Browsing by Author "Kean, Adam C."

Now showing 1 - 8 of 8
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    Conduction System Pacing in Pediatrics and Congenital Heart Disease: A Case Report and Literature Review
    (MediaSphere Medical, 2024-02-15) Scott, Michael; Needleman, Joseph S.; Kean, Adam C.; Pediatrics, School of Medicine
    Conduction system pacing involving either His bundle pacing (HBP) or left bundle branch pacing (LBBP) is a modality that has been introduced as a safe and effective alternative to right ventricular (RV) pacing to help prevent pacemaker-associated cardiomyopathy. While HBP has been employed in the pediatric and congenital populations, several small studies have shown LBBP to be safe and effective in the pediatric population. We present a patient with congenital atrioventricular block and postoperative ventricular septal defect repair cardiomyopathy with subsequent left ventricular function improvement following a transition from an RV epicardial pacemaker system to an LBBP system. This case report serves as a foundation for a review of the current state of LBBP in pediatrics and congenital heart disease.
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    The Effects of Progestin-Only Hormone Treatment on QT Interval in the Adolescent Female
    (Elsevier, 2021-01) Kean, Adam C.; Ayers, Mark D.; Farrell, Anne G.; Kean, Kelly A.; Brooks, Patricia W.; Shew, Marcia L.; Pediatrics, School of Medicine
    We describe the effect of exogenous progestin on the corrected QT interval (QTc) in adolescent females. In post-menarcheal females, <18 years old, we compared QTc in milliseconds (ms) on ECG evaluations in those taking exogenous progestin vs those who are not. There were 40 controls and 21 treated participants. The age range was 10–17 years. There were no differences between the groups with regard to race, height, weight, BMI, or blood pressure. In the controls, the mean QTc was 403 ±19 milliseconds (ms) vs. 397 ±15 ms in those treated (p = 0.22). Those on progestin therapy had a shorter QTc by the same magnitude difference (six ms) as the hormonal naïve group in the adult literature. We report no adverse effects of progestin associated with QTc prolongation and a trend suggesting a decreased QTc in a population of post-menarcheal adolescent females.
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    Management of Complications Caused By a Massive Left Ventricle Tumor in a Neonate
    (Elsevier, 2018) Yabrodi, Mouhammad; Mastropietro, Christopher W.; Darragh, Robert K.; Parent, John J.; Ayres, Mark D.; Kean, Adam C.; Turrentine, Mark; Pediatrics, School of Medicine
    We report a case of a neonate born with a giant fibroma occupying the entirety of her left ventricle. Due to the extensive resection, her postoperative course was complicated by severely diminished left ventricular function and complete heart block necessitating extracorporeal support. Ultimately, cardiac resynchronization therapy was employed, after which the infant’s ventricular function gradually improved and she was successfully discharged to home.
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    Permanent His Bundle Pacing in Patients With Congenital Complete Heart Block: A Multicenter Experience
    (Elsevier, 2021-04) Dandamudi, Gopi; Simon, Joel; Cano, Oscar; Master, Vivak; Koruth, Jacob S.; Naperkowski, Angela; Kean, Adam C.; Schaller, Robert; Ellenbogen, Kenneth A.; Kron, Jordana; Vijayaraman, Pugazhendhi; Pediatric Dentistry, School of Dentistry
    Objectives This study retrospectively assessed the safety and efficacy of permanent His bundle pacing (HBP) in patients with congenital complete heart block (CCHB). Background HBP has become an accepted form of pacing in adults. Its role in CCHB is not known. Methods Seventeen patients with CCHB who underwent successful HBP were analyzed at 6 academic centers between 2016 and 2019. Nine patients had de novo implants, and 8 patients had previous right ventricular (RV) leads. Three RV paced patients had reduced left ventricular ejection fractions at the time of HBP. Implant/follow-up device parameters, New York Heart Association functional class, QRS duration, and left ventricular ejection fraction data were analyzed. Results Patients’ mean age was 27.4 ± 11.3 years, 59% were women, and mean follow-up was 385 ± 279 days. The following parameters were found to be statistically significant between implant and follow-up, respectively: impedance, 602 ± 173 Ω versus 460 ± 80 Ω (p < 0.001); and New York Heart Association functional class, 1.7 ± 0.9 versus 1.1 ± 0.3 (p = 0.014). In patients with previous RV pacing, HBP resulted in a significant decrease in QRS duration: 167.1 ± 14.3 ms versus 118.3 ± 13.9 ms (p < 0.0001). In de novo implants, HBP resulted in increases in QRS duration compared with baseline: 111.1 ± 19.4 ms versus 91.0 ± 4.8 ms (p = 0.016). Other parameters exhibited no statistically significant differences. During follow-up, 2 patients required lead revision due to elevated pacing thresholds. Conclusions HBP seems to be safe and effective, with improvement in clinical outcomes in patients with CCHB. Larger studies with longer follow-up periods are required to confirm our findings.
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    Permanent His-bundle Pacing in Pediatrics and Congenital Heart Disease
    (MediaSphere Medical LLC, 2020-02-15) Lyon, Shannon; Dandamudi, Gopi; Kean, Adam C.; Pediatrics, School of Medicine
    Permanent His-bundle pacing has been gaining popularity in the adult population requiring cardiac resynchronization therapy. Initial procedural challenges are being overcome, and this method of pacing has been shown to improve left ventricular function and heart failure symptoms secondary to ventricular dyssynchrony. Though the etiologies of ventricular dyssynchrony may differ in children and those with congenital heart disease than in adults with structurally normal hearts, His-bundle pacing may also be a preferred option in these groups to restore more physiologic electric conduction and improve ventricular function. We present a review of the current literature and suggested directions involving deploying permanent His-bundle pacing in the pediatric and congenital heart disease population.
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    Permanent Nonselective His Bundle Pacing in an Adult with L-Transposition of the Great Arteries and Complete AV Block
    (Wiley, 2017) Kean, Adam C.; Kay, W. Aaron; Patel, Jyoti K.; Miller, John M.; Dandamudi, Gopi; Department of Pediatrics, IU School of Medicine
    We report the placement of a permanent transvenous nonselective His bundle pacing lead in conjunction with a transvenous pacemaker/implantable cardioverter-defibrillator in an adult with Levo-Transposition of the Great Arteries (L-TGA) and a stenotic coronary sinus (CS) ostium, which would not accommodate a transvenous left ventricular (LV) pacing lead. Nonselective His bundle pacing provided a nearly identical ventricular activation pattern in this previously unpaced patient. Many L-TGA patients will have an eventual need for permanent pacing and, given the challenges of CS cannulation, His bundle pacing may represent a preferred modality rather than pure morphologic LV pacing or surgical systemic ventricular lead placement to achieve optimal electrical synchrony.
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    The Risk of Thromboembolic Complications in Fontan Patients with Atrial Flutter/fibrillation Treated with Electrical Cardioversion
    (Springer, 2016-10) Lin, Jiuann-Huey I.; Kean, Adam C.; Cordes, Timothy M.; Department of Pediatrics, IU School of Medicine
    Atrial flutter or fibrillation (AFF) remains a major chronic complication of the Fontan procedure. This complication further predisposes this patient population to thromboembolic events. However, the incidence of thromboembolic complications in Fontan patients with AFF prior to or acutely after electrical cardioversion is unknown. This study aimed to characterize the risk of post-cardioversion thromboembolic events in this population. We performed a retrospective medical record review of all patients with a history of Fontan operation treated with direct current cardioversion for AFF at Riley Children’s Hospital between June 1992 and March 2014. A total of 57 patients were identified and reviewed. A total of 216 episodes of AFF required electrical cardioversion. Patients were treated with anticoagulation/antiplatelet therapy in 86.1 % (N = 186) of AFF episodes. Right atrial or Fontan conduit clots were observed in 33 patients (57.9 %) with 61 episodes of AFF. Approximately half (49.2 %, N = 30) of these episodes were treated immediately with electrical cardioversion. Twenty-five of 33 (75.8 %) patients with intracardiac thrombi had an atriopulmonary Fontan. Five (15.2 %) patients with a lateral caval tunnel had clots in the Fontan conduit, and three (9.1 %) patients with right atrium to right ventricular outflow tract (RVOT) connections presented with right atrial mural thrombi. Nine of the 57 (15.8 %) patients had documented stroke, and three (5.3 %) patients had pulmonary emboli during follow-up, although none of these emboli were associated with electrical cardioversion. The risk of thrombus and thromboembolism associated with AFF is high in the Fontan population. However, the risk of thromboembolism associated with cardioversion in the setting of anticoagulation is very low.
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    To the Editors—Risk factors for complications in the implantation of epicardial pacemakers in neonates and infants
    (Elsevier, 2017) Kean, Adam C.; Rodefeld, Mark; Department of Surgery, IU School of Medicine