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T Paul

Publications and source records attributed to T Paul.

At least 19 recordsLinked to original sources
PubMed1996

Enhanced release of nitric oxide causes increased cytotoxicity of S-nitroso-N-acetyl-DL-penicillamine and sodium nitroprusside under hypoxic conditions.

S-Nitroso-N-acetyl-DL-penicillamine (SNAP) and sodium nitroprusside (SNP), both of which are known to release nitric oxide (.NO), exhibited cytotoxicity against cultivated endothelial cells. Under hypoxic conditions 5 mM SNAP and 20 mM SNP induced a loss in cell viability of about 90% and 80% respectively, after an 8 h incubation. Under normoxic conditions, cell death was only 45% and 42% respectively within the same time period. Concentrations of .NO liberated from SNAP and SNP were measured by the oxyhaemoglobin method and by two of the recently developed nitric oxide cheletropic traps (NOCTs). The .NO concentrations from SNAP and SNP increased from 74 microM and 28 microM to 136 microM and 66 microM respectively within 15 min of hypoxic incubation, and then decreased to 36 microM and 28 microM. In the respective normoxic incubations the .NO levels from SNAP and SNP remained in the region of about 30 microM and 20 microM respectively. In contrast, spermine/NO adduct (spermineNONOate) was shown to be more toxic under normoxic than under hypoxic conditions. Under either of these conditions, the concentration of .NO liberated from 2 mM spermineNONOate was about 20 microM. The results demonstrate that the cytotoxicity of SNAP and SNP, but not of spermineNONOate, is significantly enhanced under hypoxic compared with normoxic incubations. Studies on the .NO-releasing behaviour of these compounds indicate that the increased toxicity of SNAP and SNP under hypoxic conditions is related to the influence of O2 on the chemical processes by which .NO is produced from the precursors, rather than to an increased sensitivity of the hypoxic cells towards .NO.

Animals↗
PubMed1996

Familial idiopathic atrial fibrillation with bradyarrhythmia.

UNLABELLED: A 10-year-old boy is reported who presented with idiopathic atrial fibrillation and bradyarrhythmia. After history of intrauterine and postnatal bradycardia, atrial fibrillation was first documented electrocardiographically at 16 months of age. An underlying structural heart disease was not evident. At the age of 10 years, implantation of a permanent ventricular demand pacemaker was indicated after syncope due to severe bradyarrhythmia. The family history revealed five persons of four generations with bradyarrhythmias. Idiopathic atrial fibrillation known since childhood was documented in three close relatives. A high grade AV block resulting in bradyarrhythmias and the occurrence of ST-T-changes in precordial leads could be demonstrated in all affected family members suggesting a diffuse general conduction abnormality in these patients. In this family, idiopathic atrial fibrillation seems to be transmitted as an autosomal dominant trait. CONCLUSION: Atrial fibrillation without underlying heart disease is extremely rare in children. Careful electrocardiographic follow-up of these patients and the evaluation of ECG recordings of all family members is recommended.

Atrial Fibrillation↗
PubMed1996

Lack of evidence of areas of slow conduction early after radiofrequency current application at porcine atrial myocardium.

Electrophysiological sequelae after creation of atrial myocardial lesions by radiofrequency current (RFC) application have not been studied in vitro. During general anesthesia, a steerable 6 French electrode catheter, equipped with a thermistor at the 4-mm tip electrode, was positioned at the lateral atrial aspect of the tricuspid valve annulus in 5 piglets (German Landrace, mean body weight 12.5 kg). Temperature-guided (75 degrees C) RFC (500 kHz) was delivered over 30 seconds. Forty-eight hours later, the hearts were removed and placed in ice-cold Turner's solution. The right atria were dissected, and the RFC lesions with surrounding tissue were cut out and transferred to an organ bath according to Steiert. Preparations were superfused with Turner's solution at 37 degrees C. Pacing of the viable tissue at the border of the preparations was accomplished at a cycle length of 500 ms. Whole atrial preparations were impaled (76 to 150 impalements per specimen) with KCl capillary microelectrodes containing 3 MKCl. In the surrounding viable tissue of the five preparations, mean maximum diastolic transmembrane potential ranged from -61.3 to -63.7 mV, mean action potential duration at 90% repolarization ranged from 135.2 to 156.1 ms, and mean maximum upstroke velocity of phase 0 of the action potential was between 104.7 and 112.9 V/sec. Statistical analysis revealed no significant differences among all 3 variables. No intracellular action potential was recorded from the surface of all 5 lesions. The surrounding tissue was sharply demarcated, with unaltered transmembrane action potential characteristics in the vicinity of the lesions. Areas of slow conduction were not observed. Lack of evidence of areas of slow conduction after RFC application to the atrial myocardium may imply that this technique is safe regarding occurrence of atrial tachyarrhythmias.

Action Potentials↗
PubMed1996

[Atrial flutter in young patients after corrective operation of congenital heart defects: therapy by high frequency catheter ablation].

UNLABELLED: Radiofrequency catheter ablation has been used successfully in adult patients for treatment of atrial flutter. Three young patients (mean age 14.6 years) with common type atrial flutter (n = 2) and uncommon type atrial flutter (n = 1) underwent electrophysiologic study. Cardiac diagnoses included tricuspid atresia after Fontan operation, status after closure of an atrial septal defect of secundum type, and status after surgical valvotomy for valvular pulmonary stenosis, respectively. Indication for ablation were syncopal episodes in one and presyncopal episodes in two patients. Flutter cycle length ranged from 280 to 320 ms. Right atrial endocardial mapping revealed areas with local electrograms preceding the onset of the flutter-P-wave by 70 to 80 ms. In these regions pace mapping was performed with the intention to produce an identical P-wave morphology and short stimulus to P-wave interval. Radiofrequency current application (500 kHz) with 30 W for 30 s at theses sites terminated atrial flutter and prevented reinduction in all three patients. No complications were observed. Follow-up (7 to 11 months) revealed recurrence of uncommon type of atrial flutter in one patient who previously had had common type. The remaining two patients are in stable sinus rhythm. CONCLUSION: Radiofrequency catheter ablation appears to be an effective treatment of atrial flutter after surgery for congenital heart defects in young patients.

Adolescent↗
PubMed1996

[Intermediate and long-term outcome after percutaneous balloon dilatation of valvular pulmonary stenoses in childhood].

Pulmonary balloon valvuloplasty was performed in 52 patients aged 7 days to 19 years (mean 5.5 years). Mean balloon/anulus ratio was 1.24. Mean right ventricular outflow tract (RVOT) systolic pressure gradient was 79.9 +/- 37.3 (x +/- SD) mm Hg before valvuloplasty and 37.2 +/- 29.6 mm Hg (p < 0.001) immediately after the procedure. 33 patients had residual RVOT-gradient < or = 36 (22 +/- 7) mm Hg, 19 patients had gradients > 36 (67.1 +/- 35.6) mm Hg. During intermediate follow-up (< 2 years) RVOT gradient assessed by catheterization or Doppler echocardiography improved without any additional intervention in 10/19 patients with RVOT gradient > 36 mm Hg early after valvuloplasty. 6/19 patients required additional reduction of RVOT gradient by repeated valvuloplasty (51 +/- 19 to 29 +/- 5 mm Hg; p < 0.01). 3/19 patients needed surgical resection of extremely thickened dysplastic valves. 49 patients had a mid- to long-term follow-up by echocardiography (mean 4.3, max. 9 years); the RVOT gradient decreased from 25.7 +/- 12.8 mm Hg during intermediate follow-up to 18.0 +/- 7.0 mm Hg during long-term follow-up. If pulmonary regurgitation was present after dilatation (n = 38), it was hemodynamically not significant and did not change during follow-up. Percutaneous balloon valvuloplasty was a safe and effective treatment for pulmonary valve stenosis in infancy and childhood. Long-term results confirm the value of this method.

Adolescent↗
PubMed1996

[Permanent ventricular tachycardia in a 12-year-old boy: curative therapy by high frequency current ablation].

UNLABELLED: A 12-year old boy from Armenia presented with chronic permanent ventricular tachycardia (150/min) and reduced left ventricular shortening fraction (< 30%). Tachycardia was present > 20 h/day on several 24-h Holter monitorings. Diagnosis of ventricular tachycardia could be established on surface ECG by identification of atrioventricular dissociation and a right bundle branch block pattern with a R/S ratio < 1 in lead V6. Antiarrhythmic therapy with mexiletine and sotalol alone or in combination did not influence the presence of the dysrhythmia. During electrophysiological study, the dysrhythmia could not be terminated by administration of adenosine, ventricular extrastimuli, overdrive stimulation or direct current cardioversion. Endocardial mapping identified a region on the left ventricular surface of the anterior upper interventricular septum as the origin of the dysrhythmia. At this location stimulation at a cycle length shorter than the tachycardia produced a QRS complex nearly identical to the tachycardia QRS complex. Local ventricular electrogram preceded the onset of the tachycardia QRS complex on surface ECG by 23 ms. Radiofrequency current application with 30 W for 30 s resulted in permanent termination of the tachycardia. No complications occurred. Six months after the intervention, the boy is still in normal sinus rhythm. Left ventricular function normalized. CONCLUSION: Radiofrequency catheter ablation should be considered in young patients with drug-refractory chronic permanent ventricular tachycardia.

Bundle-Branch Block↗
PubMed1995

Role of late potentials in identifying patients at risk for ventricular tachycardia after surgical correction of congenital heart disease.

This study evaluates the role of late potentials in identifying patients with sustained ventricular tachycardia (VT) after surgery for congenital heart defects using right ventriculotomy. Nine patients with early (1 to 12 months) or late VT (spontaneous in 7 [induced during electrophysiologic study in 6 of the 7] and induced in 2) and 104 patients without VT were studied. All patients had complete right bundle branch block. Late potentials were quantified by 3 time-domain parameters of the signal-averaged electrocardiogram: total filtered QRS duration, root-mean-square voltage in the last 40 ms, and low-amplitude signal duration of the terminal filtered QRS complex. Root-mean-square voltage filtered at 80 to 250 Hz was lower in patients with than without VT (9 +/- 6 vs 16 +/- 8 microV, p < 0.01). By multivariate analysis, more complex surgery (i.e., insertion of extracardiac conduits, Kawashima operation, etc.), lower root-mean-square voltage, and higher Lown grade (2 to 5) of ventricular arrhythmias on routine postoperative Holter recordings were the only independent predictors of VT (p < 0.001, < 0.05, and < 0.05, respectively). A combination of more complex surgery, root-mean-square voltage < 14 microV, and Lown grade 2 to 5 ventricular arrhythmias was highly predictive of VT (positive predictive value 75%). Conversely, patients without complex surgery and with root-mean-square voltage of > 13 microV were not likely to develop VT (negative predictive value 100%). Late potentials are an independent predictor of VT and may improve the identification of patients at low and high risk of VT after surgery for congenital heart defects using right ventriculotomy.

Action Potentials↗
PubMed1995

Recurrent ventricular tachycardia in asymptomatic young children with an apparently normal heart.

UNLABELLED: Ventricular tachycardia without underlying heart disease is rare in infancy and childhood. Four young children (median age 8 months at initial presentation) with frequently recurrent episodes of asymptomatic and self-limiting ventricular tachycardia are reported. By noninvasive investigation no apparent heart disease has been found in all patients. Initially three of the four children had been treated with an anti-arrhythmic drug. Treatment was soon stopped in two patients for lack of symptoms and for lack of efficacy of therapy; one patient remained on beta-blocker therapy. One child did not receive anti-arrhythmic therapy. After a mean follow up of 32 months all patients continued to be asymptomatic despite frequently recurrent episodes of self-limiting ventricular tachycardia. CONCLUSION: Ventricular tachycardia in asymptomatic children with an otherwise normal heart carries a good prognosis. Invasive investigation (cardiac catheterization with electrophysiological study and right ventricular biopsy) can be withhold, as long as there are no symptoms. For lack of efficiency of antiarrhythmic drugs in suppressing ventricular tachycardia in asymptomatic children with apparently normal hearts, these patients may be left without therapy but have to be followed closely.

Anti-Arrhythmia Agents↗
PubMed1995

Successful management of junctional tachycardia by hypothermia after cardiac operations in infants.

BACKGROUND: Junctional ectopic tachycardia is an early postoperative complication after intracardiac repair of congenital heart disease, especially in infants. Because of the high ventricular rate and the usually poor response to antiarrhythmic drugs, this condition is associated with a high morbidity and mortality. The purpose of this study was to assess the safety and efficacy of moderate body surface hypothermia in the treatment of postoperative junctional ectopic tachycardia in infants. METHODS: Six consecutive infants with postoperative junctional ectopic tachycardia (mean age at operation, 14 weeks) were treated with surface cooling. The decision to start treatment was based on the definition of a critical heart rate (180 to 200 beats/min) in the presence of junctional ectopic tachycardia diagnosed according to established criteria. Moderate hypothermia (rectal temperature between 32 degrees and 34 degrees C) was achieved by placing ice bags on the child's body surface. The patients were sedated, mechanically ventilated, and paralyzed. RESULTS: Mean interval between diagnosis of tachycardia and initiation of hypothermia was 4 hours. Rectal temperature was rapidly (within 1 hour) lowered to 32 degrees to 34 degrees C in all 6 patients. This significantly lowered the tachycardia rate from 219 +/- 27 beats/min to 165 +/- 25 beats/min (mean +/- standard deviation; p < 0.001). Three patients with signs of low cardiac output had restoration of stable hemodynamics once the tachycardia rate had been decreased by hypothermia. Cooling was maintained for a period of 24 to 88 hours (mean, 59 hours). No serious side effects were observed. CONCLUSIONS: Early institution of moderate hypothermia by body surface cooling was a safe and efficient measure to control ventricular rate in infants with postoperative junctional ectopic tachycardia.

Body Temperature↗
PubMed1995

Total cavopulmonary anastomosis in patients less than three years of age.

BACKGROUND: As young age at modified Fontan operation was thought to be a preoperative risk factor for poorer survival, we studied early and intermediate outcome in our young patient group. METHODS: Results in children less than 3 years of age (group I; n = 26; age range, 7 to 35 months) were compared with those in older patients (group II; n = 46; age range, 36 to 219 months). For both groups there was no significant difference with regard to preoperative pathology and hemodynamics. RESULTS: With an overall mortality of 9.7% (7/72) there was no significant difference for both groups. Group I (n = 23) and group II (n = 42) survivors did not differ with respect to early postoperative incidence of atrial dysrhythmias, duration and volume of pleural effusion, or incidence of reoperation. Results on intermediate follow-up (group I, 31 +/- 14 months; group II, 44 +/- 20 months) demonstrated a relatively low incidence of late atrial dysrhythmias (12.3%; 8/65). Late atrioventricular valve insufficiency was significantly more frequent in group I patients. CONCLUSIONS: With similar preoperative anatomic and hemodynamic parameters including 68% of patients with complex univentricular heart, total cavopulmonary anastomosis could be performed in patients less than 3 years of age with good clinical and hemodynamic results, as achieved in older patients.

Child, Preschool↗
PubMed1995

Efficacy and proarrhythmia of oral sotalol in pediatric patients.

OBJECTIVES: This study sought to assess the efficacy of oral sotalol for various arrhythmias in pediatric patients and to evaluate the incidence of proarrhythmia and systemic side effects. BACKGROUND: Sotalol is a beta-adrenergic blocking agent with additional class III antiarrhythmic properties. Experience in pediatric patients is limited. Data concerning the incidence of proarrhythmia in children are lacking. METHODS: Seventy-one pediatric patients (mean age 7.3 years) with various supraventricular and ventricular tachyarrhythmias were treated with oral sotalol. All the patients were admitted to the hospital for initiation of sotalol therapy. Antiarrhythmic and proarrhythmic effects of sotalol were assessed by daily surface electrocardiograms (ECGs) during the in-hospital phase and by serial Holter monitoring. RESULTS: Sotalol was either completely (27 [66%] of 41 patients) or partially effective (11 [27%] of 41) in 38 (93%) of 41 patients with supraventricular reentrant tachycardias. In patients with atrial flutter predominantly after operation for congenital heart disease, sotalol was effective in 84% of patients (completely in 9 of 19 and partially in 7 of 19). Ventricular tachycardia was completely (3 of 11) or partially (4 of 11) controlled in 64% of children. Proarrhythmia occurred in seven patients (10%) and consisted of symptomatic bradycardia from sinoatrial block and high grade atrioventricular (AV) block, respectively, in two children; asymptomatic high grade AV block in one; torsade de pointes in one; and relevant increased ventricular ectopic activity in three. Proarrhythmia required drug discontinuation in four patients. Mean duration of treatment for all patients was 18 months (range 1 to 40). CONCLUSIONS: Sotalol was an effective antiarrhythmic drug for a wide range of pediatric tachyarrhythmias. The considerable number of patients with proarrhythmic effects indicates the need for initiation of treatment on an inpatient basis and close monitoring by serial Holter electrocardiography.

Administration, Oral↗
PubMed1995

[Sotalol-induced torsade de pointes tachycardia in a 15-month-old infant].

Torsade de pointes (tdp) is a form of ventricular tachycardia whose occurrence in childhood is very rare. In adults treated with sotalol (Sotalex), tdp has been reported to have an incidence of 2-4%. There have been no reports of its occurrence in children treated with sotalol. We report about a 15-month-old girl with Wolff-Parkinson-White syndrome who developed recurrent syncopal attacks. She had been treated with sotalol at 1.5 mg/kg daily since being a newborn because of recurrent episodes of paroxysmal supraventricular tachycardia. Electrocardiogram exhibited frequent tdp tachycardia. Serum electrolyte levels were normal. Echocardiography excluded a structural heart defect and showed no signs of myocardial infection. After sotalol was ceased, infusion with lidocain was started. Despite this therapy the tdp continued. Magnesium aspartate (Magnesiocard) was then administered, and this finally stopped the tdp. As no other cause was evident, tdp in this child must be judged as a proarrhythmia related to sotalol therapy.

Anti-Arrhythmia Agents↗
PubMed1995

[Therapeutic efficacy and diagnostic potential of adenosine in infants and children].

In an open study a total of 53 episodes of supraventricular reentrant tachycardia in 31 infants and children were treated with intravenous adenosine at two centers. Adenosine was given as a rapid intravenous bolus injection beginning with a dose of 0.1 mg/kg. If there was persistence of the dysrhythmia dosage was increased in 0.05 mg/kg-steps up to a maximum dose of 0.3 mg/kg if necessary. The median dose required for successful termination of the tachycardias was 0.15 mg/kg. In 26 patients with 48 episodes of regular narrow-QRS-complex tachycardia adenosine was used as the therapeutic agent of first choice. In all patients a shortlasting atrioventricular block occurred within seconds after the administration of adenosine. In 42 of 48 episodes of tachycardia (87%) the dysrhythmias were converted to a stable sinus rhythm. In six episodes (13%) recurrence of the tachycardia was observed immediately. In five children adenosine was used for diagnostic purpose: in three children with wide-QRS-complex tachycardia successful termination with adenosine proved the supraventricular origin of the dysrhythmia. In two children with suspected atrial flutter adenosine-induced atrioventricular block allowed identification of flutter waves in one patient while in the other patient no effect of adenosine was seen. Side-effects such as flush, chest-pain or abdominal pain were frequent but mild and only of a few seconds' duration. No influence of adenosine on blood pressure was noted. Only in one child with previously unknown sinus node dysfunction was a relevant electrophysiologic side effect seen: a prolonged sinus arrest with asystole of 12 seconds' duration occurred after adenosine administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1995

[Q-fever associated myocarditis in a 14-year-old boy].

A 14-year-old boy presented with the symptoms and clinical signs of myocarditis. Ventricular arrhythmias were the main manifestation. Dilated left ventricle with slightly impaired contractility and spongy appearance of the myocardium were also noted. Laboratory signs of an acute infectious disease were absent, but a significant rise in the complement fixation titer for Coxiella burnetii was observed. Treatment with oral tetracycline for 6 months resulted in improvement of ventricular arrhythmias and normalization of left ventricular dimensions and structure over the following months. Cardiac involvement in Q fever is rare, and with it endocarditis is usually seen as a chronic form of the disease. Myocarditis associated with Q fever has been reported only in some rare cases but not in children. The case reported here illustrates that the diagnosis of Q fever should also be considered in a case of myocardial involvement in an infectious disease of unknown etiology.

Adolescent↗
PubMed1995

[Nitric oxide in therapy of pulmonary hypertension after correction of congenital single atrium].

We report on a 19-month-old boy with congenital single atrium. Cardiac catheterization preceding the surgical repair revealed an elevated pulmonary artery pressure of 60/15 mmHg (mean pressure 40 mmHg). Pulmonary flow was 8.4 l/min.m2 and systemic flow was 5.5 l/min.m2. Pulmonary arteriolar resistance was elevated to 4.2 U.m2 with 64% left-right shunt and 25% right-left shunt. Arterial O2-saturation varied around 90%. After surgical repair (insertion of a Goretex patch), the patient required mechanical ventilation with 100% oxygen for adequate oxygenation. Cardiac catheterization was repeated on the first postoperative day. No residual shunts were found. The pulmonary artery pressure was 66/40 mmHg (mean pressure 50 mmHg), systemic arterial pressure was 85/62 mmHg (mean pressure 68 mmHg). Cardiac index was 2.8 l/min.m2, pulmonary vascular resistance was 12 U.m2. After administration of prostacyclin a significant decrease of pulmonary artery pressure was observed, but without changing the ratio between pulmonary and systemic pressure. The AaDO2 varied between 400 and 580 mmHg and the oxygenation-index (PaO2/FiO2) was less than 1.0. In this situation, an attempt with inhaled nitric oxide (NO) was performed. After adding 20 ppm NO to the inspired gas, the AaDO2 decreased significantly from 580 to 270 mmHg and the oxygenation-index (OI) rose from 0.9 to 1.5. The inspired fraction of oxygen could be reduced quickly to 60%. During the next days, the concentration of NO was reduced stepwise to 1 ppm. Finally, the AaDO2 was within the normal range (25-65 mmHg) and the OI rose to a level about 4.0. The FiO2 could be reduced to 30% and nitric oxide therapy could be stopped and the child could be extubated.

Administration, Inhalation↗
PubMed1994

[Results of oral sotalol therapy in children with supraventricular and ventricular arrhythmias].

Experience with oral sotalol, a beta-blocker with class III-antiarrhythmic properties, is limited in the pediatric population. Sotalol was administered to 32 patients with a mean age of 8.7 years (range 1 day-19.9 years). Mean dosage was 4.6 (1.5-9.4) mg/kg or 122.1 (52-306) mg/m2, respectively. In 27/32 patients, at least 1 antiarrhythmic agent had failed to control the dysrhythmia before sotalol was started. Cardiac diagnoses included normal heart (n = 16), status after correction of congenital heart disease (n = 13), and cardiomyopathy (n = 3). Success (based on symptoms and 24-h electrocardiogram) was achieved in 16/18 patients with reentry supraventricular tachycardia, in 7/8 patients with atrial flutter, and in 4/6 patients with ventricular tachycardia. During a mean follow-up of 15.6 (2-78) months, proarrhythmia occurred in five (16%) patients (symptomatic bradycardia n = 2, QT-prolongation and ventricular extrasystoles n = 1, ventricular extrasystoles n = 1, 2 degrees av-block n = 1), requiring dosage reduction (n = 3), cessation of treatment (n = 1) and pacemaker implantation in one patient, respectively. Symptomatic hypotension was noted in two patients, in whom therapy had to be stopped. Sotalol was a very effective agent for the treatment of various pediatric cardiac dysrhythmias. However, incidence of proarrhythmic effects warrants close electrocardiographic monitoring.

Administration, Oral↗
PubMed1994

Atrial baffle procedures for complete transposition of the great arteries: natural course of sinus node dysfunction and risk factors for dysrhythmias and sudden death.

359 patients after the Mustard (275) or Senning (84) operations for transposition of the great arteries were followed-up for a mean of 103.7 (range 0.4 to 204) months. 259 patients had postoperative 24-h Holter recordings. In 129 Mustard children serial (mean 4.4) postoperative Holter recordings were available for evaluation. Criteria based on Holter and scalar electrocardiograms at normal sinus node functions were used for rhythm analysis. Postoperative dysrhythmias appeared in 70% of the patients: sinus node dysfunction in 62.8%, second or third degree atrioventricular block in 3.2%, sustained atrial tachycardia or atrial flutter in 4.5%, and significant ventricular arrhythmia (Lown 2-5) in 21.4%. The prevalence of sinus node dysfunction increased slightly from 50.8% during the first 2 postoperative years to 64.4% in patients more than 10 years postoperatively. Fifteen patients (4.2%) died suddenly during follow-up. By multivariate analysis severe tricuspid regurgitation and/or right ventricular dysfunction and uncontrolled supraventricular tachydysrhythmias were identified as the two significant risk factors for sudden death.

Adolescent↗