CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
257
Alev Kiziltas, Nazan Ozbarlas, Sevcan Erdem, Osman
Kucukosmanoglu
Department of Pediatric Cardiology Cukurova University, Saricam,
Turkey
Objective:
The aim of this study was to evaluate the effect of
spironolactone, furosemide and captopril on blood electrolyte levels
in congenital heart defect infants with uncontrolled congestive heart
failure.
Material and method:
We examined 27 infants with congestive
heart failure who had been treated with furosemide and captopril for
at least 1 month in the Cukurova University Department of Pediatric
Cardiology. Before the spironolactone treatment and after the first
week of the treatment blood sodium, potassium, urinary creatinine
levels were checked. The dosage of spironolactone was determined
as 1–3 mg/kg/day. Patients treated with the dosage of spironolactone
≤
2 mg/kg/day were Group 1, and with the dosage of 2–3 mg/kg/day
were group 2.
Results:
Seventeen patients (63%) were in Group 1 and 10 (37%) in
Group 2. After the first week of the treatment, mean blood sodium
level was 134 mmol/l, and mean blood potassium level was 4.6
mmol/l. Hyponatraemia occurred in 12 patients. There were statisti-
cal differences in mean blood sodium levels between group 1 and
2 (
p
<
0.02). There was no statistical difference in development of
hyponatremia between two groups. There was no statistical difference
in potassium levels between the groups and no hyperpotassaemia.
Conclusion:
There is no safe dosage range or safe combination
protocol in congestive heart failure treatment in paediatric patients.
Because of the development of natriuresis and hyperpotassae-
mia, clinical and laboratory monitoring is needed in combination
therapy. We did not encounter to hyperpotassaemia at different
spironolactone dosages. There was no statistical upgrade of potas-
sium levels between groups with different spironolactone dosages.
Hyponatraemia improved quickly with reduction or stopping the
spironolactone dose. In this prospective pilot study there was no
statistical difference in potassium levels with spironolactone treat-
ment; hyperpotassaemia did not occur even with high dosages.
But the occurrence of hyponatraemia in 44% of the patients was a
remarkable result. In conclusion, frequent electrolyte monitoring is
needed with the treatment of congestive heart failure when spironol-
actone is added to furosemide and captopril.
1657: PERMANENT CARDIAC PACING IN CHILDREN
- CHOOSING THE OPTIMAL PACING-SITE: A MULTI-
CENTRE STUDY
Jan Janousek
1
, Irene van Geldorp
2
, Sylvia Krupickova
3
, Eric
Rosenthal
4
, Maren Tomaske
5
, Andreas Frueh
6
, Jan Elders
7
, Anita
Hiippala
8
, Frits Prinzen
9
, Tammo Delhaas
10
1
Children’s Heart Centre, University Hospital Motol, Prague, Czech
Republic
2
Pediatric Cardiology, CRIM, Maastricht, Netherlands
3
Children’s Heart Centre, University Hospital Motol, Prague, Czech
Republic
4
Evelina Children’s Hospital, London, UK
5
University Children’s Hospital, Department of Cardiology, Zurich,
Switzerland
6
Oslo University Hospital, Oslo, Norway
7
Radboud University Medical Centre, Department of Cardiology,
Nijmegen, Netherlands
8
Department of Pediatric Cardiology, Children’s Hospital, Helsinki,
Finland
9
Department of Physiology, CRIM, Maastricht, Netherlands
10
Department of Biomedical Engineering, CRIM, Maastricht,
Netherlands
Purpose:
We evaluated the effects of pacing-site on left ventricular
(LV) synchrony and function in children requiring permanent pacing.
Methods:
A total of 178 children (age
<
18 years) from 21 centres
with complete AV block and a structurally normal heart undergoing
permanent pacing were cross-sectionally studied. Median age at eval-
uation was 11.2 (inter-quartile range (IQR) 6.3–15.0) years. Median
pacing duration was 5.4 (IQR 3.1–8.8) years. Data were analysed
in a core lab. Pacing-sites were the free wall of the right ventricular
outflow tract (RVOT) (
n
=
8), lateral RV (RVLat) (
n
=
44), RV apex
(RVA) (
n
=
61), RV septum (RVS) (
n
=
29), LV apex (LVA) (
n
=
12),
LV mid-lateral wall (LVLat) (
n
=
17) and LV base (LVB) (
n
=
7).
Results:
LV synchrony, pump function (ejection fraction (EF), end-
systolic volume index and change in shortening fraction as compared
to pre-implantation values) and contraction efficiency were signifi-
cantly affected by pacing-site and were superior in children paced
at LVA/LVLat. LV dyssynchrony assessed by radial strain correlated
inversely with LV EF (r
=
0.80,
p
=
0.031). Pacing from RVOT/
RVLat predicted decreased LV function (LV EF
<
45%; odds ratio
(OR) 5.19, confidence interval (CI) 1.74-15.50,
p
=
0.003) whereas
LVA/LVLat pacing was associated with preserved LV function (LV
EF
>
55%; OR 6.97, CI 2.21-22.00,
p
<
0.001). Age at implantation,
pre-implantation LV size and function, duration of pacing, DDD
mode, QRS duration and presence of maternal auto-antibodies had
no significant impact in a multivariable analysis.
Conclusions:
LV mechanical synchrony, pump function and contrac-
tion efficiency may significantly deteriorate with RVOT/RVLat
pacing and are best preserved with LVA/LVLat pacing.
(JJ and SK received a research grant of the Internal Grant Agency of
the Ministry of Health of the Czech Republic NT 12321-3/2011,IvG
received a Dr. E. Dekker Grant for Research Fellow in Pediatric
Cardiology, Dutch Heart Foundation, NHS-2010T078.)
1663: OUTCOME OF CHILDREN AND ADOLESCENTS
UNDERGOING INVASIVE TESTING FOR ASYMPTOMATIC
WOLFF-PARKINSON-WHITE PRE-EXCITATION
Jan Janousek
1
, Peter Kubus
1
, Pavel Vit
2
, Roman Gebauer
3
, Ondrej
Materna
1
1
Children’s Heart Centre, University Hospital Motol, Prague, Czech
Republic
2
Paediatric Cardiology, Children’s University Hospital, Brno, Czech
Republic
3
Department of Paediatric Cardiology, Heart Centre, Leipzig,
Germany
Objective:
Results of a risk stratification strategy in asymptomatic
Wolff-Parkinson-White (WPW) pre-excitation in the young were
evaluated.
Methods:
Eighty-five consecutive patients aged
<
18 years with a
WPW pattern (with persistent pre-excitation at maximum exercise)
undergoing an invasive electrophysiological study for risk stratifica-
tion were retrospectively evaluated. Potentially dangerous acces-
sory pathway (AP) properties were defined as any of the following:
antegrade effective refractory period
≤
250 ms, shortest pre-excited
RR interval during atrial fibrillation/rapid atrial pacing
≤
250 ms,
inducible atrioventricular re-entrant tachycardia (AVRT) or presence
of multiple APs.
Results:
Age at evaluation was median 14.9 (interquartile range
(IQR) 12.5–16.6) years. Eighty-two patients had a structurally
normal heart and 3 had hypertrophic cardiomyopathy. A single mani-
fest AP was present in 80 patients, one manifest and 1 concealed AP
in 4 and two manifest APs in 1 patient. Potentially dangerous AP
properties were present in 33/85 patients (38.8 %) at baseline and in
an additional 16/44 (36.4 %) of those subjected to isoproterenol chal-
lenge. Ablation was performed in 41/49 patients with a potentially
dangerous AP and deferred in the remaining 8 because of proximity
to the atrioventricular node. In addition, 18 of low-risk patients were
ablated based on patient’s/parental decision.
Conclusion:
39 % of the evaluated patients with asymptomatic
WPW pre-excitation persisting at peak exercise exhibited potentially
dangerous AP properties at baseline. Isoproterenol challenge yielded
an additional 36% of those tested at risk. Ablation was performed in
69% of patients.
