CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
236
AFRICA
1387: ADENOSINE IMPROVES THE EFFICACY AND COST-
EFFICIENCY OF TRANSOESOPHAGEAL ELECTRO-
PHYSIOLOGY STUDIES TO RISK-STRATIFY PATIENTS
WITH ASYMPTOMATIC WOLFF–PARKINSON–WHITE
SYNDROME
Christopher Snyder
1
, Walter Hoyt
2
, Joni Steinberg
3
1
Case Western University School of Medicine, Rainbow Babies and
Children’s Hospital, USA
2
Department of Paediatric Cardiology, University of Virginia, USA
3
Department of Global Health Systems and Development, Tulane
University, Louisiana, USA
Introduction
: All patients with Wolff–Parkinson–White (WPW)
syndrome, even if asymptomatic, are at risk of sudden death during
atrial fibrillation (AFib). This risk can be determined by measuring
the shortest pre-excited R-R interval during AFib. This study evalu-
ated adenosine’s potential to induce AFib during transoesophageal
electrophysiological studies (TEEPS) when atrial-pacing modalities
alone failed to do so, and analysed its cost-saving potential during the
work-up of asymptomatic WPW.
Methods
: A retrospective review was carried out of patients with
WPW who had had a TEEPS performed. Inclusion criteria: evidence
of WPW on electrocardiogram, no history of arrhythmias or associ-
ated symptoms, age
<
18 years, and failure to induce AFib by initial
TEEPS protocol. When TEEPS protocol was unsuccessful, adenosine
0.2 mg/kg was administered via rapid intravenous push during atrial-
burst pacing. AFib was considered successfully induced if persisting
>
20 s. If induced, patients were classified as at risk of sudden death if
the shortest pre-excited R-R interval during AFib was
<
250 ms or at
no risk if
≥
250 ms. Using 2011 and 2012 Medicaid re-imbursement
data, the cost of adenosine during TEEPS was compared to proceed-
ing directly to a transvenous electrophysiological study (TVEPS).
Results:
Inclusion criteria were met by seven patients. Adenosine
and atrial-burst pacing induced AFib in four of these patients (57%).
Of those induced, three (75%) had no risk and one (25%) had risk.
No complications occurred. The average cost of TEEPS was $999,
TVEPS $4 524, and adenosine $84.21. The average cost of the
adenosine-decision arm was $2 669.35, resulting in an average cost
saving of $1 854.65.
Conclusions
: To improve the efficacy and cost-efficiency of TEEPS
to risk-stratify patients with asymptomatic WPW, we recommend
rapid intravenous adenosine administration during atrial-burst pacing
when prior modalities have failed to induce AFib.
1389: REFERENCE ECHOCARDIOGRAPHIC MEASURE-
MENTS IN LOW-BIRTHWEIGHT INFANTS INA DEVELOP-
ING COUNTRY
Stephen Brown, Daniel Buys, Salomi Jacobs, Carri-Lee Greig
1
Department of Paediatric Cardiology, University of the Free State,
Bloemfontein, South Africa
Aim:
To obtain a set of reference echocardiographic values in a
group of low-birth weight infants in central South Africa as none
exist for sub-Saharan Africa.
Methods:
Over a 12-month period, 290 infants were included.
Standardised M-mode, two-dimensional and systolic functional
assessments [shortening fraction (SF), myocardial performance index
(MPI)] were carried out according to the guidelines of the American
Society of Echocardiography. Studies were performed by three expe-
rienced echocardiographers and reviewed by a paediatric cardiolo-
gist. A longitudinal study was also included to examine changes in
these indices from days 1–28 of life.
Results:
Median weight was 1.36 kg (range: 0.69–2.50) with a
median gestational age of 31 weeks (range: 26–38). Eighty-seven
(29%) infants were small for gestational age (SGA). Body surface
area (BSA) and weight had a near-perfect correlation (
r
=
0.98).
Inter-observer variation was less than 6%. Cardiac dimensions
increased with increase in body weight. SF and MPI for left and
right ventricles were 34.6
±
6%, 0,29
±
0.14 and 0.23
±
0.15, respec-
tively. Dimensions of SGA infants did not differ from other infants
of comparable weight. Longitudinal data showed that all dimensions
from birth to 28 days remained within the ranges determined by the
study. Comparison with international reference ranges showed that
local interventricular septal and posterior wall thicknesses as well as
left atrial dimensions were significantly larger (
p
<
0.01).
Conclusion:
Cardiac dimensions increased parallel to increase in
body weight. BSA and weight correlated excellently and either can
be used. Longitudinal data indicated that reference values obtained
are applicable to infants from 0–28 days of age. The differences
in certain cardiac dimensions from international reference values
demonstrate that regional differences exist and emphasise the need
for development of local reference ranges.
1395: CONGENITAL COMPLETE HEART BLOCK: REVIEW
OF CASES SEEN AT CHRIS HANI BARAGWANATH
ACADEMIC HOSPITAL FROM 1986–2012
Gcina Dumani, Barend Fourie, Paul Adams, Antoinette Cilliers
Division of Paediatric Cardiology, Department of Paediatrics
and Child Health, Chris Hani Baragwanath Academic Hospital,
University of Witwatersrand, Johannesburg, South Africa
Introduction:
Congenital complete heart block is a rare conduction
anomaly, which may either be isolated or associated with congenital
structural heart disease. Prenatal diagnosis, identification of high-
risk neonates and early planned management is associated with
improved outcomes.
Methods
: This was a retrospective clinical review of 30 cases between
1986 and 2012 presenting to the Division of Paediatric Cardiology at
the CH Baragwanath Academic Hospital, which is a southern African
tertiary care institution. Data related to clinical features, diagnosis,
pacemaker interventional procedures and follow up were collected.
Results
: Thirty-four patients (18 males and 16 females) were diag-
nosed: 33 (97.1%) postnatally, and one antenatally. Eight patients
were delivered by Caesarian section for foetal distress, including
six premature babies. Presenting features included bradycardia,
congestive cardiac failure, respiratory distress, cardiac murmur,
cardiomyopathy with poor left ventricular function and metabolic
acidosis. Median age at diagnosis was two days. Antibodies Ro/Lo
were positive in 21 patients (61.8%). The major associated cardiac
lesion was patent ductus arteriosus in 15 patients, four of whom had
left ventricular non-compaction. Four patients had heterotaxia associ-
ated with atrio-ventricular septal defects. Other cardiac defects found
in two patients were valvar pulmonary stenosis and a secundum atrial
septal defect. The median ventricular rate was 50 beats/min. The
median atrial rate was 150 beats/min. Four patients (11.8%) had QTc
interval
>
460 ms. Two patients had a wide QRS duration greater
than 120 ms. Thirteen patients (38.2%), including six neonates had
permanent pacemaker insertion at median age of five weeks. Thirteen
patients (38.2%) died prior to permanent pacemaker placement,
including three patients with heterotaxia. Three patients died after
permanent pacemaker insertion.
Conclusion
: Congenital heart block in our setting has a high mortali-
ty rate and is linked with premature delivery. The majority of patients
were associated with autoimmune antibodies.
1397: INVESTIGATING SYNCOPE IN CHILDREN, WHERE
TO DRAW THE LINE
Ranya Hegazy, Sonia El Saeidy, Wael Lotfy, Osama Abdel Aziz
Department of Paediatrics, Faculty of Medicine, Cairo University,
Egypt
Background:
Syncope is the temporary loss of consciousness and
postural tone resulting from an abrupt transient decrease in cerebral
blood flow. Its death-like quality makes it an alarming presenta-
tion for parents and investigating it is troublesome, expensive and
often fruitless. The present work aimed at determining the yield of
diagnostic tests in paediatric syncope at a tertiary paediatric referral
