Publications by authors named "Svjetlana Tisma-Dupanovic"

17 Publications

  • Page 1 of 1

Post-operative arrhythmias in patients with hypoplastic left heart syndrome and anatomic variants: incidence, type, and course.

Cardiol Young 2021 Mar 9:1-7. Epub 2021 Mar 9.

Children's Mercy Hospital, Ward Family Heart Center, Department of pediatric cardiology, 2401 Gillham Road, Kansas City, MO64108, USA.

Background: Arrhythmias are common in the post-operative course of patients with hypoplastic left heart syndrome. We sought to determine the types, incidence, risk factors, and impact of arrhythmias in patients with HLHS and anatomic variants.

Methods: We performed a retrospective chart review of 120 consecutive patients with HLHS and anatomical variants, who had single-ventricle palliation at our institution from January, 2006 to December, 2016.

Results: A total of thirty-one patients (26%) had 37 episodes of arrhythmias over a median follow-up period of 3.5 years. Of the 37 episodes, 12 (32.4%) were ectopic atrial tachycardia, 9 (24.3%) were paroxysmal supraventricular tachycardia, 4 (10.8%) were junctional ectopic tachycardia, 5 (13.6%) were sinus node dysfunction, 3 (8.1%) were heart block, 2 (5.4%) were atrial flutter, and 2 (5.4%) were ventricular tachycardia. Twenty-four (65%) of the arrhythmias occurred at post-stage 1 surgery. Most (64.8%) of the arrhythmias were resolved. Arrhythmias that occurred at post-stage 1 surgery were more likely to resolve compared to post-stages 2 or 3 (p = 0.006). No anatomical, surgical, or clinical variables were associated with arrhythmia except for age (OR per unit decrease in age at stage 1 palliation: 1.12 (95% CI 1.003, 1.250); p = 0.0439). Arrhythmias were not associated with length of hospital stay or mortality.

Conclusion: Arrhythmias are common in patients with HLHS and anatomic variants, with EAT and PSVT being the most common types. Arrhythmias were associated with younger age at surgery, but did not affect mortality or length of hospital stay.
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http://dx.doi.org/10.1017/S1047951121000299DOI Listing
March 2021

The approach to pediatric syncope with exercise.

HeartRhythm Case Rep 2019 Oct 15;5(10):485-488. Epub 2019 Oct 15.

The Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri.

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http://dx.doi.org/10.1016/j.hrcr.2019.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593692PMC
October 2019

A novel technique for extraction of a leadless pacemaker that embolized to the pulmonary artery in a young patient: A case report.

HeartRhythm Case Rep 2020 Oct 18;6(10):724-728. Epub 2020 Jul 18.

Department of Radiology, Saint Luke's Hospital of Kansas City, Kansas City, Missouri.

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http://dx.doi.org/10.1016/j.hrcr.2020.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573366PMC
October 2020

Atrioventricular Nodal Reentrant Tachycardia in Patients With Congenital Heart Disease: Outcome After Catheter Ablation.

Circ Arrhythm Electrophysiol 2017 Jul 7;10(7). Epub 2017 Jul 7.

For the author affiliations, please see the Appendix.

Background: The relationship of atrioventricular nodal reentrant tachycardia to congenital heart disease (CHD) and the outcome of catheter ablation in this population have not been studied adequately.

Methods And Results: A multicenter retrospective study was performed on patients with CHD who had atrioventricular nodal reentrant tachycardia and were treated with catheter ablation. There were 109 patients (61 women), aged 22.1±13.4 years. The majority, 86 of 109 (79%), had CHD resulting in right heart pressure or volume overload. Patients were divided into 2 groups: group A (n=51) with complex CHD and group B (n=58) with simple CHD. There were no significant differences between groups in patients' growth parameters, use of 3-dimensional imaging, and type of ablation (radiofrequency versus cryoablation). Procedure times (251±117 versus 174±94 minutes; =0.0006) and fluoroscopy times (median 20.8 versus 16.6 minutes; =0.037) were longer in group A versus group B. There were significant differences between groups in the acute success of ablation (82% versus 97%; =0.04), risk of atrioventricular block (14 versus 0%; =0.004), and need for chronic pacing (10% versus 0%; =0.008). There was no permanent atrioventricular block in patients who underwent cryoablation. After 3.2±2.7 years of follow-up, long-term success was 86% in group A and 100% in group B (=0.004).

Conclusions: Atrioventricular nodal reentrant tachycardia can complicate the course of patients with CHD. This study demonstrates that the outcome of catheter ablation is favorable in patients with simple CHD. Patients with complex CHD have increased risk of procedural failure and atrioventricular block.
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http://dx.doi.org/10.1161/CIRCEP.116.004869DOI Listing
July 2017

External Cardioversion of Supraventricular Tachycardia in Omphalo-Thoracopagus Conjoined Twins.

JACC Clin Electrophysiol 2017 03 14;3(3):310-312. Epub 2016 Sep 14.

Division of Cardiology, Children's Mercy Hospital, Kansas City, Missouri. Electronic address:

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http://dx.doi.org/10.1016/j.jacep.2016.08.003DOI Listing
March 2017

Acquired right atrial appendage to right ventricle accessory pathway in a lateral tunnel Fontan patient: Successful ablation via transconduit approach.

HeartRhythm Case Rep 2015 Nov 8;1(6):481-485. Epub 2015 Sep 8.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.

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http://dx.doi.org/10.1016/j.hrcr.2015.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419733PMC
November 2015

Current management of focal atrial tachycardia in children: a multicenter experience.

Circ Arrhythm Electrophysiol 2014 Aug 11;7(4):664-70. Epub 2014 Jul 11.

From the Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children's Hospital, Salt Lake City, UT (S.P.E.); Stollery Children's Hospital, Edmonton, AB, Canada (M.J.K.); Children's Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin, Milwaukee (A.K.S.); Mayo Clinic, Rochester, MN (B.C.C.); and The Children's Hospital Colorado, Aurora (M.S.S.).

Background: Focal atrial tachycardia (FAT) is an uncommon cause of supraventricular tachycardia in children. Incessant FAT can lead to tachycardia-induced cardiomyopathy. There is limited information regarding the clinical course and management of FAT. This study characterizes current management strategies for FAT in children including the prevalence of spontaneous resolution and the role of catheter ablation.

Methods And Results: This is a retrospective chart review of pediatric patients with FAT managed between January 2000 and November 2010 at 10 pediatric centers. There were 249 patients with a median age at diagnosis of 7.2 (95% confidence interval, 5.8-10.4) years. Cardiomyopathy was observed in 28%. Resolution of FAT occurred in 89%, including spontaneous resolution without catheter ablation in 34%. Antiarrhythmic medications were used for initial therapy in 154 patients with control of FAT in 72%. Among first-line medications, β-blockers were the most common (53%) and effective (42%). Catheter ablation was successful in 80% of patients. FAT recurrence was less common with electroanatomic mapping compared with conventional mapping techniques (16% versus 35%; P=0.02). Patients were followed for a median of 2.1 (95% confidence interval, 1.8-2.6) years.

Conclusions: FAT is managed successfully in most children. Current approaches are variable. Many patients have control of FAT with medications; however, catheter ablation is used for most patients. Spontaneous resolution is common for young children, emphasizing the role for delayed ablation in this group. Ablation is successful for all ages. Lower recurrence occurs when electroanatomic mapping techniques are used.
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http://dx.doi.org/10.1161/CIRCEP.113.001423DOI Listing
August 2014

An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations.

J Thorac Cardiovasc Surg 2014 Aug 27;148(2):576-81. Epub 2013 Oct 27.

Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address:

Objective: The study objective was to determine whether the extracardiac conduit Fontan confers an arrhythmia advantage over the intracardiac lateral tunnel Fontan.

Methods: This multicenter study of 1271 patients compared bradyarrhythmia (defined as need for pacing) and tachyarrhythmia (defined as needing antiarrhythmic therapy) between 602 patients undergoing the intracardiac Fontan and 669 patients undergoing the extracardiac Fontan. The median age at the time of the Fontan procedure was 2.1 years (interquartile range, 1.6-3.2 years) for the intracardiac group and 3.0 years (interquartile range, 2.4-3.9) for the extracardiac group (P < .0001). The median follow-up was 9.2 years (interquartile range, 5-12.8) for the intracardiac group and 4.7 years (interquartile range, 2.8-7.7) for the extracardiac group (P < .0001).

Results: Early postoperative (<30 days) bradyarrhythmia occurred in 24 patients (4%) in the intracardiac group and 73 patients (11%) in the extracardiac group (P < .0001). Early postoperative (<30 days) tachyarrhythmia occurred in 32 patients (5%) in the intracardiac group and 53 patients (8%) in the extracardiac group (P = not significant). Late (>30 days) bradyarrhythmia occurred in 105 patients (18%) in the intracardiac group and 63 patients (9%) in the extracardiac group (P < .0001). Late (>30 days) tachyarrhythmia occurred in 58 patients (10%) in the intracardiac group and 23 patients (3%) in the extracardiac group (P < .0001). By multivariate analysis factoring time since surgery, more patients in the extracardiac group had early bradycardia (odds ratio, 2.9; 95% confidence interval, 1.8-4.6), with no difference in early tachycardia, late bradycardia, or late tachycardia.

Conclusions: Overall arrhythmia burden is similar between the 2 groups, but the extracardiac Fontan group had a higher incidence of early bradyarrhythmias. There was no difference in the incidence of late tachyarrhythmias over time between the 2 operations. Therefore, the type of Fontan performed should be based on factors other than an anticipated reduction in arrhythmia burden from the extracardiac conduit.
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http://dx.doi.org/10.1016/j.jtcvs.2013.08.070DOI Listing
August 2014

An adolescent with possible arrhythmogenic right ventricular dysplasia and long QT syndrome: evaluation and management.

Ann Noninvasive Electrocardiol 2013 Jan;18(1):75-8

University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.

We describe a unique presentation of arrhythmogenic right ventricular dysplasia (ARVD) in a 14-year-old Caucasian male who was additionally diagnosed with long QT syndrome (LQTS). Genetic testing eventually confirmed the diagnosis of both ARVD and LQTS, which combined, to our knowledge, has not been reported in the literature.
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http://dx.doi.org/10.1111/anec.12043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6932431PMC
January 2013

Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study.

Circulation 2013 Feb 30;127(5):613-23. Epub 2012 Dec 30.

Children's Heart Center, University Hospital Motol, V Úvalu 84, 150 06 Prague 5, Czech Republic.

Background: We evaluated the effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children requiring permanent pacing.

Methods And Results: One hundred seventy-eight children (aged <18 years) from 21 centers with atrioventricular block and a structurally normal heart undergoing permanent pacing were studied cross-sectionally. Median age at evaluation was 11.2 (interquartile range, 6.3-15.0) years. Median pacing duration was 5.4 (interquartile range, 3.1-8.8) years. Pacing sites were the free wall of the right ventricular (RV) outflow tract (n=8), lateral RV (n=44), RV apex (n=61), RV septum (n=29), LV apex (n=12), LV midlateral wall (n=17), and LV base (n=7). LV synchrony, pump function, and contraction efficiency were significantly affected by pacing site and were superior in children paced at the LV apex/LV midlateral wall. LV dyssynchrony correlated inversely with LV ejection fraction (R=0.80, P=0.031). Pacing from the RV outflow tract/lateral RV predicted significantly decreased LV function (LV ejection fraction <45%; odds ratio, 10.72; confidence interval, 2.07-55.60; P=0.005), whereas LV apex/LV midlateral wall pacing was associated with preserved LV function (LV ejection fraction ≥55%; odds ratio, 8.26; confidence interval, 1.46-47.62; P=0.018). Presence of maternal autoantibodies, gender, age at implantation, duration of pacing, DDD mode, and QRS duration had no significant impact on LV ejection fraction.

Conclusions: The site of ventricular pacing has a major impact on LV mechanical synchrony, efficiency, and pump function in children who require lifelong pacing. Of the sites studied, LV apex/LV midlateral wall pacing has the greatest potential to prevent pacing-induced reduction of cardiac pump function.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.112.115428DOI Listing
February 2013

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.

Circ Arrhythm Electrophysiol 2012 Oct 8;5(5):984-91. Epub 2012 Sep 8.

Division of Pediatric Cardiology, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.

Background: 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.

Methods And Results: 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 treatment. The 6-month recurrence-free status was 79% for patients on digoxin and 67% for patients on propranolol (P=0.34), and there were no first recurrences in either group between 6 and 12 months. There were no deaths and no serious adverse events related to study medication.

Conclusions: There was no difference in SVT recurrence in infants treated with digoxin versus propranolol. The current standard practice may be treating infants longer than required and indicates the need for a placebo-controlled trial. Clinical Trial Registration Information- http://clinicaltrials.gov; NCT-00390546.
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http://dx.doi.org/10.1161/CIRCEP.112.972620DOI Listing
October 2012

Congenital long QT 3 in the pediatric population.

Am J Cardiol 2012 May 21;109(10):1459-65. Epub 2012 Feb 21.

Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, USA.

There is insufficient knowledge concerning long-QT (LQT) 3 in the pediatric population to determine whether recommendations for more aggressive therapy in these patients are appropriate. An international multicenter review of 43 children with cardiac sodium channel (SCN5A) mutations and clinical manifestations of LQT syndrome without overlap of other SCN5A syndromes was undertaken to describe the clinical characteristics of LQT3 in children. Patients were aged 7.6 ± 5.9 years at presentation and were followed for 4.7 ± 3.9 years. There was significant intrasubject corrected QT interval (QTc) variability on serial electrocardiography. Forty-two percent presented with severe symptoms or arrhythmia and exhibited longer QTc intervals compared to asymptomatic patients. None of the 14 patients who underwent primary prevention implantable cardioverter-defibrillator (ICD) implantation received appropriate shocks in 41 patient-years of follow-up, while 2 of 6 patients who underwent secondary prevention ICD implantation received appropriate shocks in 30 patient-years of follow-up. Half of patients who underwent ICD implantation experienced inappropriate shocks or ICD-related complications. Mexiletine significantly shortened the QTc interval, and QTc shortening was greater in patients with longer pretreated QTc intervals. Two ICD patients with frequent appropriate ICD shocks showed immediate clinical improvement, with elimination of appropriate ICD shocks after mexiletine loading. In conclusion, severe symptoms are common in children with LQT3 and are associated with longer QTc intervals. ICD implantation is associated with significant morbidity. Mexiletine shortens the QTc interval, and it may be beneficial.
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http://dx.doi.org/10.1016/j.amjcard.2012.01.361DOI Listing
May 2012

Impact of the permanent ventricular pacing site on left ventricular function in children: a retrospective multicentre survey.

Heart 2011 Dec 14;97(24):2051-5. Epub 2011 Sep 14.

Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, PO Box 616, Maastricht NL-6200, The Netherlands.

Background: Chronic right ventricular (RV) pacing is associated with deleterious effects on cardiac function.

Objective: In an observational multicentre study in children with isolated atrioventricular (AV) block receiving chronic ventricular pacing, the importance of the ventricular pacing site on left ventricular (LV) function was investigated.

Methods: Demographics, maternal autoantibody status and echocardiographic measurements on LV end-diastolic and end-systolic dimensions and volumes at age <18 years were retrospectively collected from patients undergoing chronic ventricular pacing (>1 year) for isolated AV block. LV fractional shortening (LVFS) and, if possible LV ejection fraction (LVEF) were calculated. Linear regression analyses were adjusted for patient characteristics.

Results: From 27 centres, 297 children were included, in whom pacing was applied at the RV epicardium (RVepi, n = 147), RV endocardium (RVendo, n = 113) or LV epicardium (LVepi, n = 37). LVFS was significantly affected by pacing site (p = 0.001), and not by maternal autoantibody status (p = 0.266). LVFS in LVepi (39 ± 5%) was significantly higher than in RVendo (33 ± 7%, p < 0.001) and RVepi (35 ± 8%, p = 0.001; no significant difference between RV-paced groups, p = 0.275). Subnormal LVFS (LVFS < 28%) was seen in 16/113 (14%) RVendo-paced and 21/147 (14%) RVepi-paced children, while LVFS was normal (LVFS ≥ 28%) in all LVepi-paced children (p = 0.049). These results are supported by the findings for LVEF (n = 122): LVEF was <50% in 17/69 (25%) RVendo- and in 10/35 (29%) RVepi-paced patients, while LVEF was ≥ 50% in 17/18 (94%) LVepi-paced patients.

Conclusion: In children with isolated AV block, permanent ventricular pacing site is an important determinant of LV function, with LVFS being significantly higher with LV pacing than with RV pacing.
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http://dx.doi.org/10.1136/heartjnl-2011-300197DOI Listing
December 2011

Cardiomyocyte injury to transplant: pediatric management.

Curr Opin Cardiol 2003 Mar;18(2):91-7

Division of Pediatric Cardiology, Golisano Children's Hospital at Strong, University of Rochester School of Medicine and Dentistry, New York 14642, USA.

Cardiomyocyte injury in pediatric patients has a vast number of causes, which are often distinct from the causes of adult heart failure. However, the management of pediatric heart failure and heart transplantation has generally been inferred from adult studies. New therapies show great promise for the neurohormonal regulation of heart failure and the ability to control immunosuppression after heart transplantation. Large, randomized, multicenter, controlled clinical trials are needed to determine the efficacy of these therapies in this population. This article reviews the current recommendations and evidence-based medicine, where available, for the medical management of myopathic dysfunction and transplantation in pediatric patients.
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http://dx.doi.org/10.1097/00001573-200303000-00003DOI Listing
March 2003