber Pacemaker Implantation on Aortic Dilatation in Patients With Congenital Heart Block

The American Journal of Cardiology, 2014

Ascending aortic dilatation (AoD) in patients with structurally normal hearts and congenital hear... more Ascending aortic dilatation (AoD) in patients with structurally normal hearts and congenital heart block (CHB) has been previously described. The cause and management of AoD are yet to be determined. The aim of this study was to test the hypothesis that AoD in children with CHB regresses after the implantation of cardiac dual-chamber pacemakers (PMs). The secondary hypothesis was an association between the presence of maternal antibodies (SS-A or SS-B) and the degree of aortic dilatation. Clinical data with echocardiographic correlates of patients with CHB followed at a single institution were retrospectively reviewed. Comparison of the target structures diameter was based on 3 different z-score equations, with AoD defined as a z score >2. Inclusion criteria were CHB diagnosis by 12-lead electrocardiography or Holter recording and benefit from a permanent dualchamber PM. Excluded were patients with incomplete echocardiographic measurements, those with major structural heart defects, and those with syndromes or diseases known to be associated with AoD. There were 17 patients, diagnosed at a median age of 6 months (interquartile range 0 to 47.8). Maternal antibodies were positive in 6 patients and negative in 11. All patients underwent PM implantation at a median age of 4.5 years (interquartile range 1.4 to 7.9). AoD (z score >2.0 according to 3 different equations) was present in 35% to 59% of patients. There was a significant reduction of mean ascending aortic z score in patients with AoD from 4.66 to 3.67 (p [ 0.06), from 4.82 to 2.95 (p [ 0.002), and from 6.07 to 3.39 (p [ 0.006) according to the various z-score equations. Most patients with positive serology had AoD, without reaching statistical significance. In conclusion, AoD is associated with CHB, more likely in infants exposed to maternal antibodies. AoD decreases after the implantation of a PM. This is probably related to the regularization of stroke volume.

The study of antiarrhythmic medications in infancy (SAMIS): a multicenter, randomized controlled trial comparing the efficacy and safety of digoxin versus propranolol for prophylaxis of supraventricular tachycardia in infants

Circulation. Arrhythmia and electrophysiology, 2012

Supraventricular tachycardia (SVT) is one of the most common conditions requiring emergent cardia... more 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. This was a randomized, double-blind, multicenter study of infants <4 months with SVT (atrioventricular reciprocating tachycardia or atrioventricular nodal reentrant tachycardia), excluding Wolff-Parkinson-White, comparing digoxin with propranolol. The primary end point was recurrence of SVT requiring medical intervention. Time to recurrence and adverse events were secondary outcomes. Sixty-one patients completed the study, 27 randomized to digoxin and 34 to propranolol. SVT recurred in 19% of patients on digoxin and 31% of patients on propranolol (P=0.25). No first recurrence occurred after 110 days of ...