HF and Pediatric Considerations

Question 1

What is the goal of BiV pacing?

Answer 1

To deliver > 98% pacing for all ventricular beats

Question 2

In medtronic devices, what does the effective vs ineffective CRT pacing indicate?

Answer 2

Ineffective pacing is labeled when there are changes in morphology of ventricular paced events that could be optimized for better resynchronization therapy

Question 3

How do modern day devices estimate fluid status?

Answer 3

Measure pulmonary fluid by changes in intrathoracic impedance.

Fluid has less impedance than air. Decreasing impedances can indicate fluid overload.

Question 4

What factors are included in the HeartLogic score?

Answer 4

Heart sounds (S3)
Thoracic impedance
Respiration
Heart rate
Activity

Question 5

What are factors to consider when choosing device therapy in pediatric patients?

Answer 5

Heart rate criteria
Congenital AV block
Prolonged QT
Rhythm disturbances associated with CHD

Question 6

What is class I indication for PPM in pediatrics with SND?

Answer 6

Correlation of symptoms during AGE INAPPROPRIATE sinus bradycardia

Question 7

What are class IIa indications for PPM in pediatrics with SND?

Answer 7

1. CHD and sinus bradycardia for prevention of recurrent episodes of IART
2. CHD with HR < 40 bpm or pauses > 3 seconds
3. CHD and impaired hemodynamics due to sinus bradycardia or loss of AV synchrony

Question 8

Class I indications for PPM in pediatric patients with AV node dysfunction

Answer 8

1. Advanced 2nd or 3rd degree AV block associated with symptomatic bradycardia, ventricular dysfunction, or low cardiac output
2. Congenital complete AV block (CCAVB) with wide QRS escape rhythm, complex ectopy, or ventricular dysfunction
3. CCAVB in infants with ventricular rate < 55 or < 70 in infants with other CHD

Question 9

Class IIA indications for PPM in pediatric patients with AV node dysfunction

Answer 9

CCAVB beyond the first year of life with avg heart rate < 55, abrupt pauses 2-3 times basic cycle length, or symptoms associated with chronotropic incompetence

Question 10

When is pacing indicated for advanced AV block following pediatric cardiac surgery?

Answer 10

AV block not expected to resolve

AV block persists past 7 days

Question 11

What are the most common cardiac malformations affecting children?

Answer 11

ASD, VSD, PDA, TOF, TPGV, truncus arteriosus, hypoplastic left heart syndrome, coarctation of the aorta, total anomalous pulmonary venous return (TAPVR)

Question 12

What is a patent ductus arteriosus (PDA)?

Answer 12

Communication between pulmonary artery and the aorta that is normal during fetal development but should close after birth.

Allows blood flow from high pressure aorta to low pressure pulmonary artery and causes lung congestion

Question 13

What are the 4 abnormalities in TOF?

Answer 13

VSD
Pulmonary valve stenosis
Overriding aorta
RV hypertrophy

Question 14

What is truncus arteriosus?

Answer 14

Defect where there is only one common outflow vessel for the right and left ventricles. Because of this, a VSD exists to allow blood from both ventricles to flow outward.

Question 15

What is coarctation of the aorta?

Answer 15

Narrowing of the aorta near the ductus arteriosus.

Varying degrees of severity but can result in hypertension and LVH.

Question 16

Describe the abnormality seen in TAPVR.

Answer 16

Pulmonary veins drain into a different vessel rather than the left atrium such as the left innominate vein, coronary sinus, etc.

Leads to possible mixing of blood and right-sided overload.

Question 17

Why might DFTs be higher in HCM patients?

Answer 17

Increased left ventricular mass

Concomitant AAD use (amiodarone)