title: Management of pediatric tachyarrhythmias on mechanical support.
abstract: BACKGROUND
  Pediatric patients with persistent arrhythmias may require mechanical cardiopulmonary support. We sought to classify the population, spectrum, and success of current treatment strategies.
  
  
  RESULTS
  A multicenter retrospective chart review was undertaken at 11 sites. Inclusion criteria were (1) patients <21 years, (2) initiation of mechanical support for a primary diagnosis of arrhythmias, and (3) actively treated on mechanical support. A total of 39 patients were identified with a median age of 5.5 months and median weight of 6 kg. A total of 69% of patients were cannulated for supraventricular tachycardia with a median rate of 230 beats per minute. A total of 90% of patients were supported with extracorporeal membrane oxygenation for an average of 5 days. The remaining 10% were supported with ventricular assist devices for an average of 38 (20-60) days. A total of 95% of patients were treated with antiarrhythmics, with 43% requiring >1 antiarrhythmic. Amiodarone was the most frequently used medication alone or in combination. A total of 33% patients underwent electrophysiology study/transcatheter ablation. Radiofrequency ablation was successful in 9 patients on full flow extracorporeal membrane oxygenation with 3 radiofrequency-failures/conversion to cryoablation. One patient underwent primary cryoablation. A total of 15% of complications were related to electrophysiology study/ablation. At follow-up, 23 patients were alive, 8 expired, and 8 transplanted.
  
  
  CONCLUSIONS
  Younger patients were more likely to require support in the presented population. Most patients were treated with antiarrhythmics and one third required electrophysiology study/ablation. Radiofrequency ablation is feasible without altering extracorporeal membrane oxygenation flows. There was a low frequency of acute adverse events in patients undergoing electrophysiology study/ablation, while on extracorporeal membrane oxygenation.
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.). Silva_j@kids.wustl.edu.
authors.forename: Jennifer N A
authors.initials: JN
authors.lastname: Silva
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Erickson
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Carter
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: E Anne
authors.initials: EA
authors.lastname: Greene
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Michal
authors.initials: M
authors.lastname: Kantoch
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Collins
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Miyake
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Michael P
authors.initials: MP
authors.lastname: Carboni
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Edward K
authors.initials: EK
authors.lastname: Rhee
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Andrew
authors.initials: A
authors.lastname: Papez
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Vijay
authors.initials: V
authors.lastname: Anand
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Bowman
authors.affiliation: From the Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S., T.M.B., G.F.V.H.); Division of Pediatric Cardiology, Children's Hospital and Medical Center/UNMC/CUMC, Omaha, NE (C.C.E.); Division of Pediatric Cardiology, Children's Hospital of Minnesota, Minneapolis (C.D.C.); Division of Pediatric Cardiology, Children's National Medical Center, Washington, DC (E.A.G.); Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada (M.K.); Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora (K.K.C.); Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (C.Y.M.); Division of Pediatric Cardiology, Duke University, Durham, NC (M.P.C.); Division of Pediatric Cardiology, Scott & Laura Eller Congenital Heart Center, Phoenix, AZ (E.K.R.); Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.P.); and Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (V.A.).
authors.forename: George F
authors.initials: GF
authors.lastname: Van Hare
mesh_terms: D000367:Age Factors; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002170:Canada; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D003452:Cryosurgery / Q000009:adverse effects / Q000401:mortality; D022062:Electrophysiologic Techniques, Cardiac; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: ablation techniques; antiarrhythmic drugs; heart-assist device; pediatrics