Multisystem inflammatory syndrome in children (MIS-C) has spread through the pediatric population during the coronavirus disease 2019 pandemic. Our objective for the study was to report the ...prevalence of conduction anomalies in MIS-C and identify predictive factors for the conduction abnormalities.
We performed a single-center retrospective cohort study of pediatric patients <21 years of age presenting with MIS-C over a 1-month period. We collected clinical outcomes, laboratory findings, and diagnostic studies, including serial electrocardiograms, in all patients with MIS-C to identify those with first-degree atrioventricular block (AVB) during the acute phase and assess for predictive factors.
Thirty-two patients met inclusion criteria. Median age at admission was 9 years. Six of 32 patients (19%) were found to have first-degree AVB, with a median longest PR interval of 225 milliseconds (interquartile range 200-302), compared with 140 milliseconds (interquartile range 80-178) in patients without first-degree AVB. The onset of AVB occurred at a median of 8 days after the initial symptoms and returned to normal 3 days thereafter. No patients developed advanced AVB, although 1 patient developed a PR interval >300 milliseconds. Another patient developed new-onset right bundle branch block, which resolved during hospitalization. Cardiac enzymes, inflammatory markers, and cardiac function were not associated with AVB development.
In our population, there is a 19% prevalence of first-degree AVB in patients with MIS-C. All patients with a prolonged PR interval recovered without progression to high-degree AVB. Patients admitted with MIS-C require close electrocardiogram monitoring during the acute phase.
Abstract Background Advanced second- or third-degree heart block has been reported with variable incidence after surgery for congenital heart disease in children. We report the incidence of heart ...block requiring a pacemaker and describe the risk factors for this complication in a large multicenter study. Methods We performed a retrospective cohort study, using the Pediatric Health Information System database from 45 hospitals in the United States, for all children aged 18 years, discharged between January 1, 2004, and December 31, 2013, who underwent open surgery for congenital heart disease. Patients who had heart block and placement of a pacemaker during the same hospitalization were identified. Demographic characteristics, procedure and diagnostic codes, length of stay, and mortality were analyzed. Univariable and multivariable analyses were performed. Results There were 101,006 surgeries performed. The median age of patients was 0.5 years (interquartile range, 26 days to 3.2 years), and 1% of patients (n = 990) had heart block and placement of a pacemaker. Surgeries associated with the highest incidences of heart block and placement of a pacemaker included the double switch operation (15.6%), tricuspid valve (7.8%) and mitral valve (7.4%) replacement, atrial switch with ventricular septal defect repair (6.4%), and Rastelli operation (4.8%). On multivariable analysis, after controlling for surgical complexity, other comorbidities, age at surgery, admission year, and clustering by institution, patients with heart block and placement of a pacemaker had higher odds of mortality (odds ratio, 1.67; 95% confidence interval, 1.24-2.26; P < .001). Conclusions The incidence of postoperative heart block requiring permanent pacemaker placement immediately after congenital heart surgery is low (1%). However, these patients have higher mortality even after adjusting for heart surgery complexity.
Although the use of a paternalistic style of management is widespread in the non-Western context, it has only recently received attention from Western scholars. In this study, we compare the presence ...of a paternalistic style of management and delegation practices across two culturally different organizational contexts, namely Chile and the US. We also examine the effects of these management practices on job satisfaction and organizational commitment in both contexts. Results suggest that delegation of authority was more common in the US than in Chile, whereas paternalism was higher in Chile than in the US. Furthermore, delegation and paternalism were positively related to job satisfaction and organizational commitment in both countries. Unexpectedly, delegation had a stronger effect on job satisfaction and organizational commitment than a paternalistic style of management in the Chilean context, whereas the opposite was found in the US sample. Moreover, the effect of a paternalistic management style on both job satisfaction and organizational commitment seemed to be fully mediated by delegation in Chile. We discuss both the theoretical and practical implications of these findings. Si bien el estilo gerencial paternalista está generalizado en el contexto no occidental, fue solo recientemente que recibió atención por parte de académicos occidentales. En este estudio, comparamos la presencia de un estilo gerencial paternalista y de las prácticas de delegación en dos contextos organizacionales culturalmente diferentes, a saber, Chile y los Estados Unidos. También examinamos los efectos de estas prácticas gerenciales sobre la satisfacción laboral y el compromiso organizacional en ambos contextos. Los resultados sugieren que la delegación de autoridad es más común en Estados Unidos que en Chile, mientras que el paternalismo es mayor en Chile que Estados Unidos. Además, la delegación y el paternalismo están relacionados positivamente con la satisfacción laboral y el compromiso organizacional en ambos países. Inesperadamente, la delegación tiene un mayor efecto sobre la satisfacción laboral y el compromiso organizacional que un estilo gerencial paternalista en el contexto chileno, mientras que lo contrario ocurre en la muestra de Estados Unidos. Adicionalmente, el efecto de un estilo gerencial paternalista, tanto sobre la satisfacción laboral como sobre el compromiso organizacional, parece estar completamente mediado por la delegación en el caso chileno. Discutimos las implicaciones teóricas y prácticas de estos hallazgos. Bien que le type de gérance paternaliste soit généralisé dans le contexte non occidental, elle n'a retenu que récemment l'attention des spécialistes occidentaux. Dans cette étude, nous comparons la présence d'un style de gérance paternaliste et les pratiques de délégation dans deux contextes d'organisation culturellement différents, à savoir le Chili et les États-Unis. Nous examinons également les effets de ces pratiques de gérance sur la satisfaction professionnelle et l'engagement organisationnel dans ces deux contextes. Les résultats suggèrent que la délégation d'autorité est plus fréquente aux États-Unis qu'au Chili tandis que le paternalisme est plus important au Chili qu'aux États-Unis. En outre, la délégation et le paternalisme sont liés positivement à la satisfaction professionnelle et à l'engagement organisationnel dans les deux pays. D'une manière inattendue, dans le contexte chilien, la délégation a plus d'effet sur la satisfaction professionnelle et l'engagement organisationnel qu'un style de gérance paternaliste alors que c'est le contraire dans notre échantillon des États-Unis. En outre, l'effet d'un style de gérance paternaliste, tant sur la satisfaction professionnelle que sur l'engagement organisationnel, semble être totalement modéré par la délégation dans le cas chilien. Nous discutons des implications théoriques et pratiques de ces constatations. Embora o estilo gerencial paternalista esteja generalizado no contexto não ocidental, foi só recentemente que recebeu atenção por parte de acadêmicos ocidentais. Neste estudo, comparamos a presença de um estilo gerencial paternalista e das práticas de delegação em dois contextos organizacionais culturalmente diferentes, que são o Chile e os Estados Unidos. Também examinamos os efeitos destas práticas gerenciais sobre a satisfação trabalhista e o compromisso organizacional em ambos os contextos. Os resultados sugerem que a delegação de autoridade é mais comum nos Estados Unidos do que no Chile, enquanto o paternalismo é maior no Chile do que nos Estados Unidos. Além disso, a delegação e o paternalismo estão relacionados positivamente com a satisfação trabalhista e o compromisso organizacional em ambos os países. Inesperadamente, a delegação tem maior efeito sobre a satisfação trabalhista e o compromisso organizacional do que um estilo gerencial paternalista no contexto chileno, enquanto na amostra dos Estados Unidos acontece o contrário. Adicionalmente, o efeito de um estilo gerencial paternalista, tanto sobre a satisfação trabalhista como sobre o compromisso organizacional, parece estar completamente intermediado pela delegação no caso chileno. Discutimos as implicações teóricas e práticas destes achados.
Myocarditis in children can result in significant morbidity and mortality, yet limited prognostic data exist. The aim of this study was to test the hypothesis that pediatric patients with arrhythmias ...during hospitalization for acute myocarditis have worse outcomes and increased resource utilization. A retrospective study using the Pediatric Health Information System database was performed to examine the effects of clinically significant arrhythmias on in-hospital mortality, length of stay, and costs per day. Data were obtained for children ≤18 years of age, discharged from January 1, 2004 to March 31, 2013, with a diagnosis of myocarditis. Clinically significant tachyarrhythmia was defined as supraventricular tachycardia, atrial fibrillation or flutter, or ventricular tachycardia or fibrillation in patients receiving antiarrhythmic medications or cardioversion. Clinically significant bradyarrhythmia was defined as second-degree, complete, or other heart block for which a pacemaker was placed. Multivariable analyses were performed. A total of 2,041 subjects with myocarditis were identified. Tachyarrhythmias were reported in 234 (11.5%) and bradyarrhythmias in 22 (1.1%). Overall mortality was 8.7%. In multivariable analyses, after considering the effects of gender, age at admission, geographic region, year and month of admission, presence of congenital heart disease or an identified virus, and use of steroids, nonsteroidal anti-inflammatories, or inotropes, and after controlling for clustering by institution, tachyarrhythmias were associated with a 2.3 times increase in the odds of mortality (95% confidence interval 1.6 to 3.3, p < 0.001), a 58% increase in length of stay (95% confidence interval 38% to 82%, p < 0.001), and a 28% increase in costs per day (95% confidence interval 15% to 43%, p < 0.001). Bradyarrhythmia was not associated with mortality, length of stay, or costs per day. In conclusion, tachyarrhythmias are associated with significant increases in mortality and resource utilization in children with myocarditis.
Left Ventricular Tachycardia in Pediatrics
Introduction
The aim of this study was to evaluate the clinical presentation and outcomes of pediatric patients with ventricular tachycardia (VT) ...originating from left heart structures.
Methods and Results
This international multicenter retrospective study including 152 patients (age 10.0 ± 5.1 years, 62% male), divided into those with fascicular VT (85%, 129/152) and nonfascicular LV VT (15%, 23/152). All patients had a normal heart structure or only a minor cardiac abnormality. Adenosine was largely ineffective in both groups (tachycardia termination in 4/74 of fascicular VT and 0/5 of nonfascicular LV VT). In fascicular VT, calcium channel blockers were effective in 80% (74/92); however, when administered orally, there was a 21% (13/62) recurrence rate. In nonfascicular LV VT, a variety of antiarrhythmic therapies were used with no one predominating. Ablation procedures were successful in 71% (72/102) of fascicular VT and 67% (12/18) of nonfascicular LV VT on an intention to treat analysis. Major complications occurred in 5 patients with fascicular VT and 1 patient with nonfascicular LV VT. After a follow‐up period of 2 years (1 day to 15 years), 72% of all patients with fascicular VT were off medications with no tachycardia recurrence. One patient died of noncardiac causes. In nonfascicular LV VT, follow‐up was 3.5 years (0.5–15 years), P = 0.38. A total of 65% of these patients were free from arrhythmias. Two patients died suddenly (P < 0.01).
Conclusion
The clinical course and outcomes of pediatric patients with fascicular VT and nonfascicular LV VT are varied. Catheter ablation procedures can be curative.
Background
Three‐dimensional electroanatomic mapping systems (3D mapping) allow the creation of an anatomic representation of the cardiac anatomy and real‐time monitoring of transvenous pacing ...catheters. Their use to facilitate pacemaker (PM) and implantable cardioverter defibrillator (ICD) lead placement in the pediatric population has not been well defined. We sought to review our experience using 3D mapping as an adjunct to fluoroscopy for positioning of permanent PM and ICD leads in pediatric patients.
Methods
We performed a retrospective review of all patients ≤21 years of age who underwent PM or ICD implantation with the aid of the Ensite Velocity system (Ensite) from May 2012 to September 2014. Fluoroscopy was utilized in addition to 3D mapping to aid obtaining vascular access, to visualize fixation of the lead to the myocardium, and to evaluate lead length within the vasculature.
Results
Nineteen patients (mean age 14.6 ± 4.4 years) underwent placement of active fixation PM leads (N = 17) and/or ICD leads (N = 10) with the aid of Ensite. All leads were successfully placed (eight atrial, 19 ventricular). Fluoroscopic exposure was a mean of 3.2 minutes (± 2.8, 0.1–10.5). There was one lead dislodgement.
Conclusions
Ensite was used successfully as an adjunct to fluoroscopy in all patients in whom it was attempted to aid the placement of permanent transvenous PM and ICD leads. Future evaluation could focus on the use of 3D mapping systems to further minimize or eliminate fluoroscopy from PM and ICD implantations.
Objective To determine if pediatric patients with a history of lone atrial fibrillation (AF) have other forms of supraventricular tachycardia (SVT) that may potentially trigger AF. Study design A ...multicenter review of patients with lone AF who underwent electrophysiology (EP) study from 2006-2011 was performed. Inclusion criteria: age ≤21 years, normal ventricular function, structurally normal heart, history of AF, and EP study and/or ablation performed. Exclusion criteria: congenital heart disease or cardiomyopathy. Patient demographics, findings at EP study and follow-up data were recorded. Results Eighteen patients met inclusion criteria. The mean age was 17.9 ± 2.2 years, weight was 82 ± 21 kg, body mass index was 27 ± 6, and 15 (83%) were males. Eleven (61%) were overweight or obese. Seven (39%) had inducible SVT during EP study: 5 atrioventricular nodal re-entry tachycardia (71%) and 2 concealed accessory pathways with inducible atrioventricular re-entry tachycardia (29%). All 7 patients with inducible SVT underwent radiofrequency ablation. There were no complications during EP study and/or ablation for all 18 patients. The mean follow-up was 1.7 ± 1.5 years and there were no recurrences in the 7 patients who underwent ablation. There were 2 recurrences of AF in patients with no other form of SVT during EP study. Conclusions Inducible SVT was found in 39% of pediatric patients undergoing EP study for lone AF. EP study should be considered for pediatric patients presenting with lone AF.
The gradual loss of ventricular preexcitation during exercise stress testing (EST) has an unclear risk of an association with life-threatening arrhythmia and could be related to the accessory pathway ...(AP) location. We compared the loss of preexcitation during EST with the risk assessment during invasive electrophysiology testing and determined whether the loss of preexcitation correlates with the AP location. We retrospectively reviewed patients aged ≤21 years with ventricular preexcitation who had undergone both EST and an electrophysiology study. The patients were divided into 3 groups: sudden loss (SL), gradual loss (GL), or no loss (NL) of preexcitation during EST. A total of 76 patients were included, with 11 (14%) in the SL group, 18 (24%) in the GL group, and 47 (62%) in the NL group. The SL group demonstrated a longer cycle length with 1-to-1 conduction by way of the AP during incremental atrial pacing compared with the NL group (375 ± 135 ms vs 296 ± 52 ms, p = 0.002), with no difference between the GL and NL groups (325 ± 96 vs 296 ± 52 ms, p = NS). Of the patients with 1-to-1 AP conduction of <270 ms, none (0 of 11) were in the SL group compared to 18 of 47 in the NL group (p = 0.0017), with no significant difference in the GL group (5 of 18) compared to the NL group (p = NS). The patients in the GL group were more likely to have a left-sided AP (14 of 18) than the NL group (17 of 47, p = 0.002) and the SL group (3 of 11, p = 0.002). In conclusion, a sudden loss of preexcitation during an EST predicted a long cycle length with 1-to-1 conduction by way of the AP. Also, the AP conduction characteristics in patients with GL compared to those with NL did not differ, and the GL of preexcitation was more frequently seen in patients with a left-sided AP.
The present study investigates the effect of institutional contexts on managerial practices within a multinational company. Questionnaires measuring actual and ideal managerial practices were ...completed in four different subsidiarles of the same MNC. Results show that the practices of subsidiarles operating in countries with a higher degree of institutional labor-market regulation were less formalized and directive than in those subsidiarles located in countries with a lower degree of labor-market regulation. It was also found that the degrees of acceptance of these practices differed significantly across institutional contexts: in less restrictive institutional contexts formai and directive practices were more desirable than in more restrictive institutional contexts. It is argued that there is an inverse relationship between the flexibility of subsidiarles' institutional contexts and the flexibility of their practices (formolity and directiveness). Implications and limitations of this study are discussed. El presente estudio investiga el efecto de los contextos institucionales sobre las prácticas de gestión en una empresa multinacional. Se aplicó un cuestionario para medir prácticas de gestión actuales e ideales en cuatro subsidiarias de la misma empresa multinacional. Los resultados muestran que las prácticas de gestión en subsidiarias que operan en países con un mayor nivel de regulación laboral son menos formales y dirigidas que aquellas subsidiarias localizadas en países con menor grado de regulación institucional del mercado laboral. También se encontró que los grados de aceptación de tales prácticas difieren significativamente dependiendo de los contextos institucionales: en contextos menos restrictivos, las prácticas formales y directivas son consideradas más deseables que en los contextos institucionales más restrictivos. Se argumenta que hay una relación inversa entre la flexibilidad de los contextos institucionales de las subsidiarias y la flexibilidad de sus prácticas (formalidad y directividad). Se discuten las implicaciones y limitaciones de este estudio. Cette étude effectue une recherche sur l'effet des contextes institutionnels dans les pratiques de gestion de personnes subsidiaires d'une entreprise multinationale européenne. Pour mesurer les pratiques de gestion de personnel observées, un questionnaire a été distribué parmi les employés de quatre entreprises subsidiaires situées dans quatre pays différents d'une même multinationale. Les résultats démontrent que les pratiques des entreprises subsidiaires, situées dans les pays de niveau de régulation institutionnelle du marché de travail moins élevé ont tendance à être plus formelles et plus dirigées que les entreprises subsidiaires situées dans des pays avec un niveau plus élevé de régulation institutionnelle du marché de travail. De même, le niveau d'acceptation de ces pratiques par les personnes consultées est significativement différent : dans un contexte institutionnel moins restrictif, les pratiques de gestion formelles et dirigées ont tendance à être considérées plus désirables que dans les contextes institutionnels plus restrictifs. Il est suggéré qu'il existe un rapport inverse entre la flexibilité des contextes institutionnels existants dans les pays des entreprises subsidiaires et la flexibilité de leurs pratiques de gestion de personnel (i.e. Formalité et dirigeabilité). Les applications et les limites de l'étude sont présentées. O presente estudo investiga o efeito que os contextos institucionais têm nas práticas de gestâo de pessoas em subsidiárias de uma empresa multinacional européia. Aplicou-se um questionário para medir práticas de gestão de pessoas observadas e esperadas a empregados de quatro subsidiárias localizadas em quatro países diferentes de uma mesma multinacional. Os resultados mostram que as práticas das subsidiárias operando em países com um menor grau de regulação institucional em seu mercado de trabalho tenderam a ser mais formais e diretivas que aquelas das subsidiárias localizadas em países com um maior grau de regulação institucional do mercado de trabalho. Também se observou que o grau de aceitação de tais práticas por parte dos pesquisados distinguiram significativamente: em contextos institucionais menos restritivos, as práticas de gestão formais e diretivas tenderam a ser consideradas mais desejáveis que as dos contextos institucionais mais restritivos. Entende-se que existe uma relação inversa entre a flexibilidade dos contextos institucionais imperantes nos países de operação das subsidiárias e a flexibilidade de suas práticas de gestão de pessoas (i.e. formalidade e diretividade). Apresentam-se as implicações e limitações deste estudo.
The book deals with cases about the impact of, and interaction between, the different Latin American cultural, economic, legal, and political settings on activities, strategies, structures and ...decision-making processes of MNCs. The cases focus on business processes, settings and organizational behavior in Latin America.
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