Indian J Pediatr DOI 10.1007/s12098-015-1821-4
SCIENTIFIC LETTER
Rare Association of Chiari’s Network and Ventricular Arrhythmias in a Late Premature Neonate Bassel Mohammad Nijres 1 & Chhaya Patel 1 & Daniel J. Tay 2 & Alexander M. Rodriguez 1
Received: 26 March 2015 / Accepted: 9 June 2015 # Dr. K C Chaudhuri Foundation 2015
To the Editor : A late preterm 35-wk-old girl, with intrauterine growth restriction was admitted to our Neonatal Intensive Care Unit for suspected sepsis on account of prematurity and hypoglycemia. Irregular heart rate was noted on routine physical exam on 5th day of life; vitals were normal. Electrocardiogram (EKG) showed premature ventricular contractions (PVCs) in bigeminy; which spontaneously resolved. Echocardiogram showed small patent foramen ovale (PFO) with left to right shunt and prominent Chiari’s network. On 18th day of life, the patient developed tachycardia which was noticed on continuous cardiac monitoring. EKG showed ventricular tachycardia (mistakenly the on-call team thought it was supraventricular tachycardia SVT) (Fig. 1). During this episode, the patient remained hemodynamically stable, and the ventricular tachycardia was converted to normal sinus rhythm after giving the
* Bassel Mohammad Nijres [email protected] 1
Department of Pediatrics, Woodhull Medical and Mental Health Center, Brooklyn, NY, USA
2
Department of Pediatrics, New York University Medical College, New York, NY, USA
third dose of adenosine. The baby was discharged home on 22nd day of life without medications. At the 2 mo follow up, no further SVT or other arrhythmias were reported. In addition, Chiari’s network had spontaneously resolved. Chiari network is a congenital remnant of fetal membrane in the right atrium. Prajapat et al. described abnormal atrial depolarization in a patient with Chiari’s network which is a predictor for risk of atrial fibrillation (AF) [1]. Atrial fibrillation induced by Chiari’s network may be refractory to medical treatment and requires surgical excision of the network for cure [2, 3]. Despite the association of Chiari’s network and supraventricular tachyarrhythmia including SVT and atrial fibrillation being well described in literature, yet no such association has been mentioned with ventricular arrhythmias. Therefore, our case is the first case in literature highlighting the association of Chiari’s network and ventricular arrhythmia (VT and bigeminy rhythm). We think our case may further support Dominguez EF et al. postulation that insufficient absorption of Chiari’s network may occur in conjunction with abnormalities in cardiac rhythm [4]. Additionally, our case responded to adenosine. Thus, in case of non-availability of standard of care, adenosine can be tried as an alternative therapy for ventricular tachycardia in neonates. This fact was proved by the electrophysiology study, conducted by Ozer S et al. [5].
Indian J Pediatr
Fig. 1 EKG showing monomorphic ventricular tachycardia with ventricular rate of 225 beats/min
Conflict of Interest None.
2.
Source of Funding None. 3. 4.
References 5. 1.
Prajapat L, Ariyarajah V, Spodick DH. Abnormal atrial depolarization associated with chiari network? Cardiology. 2007;108:214–6.
Alegría-Barrero E, Alegría-Barrero A, Gavira Gómez JJ, Rábago JAG. Chiari’s network and paroxysmal atrial fibrillation. Rev Esp Cardiol. 2011;64:727–8. Maheshwari M, Kaushik SK. Chiari network-induced paroxysmal atrial fibrillation. JIACM. 2014;15:47–8. Felix-Dominguez E, Mompeo-Corredera B. The chiari network: an anatomical variation or a risk factor? Case report. Eur J Anat. 2011;15:107–10. Ozer S, Allen S, Schaffer MS. Adenosine- and verapamil-sensitive ventricular tachycardia in the newborn. Pacing Clin Electrophysiol. 2001;24:898–901.
SCIENTIFIC LETTER
Rare Association of Chiari’s Network and Ventricular Arrhythmias in a Late Premature Neonate Bassel Mohammad Nijres 1 & Chhaya Patel 1 & Daniel J. Tay 2 & Alexander M. Rodriguez 1
Received: 26 March 2015 / Accepted: 9 June 2015 # Dr. K C Chaudhuri Foundation 2015
To the Editor : A late preterm 35-wk-old girl, with intrauterine growth restriction was admitted to our Neonatal Intensive Care Unit for suspected sepsis on account of prematurity and hypoglycemia. Irregular heart rate was noted on routine physical exam on 5th day of life; vitals were normal. Electrocardiogram (EKG) showed premature ventricular contractions (PVCs) in bigeminy; which spontaneously resolved. Echocardiogram showed small patent foramen ovale (PFO) with left to right shunt and prominent Chiari’s network. On 18th day of life, the patient developed tachycardia which was noticed on continuous cardiac monitoring. EKG showed ventricular tachycardia (mistakenly the on-call team thought it was supraventricular tachycardia SVT) (Fig. 1). During this episode, the patient remained hemodynamically stable, and the ventricular tachycardia was converted to normal sinus rhythm after giving the
* Bassel Mohammad Nijres [email protected] 1
Department of Pediatrics, Woodhull Medical and Mental Health Center, Brooklyn, NY, USA
2
Department of Pediatrics, New York University Medical College, New York, NY, USA
third dose of adenosine. The baby was discharged home on 22nd day of life without medications. At the 2 mo follow up, no further SVT or other arrhythmias were reported. In addition, Chiari’s network had spontaneously resolved. Chiari network is a congenital remnant of fetal membrane in the right atrium. Prajapat et al. described abnormal atrial depolarization in a patient with Chiari’s network which is a predictor for risk of atrial fibrillation (AF) [1]. Atrial fibrillation induced by Chiari’s network may be refractory to medical treatment and requires surgical excision of the network for cure [2, 3]. Despite the association of Chiari’s network and supraventricular tachyarrhythmia including SVT and atrial fibrillation being well described in literature, yet no such association has been mentioned with ventricular arrhythmias. Therefore, our case is the first case in literature highlighting the association of Chiari’s network and ventricular arrhythmia (VT and bigeminy rhythm). We think our case may further support Dominguez EF et al. postulation that insufficient absorption of Chiari’s network may occur in conjunction with abnormalities in cardiac rhythm [4]. Additionally, our case responded to adenosine. Thus, in case of non-availability of standard of care, adenosine can be tried as an alternative therapy for ventricular tachycardia in neonates. This fact was proved by the electrophysiology study, conducted by Ozer S et al. [5].
Indian J Pediatr
Fig. 1 EKG showing monomorphic ventricular tachycardia with ventricular rate of 225 beats/min
Conflict of Interest None.
2.
Source of Funding None. 3. 4.
References 5. 1.
Prajapat L, Ariyarajah V, Spodick DH. Abnormal atrial depolarization associated with chiari network? Cardiology. 2007;108:214–6.
Alegría-Barrero E, Alegría-Barrero A, Gavira Gómez JJ, Rábago JAG. Chiari’s network and paroxysmal atrial fibrillation. Rev Esp Cardiol. 2011;64:727–8. Maheshwari M, Kaushik SK. Chiari network-induced paroxysmal atrial fibrillation. JIACM. 2014;15:47–8. Felix-Dominguez E, Mompeo-Corredera B. The chiari network: an anatomical variation or a risk factor? Case report. Eur J Anat. 2011;15:107–10. Ozer S, Allen S, Schaffer MS. Adenosine- and verapamil-sensitive ventricular tachycardia in the newborn. Pacing Clin Electrophysiol. 2001;24:898–901.
