Frank Cecchin

Boston Children's Hospital, Boston, Massachusetts, United States

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Publications (98)563.99 Total impact

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    ABSTRACT: -The ability to identify and ablate different arrhythmia mechanisms following the total cavopulmonary connection (TCPC) has not been studied in detail. -After obtaining IRB approval according to institutional guidelines, consecutive patients following a TCPC undergoing electrophysiology study over a 6 year period were included (2006-2012). Arrhythmia mechanism was determined, and the procedural outcome was defined as complete, partial success, or failure. A 12-point arrhythmia severity score was calculated for each patient at baseline and on follow-up. Fifty-seven procedures were performed on 52 patients (18.4 ± 11.8 years; 53.0 ± 27.2kg). Access to the pulmonary venous atrium was necessary in 33 procedures, via fenestration (16) or transbaffle puncture (17) and in two cases an additional retrograde approach was used. In total, 80 arrhythmias were identified in 47 cases: macroreentrant (n=25) or focal atrial tachycardia (n=8), atrioventricular nodal reentry tachycardia (n=13), reentry via an accessory pathway (n=4) or via twin atrioventricular nodes (n=4), ventricular tachycardia (n=5), and undefined atrial tachycardia (n=21). Procedural outcome in 32 patients who underwent ablation was complete success (n=25), partial success (n=3), failure (n=3), or empiric ablation (n=1). Following successful ablation there was a significant decrease in arrhythmia score over 18.2 (4 - 32) months follow-up, with a sustained trend even in the face of arrhythmia recurrence (50%). -Arrhythmia mechanism post TCPC is highly varied, encompassing simple and more complex substrates, documentation of which facilitates a strategic approach to invasive arrhythmia management. Despite the anatomical limitations successful and clinically meaningful ablation is possible.
    Circulation Arrhythmia and Electrophysiology 01/2015; 8(2). DOI:10.1161/CIRCEP.114.001758 · 5.42 Impact Factor
  • The Canadian journal of cardiology 10/2014; 30(10). DOI:10.1016/j.cjca.2014.09.002 · 3.94 Impact Factor
  • Heart Rhythm 10/2014; 11(10). DOI:10.1016/j.hrthm.2014.0.5.008 · 4.92 Impact Factor
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    ABSTRACT: -Implantable cardioverter-defibrillators (ICDs) used to prevent sudden cardiac arrest in children provide appropriate therapy in 25% of patients, but also result in a significant incidence of inappropriate shocks and other device complications. ICDs placed for secondary prevention have higher rates of appropriate therapy than those placed for primary prevention. Pediatric patients with primary prevention ICDs were studied to determine time-dependent incidence of appropriate use and adverse events.
    Circulation Arrhythmia and Electrophysiology 09/2014; 7(6). DOI:10.1161/CIRCEP.114.001569 · 5.42 Impact Factor
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    ABSTRACT: Patients with repaired tetralogy of Fallot (rTOF) frequently have right bundle branch block. To better understand the contribution of cardiac dyssynchrony to dysfunction, we developed a method to quantify left (LV), right (RV), and inter-ventricular dyssynchrony using standard cine cardiac magnetic resonance (CMR).
    European Heart Journal – Cardiovascular Imaging 07/2014; DOI:10.1093/ehjci/jeu123 · 2.65 Impact Factor
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    Heart rhythm: the official journal of the Heart Rhythm Society 05/2014; DOI:10.1016/j.hrthm.2014.05.009 · 4.92 Impact Factor
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    Heart rhythm: the official journal of the Heart Rhythm Society 05/2014; DOI:10.1016/j.hrthm.2014.05.008 · 4.92 Impact Factor
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    ABSTRACT: Less is known about depression, anxiety and quality of life (QoL) in children and adolescents with pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) than is known in adults with these devices. A standardized psychiatric interview diagnosed anxiety/depressive disorders in a cross-sectional study. Self-report measures of anxiety, depression and post-traumatic stress disorder were obtained. Medical disease severity, family functioning and QoL data were collected. A total of 166 patients were enrolled (52 ICD, 114 PM; median age 15 years). Prevalence of current and lifetime psychiatric disorders was higher in patients with ICDs than PMs (Current: 27% vs. 11%, P = .02; Lifetime: 52% ICD vs. 34% PM, P = .01). Patients with ICDs had more anxiety than a healthy population (25% vs. 7%, P < .01). Patients with ICDs and PMs had similar levels of depression as a healthy population (ICD 10%, PM 4%, reference 4%, P = .29). In multivariate analysis including a medical disease score, demographics, exposure to beta-blockers, activity limitations, hospitalizations, shocks and procedures, the type of device (PM versus ICD) did not predict psychiatric diagnoses when age at implantation and the severity of medical disease were controlled for. Patients with ICDs and PMs had lower physical QoL scores (ICD 45, PM 47.5, Norm 53, P ≤ .03), but similar psychosocial functioning scores (ICD 49, PM 51, Norm 51, P ≥ .16) versus a normal reference population. Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation instead of type of device.
    PEDIATRICS 03/2014; 133(4). DOI:10.1542/peds.2013-1394 · 5.30 Impact Factor
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    ABSTRACT: Background Ebstein’s anomaly is associated with a high incidence of atrial and ventricular arrhythmias. The Cone procedure has become an effective hemodynamic intervention for this malformation. In response to two late postoperative sudden deaths in our early institutional Cone experience, a standardized plan for aggressive rhythm evaluation was instituted, including preoperative electrophysiologic studies (EPS) and intraoperative implantable loop recorder (ILR) placement. Objective The purpose of this study was to measure the yield of this diagnostic protocol for patients with Ebstein’s anomaly undergoing surgical repair and to describe its influence on patient management. Methods All patients at Boston Children’s Hospital with Ebstein’s anomaly who underwent the Cone procedure from December 2006 to September 2012 were reviewed. Pre- and postoperative arrhythmias and therapies were documented. For patients who underwent preoperative EPS, all arrhythmia substrates and interventions were recorded. Results A total of 74 patients were included, 42 of whom underwent preoperative EPS. Significant findings were documented during EPS in 29 of the 42 patients (69%), including eight patients with no prior suspicion of arrhythmias. Seventeen patients had successful catheter ablation during EPS, and EPS data guided one or more intraoperative rhythm interventions for the remainder. During follow-up, diagnostic yield from ILR was low. Since implementing a more aggressive diagnostic strategy, no further sudden deaths have occurred. Conclusion Preoperative EPS has a high diagnostic and therapeutic yield in patients with Ebstein’s anomaly undergoing the Cone operation. It is reasonable to recommend EPS as a routine preoperative test for this population.
    Heart rhythm: the official journal of the Heart Rhythm Society 02/2014; 11(2):182–186. DOI:10.1016/j.hrthm.2013.10.045 · 4.92 Impact Factor
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    ABSTRACT: We reported the outcomes of a single-institution experience using video-assisted thoracoscopic left cardiac sympathetic denervation as an adjunctive therapeutic technique in pediatric and young adult patients with life-threatening ventricular arrhythmias. We conducted a retrospective clinical review of all patients who underwent left cardiac sympathetic denervation by means of video-assisted thoracoscopic surgery at our institution. From August 2000 to December 2011, 24 patients (13 with long QT syndrome, 9 with catecholaminergic polymorphic ventricular tachycardia, and 2 with idiopathic ventricular tachycardia) were identified from the cardiology database and surgical records. There were no intraoperative complications. The median postoperative length of stay was 2 days (range, 1-32 days). There were no major perioperative complications. Longer-term follow-up was available in 22 of 24 patients at a median follow-up of 28 months (range, 4-131 months). Sixteen (73%) of the 22 patients experienced a marked reduction in their arrhythmia burden, with 12 (55%) becoming completely arrhythmia free after sympathectomy. Six (27%) of the patients were nonresponsive to treatment; each had persistent symptoms at follow-up. Video-assisted thoracoscopic left cardiac sympathetic denervation can be safely and effectively performed in most patients with life-threatening ventricular arrhythmias. This minimally invasive procedure is a promising adjunctive therapeutic option that achieves a beneficial response in most symptomatic patients. These results support the inclusion of thoracoscopic cardiac sympathetic denervation among the treatment armamentarium in all patients with ventricular arrhythmias refractive to conventional medical therapy.
    The Journal of thoracic and cardiovascular surgery 10/2013; 147(1). DOI:10.1016/j.jtcvs.2013.07.064 · 3.99 Impact Factor
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    ABSTRACT: Objective: Early results for anatomic repair of congenitally corrected transposition of the great arteries (ccTGA) are excellent. However, the development of left ventricular dysfunction late after repair remains a concern. In this study we sought to determine factors leading to late left ventricular dysfunction and the impact of cardiac resynchronization as a primary and secondary (upgrade) mode of pacing. Methods: From 1992 to 2012, 106 patients (median age at surgery, 1.2 years; range, 2 months to 43 years) with ccTGA had anatomic repair. A retrospective review of preoperative variables, surgical procedures, and postop-erative outcomes was performed. Results: In-hospital deaths occurred in 5.7% (n ¼ 6), and there were 3 postdischarge deaths during a mean follow-up period of 5.2 years (range, 7 days to 18.2 years). Twelve patients (12%) developed moderate or severe left ventricular dysfunction. Thirty-eight patients (38%) were being paced at latest follow-up evaluation. Seven-teen patients had resynchronization therapy, 9 as an upgrade from a prior dual-chamber system (8.5%) and 8 as a primary pacemaker (7.5%). Factors associated with left ventricular dysfunction were age at repair older than 10 years, weight greater than 20 kg, pacemaker implantation, and severe neo-aortic regurgitation. Eight of 9 pa-tients undergoing secondary cardiac resynchronization therapy (upgrade) improved left ventricular function. None of the 8 patients undergoing primary resynchronization developed left ventricular dysfunction. Conclusions: Late left ventricular dysfunction after anatomic repair of ccTGA is not uncommon, occurring most often in older patients and in those requiring pacing. Early anatomic repair and cardiac resynchroniza-tion therapy in patients requiring a pacemaker could preclude the development of left ventricular dysfunction. (J Thorac Cardiovasc Surg 2013;-:1-5)
    Journal of Thoracic and Cardiovascular Surgery 10/2013; 148(1). DOI:10.1016/j.jtcvs.2013.08.047 · 3.99 Impact Factor
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    ABSTRACT: In Fontan and atrial switch patients, transcatheter ablation is limited by difficult access to the pulmonary venous atrium. In recent years, transbaffle access (TBA) has been described, but limited data document its safety and utility. All ablative electrophysiological study cases of this population performed between January 2006 and December 2010 at Boston Children's Hospital were reviewed. Pre-case and follow-up clinical characteristics were documented. Adverse events were classified by severity and attributability to the intervention. We included 118 cases performed in 90 patients. TBA was attempted in 74 cases and was successful in 96%: in 20 via baffle leak or fenestration and in 51 (94%) of 54 using standard or radiofrequency transseptal techniques. There were 10 procedures with adverse events ranked as moderate or more severe. The event rate was similar in both groups (TBA 8% versus non-TBA 9%, P=1), and no events were directly attributable to TBA. There was a trend to higher proportion of cases having a >5-point drop in saturations from baseline in the TBA group versus the non-TBA group in Fontan cases (15% vs 0%, P=0.14). When cases with follow-up >90 and >365 days were analyzed, the median initial arrhythmia score of 5 significantly changed -3 points in both time periods (P≤0.001). TBA is feasible in this population; its use was not associated with a higher incidence of adverse events; and changes in clinical scores support its efficacy. Desaturation observed in some patients is of uncertain significance but warrants postablation monitoring and prospective study.
    Journal of the American Heart Association 08/2013; 2(5):e000325. DOI:10.1161/JAHA.113.000325 · 2.88 Impact Factor
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    ABSTRACT: Non-fluoroscopic imaging (NFI) devices are increasingly used in ablations. The objective was to determine the utility of intracardiac echocardiography (ICE) in ablating paediatric supraventricular tachycardias (SVTs) and assess whether its integrated use with electroanatomic mapping (EAM) resulted in lower radiation exposure than use of EAM alone.METHODS AND RESULTS: Prospective, controlled, single-centre study of patients (pts) age ≥10 years, weight ≥35 kg, with SVT and normal cardiac anatomy. Patients were randomized to ICE + EAM (ICE) or EAM only (no ICE). Both had access to fluoroscopy as needed. Eighty-four pts were enroled (42 ICE, 42 no ICE). Median age was 15 years (range 10.4-23.7 years); 57% had accessory pathways, 42% atrioventricular nodal reentry tachycardia. There was no difference in radiation dose (9 mGy ICE vs. 23 mGy no ICE, P = 0.37) or fluoroscopy time (1.1 min ICE vs. 1.5 min no ICE, P = 0.38). Transseptal punctures were performed in 25 pts (16 ICE, 9 no ICE), with ICE reducing radiation (8 mGy ICE vs. 62 mGy no ICE, P = 0.002) and fluoroscopy time (1.1 min ICE vs. 4.5 min no ICE, P = 0.01). Zero fluoroscopy was achieved in 13 pts (15% of total, 5 ICE, 8 no ICE), and low-dose cases (<50 mGy) in 57 pts (68% of total, 33 ICE, 24 no ICE). Acute success was 95% for ICE, 88% for no ICE.CONCLUSION: Use of an integrated EAM/ICE system was no better than EAM alone in limiting radiation, but can be helpful for transseptal punctures. Given the low dose savings, use of ICE may be weighed against its financial cost. Low-fluoroscopy cases are performed in most NFI procedures.
    Europace 08/2013; 16(2). DOI:10.1093/europace/eut237 · 3.05 Impact Factor
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    ABSTRACT: As mortality in patients with D-loop transposition of the great arteries (D-TGA) has decreased after the arterial switch operation (ASO), the focus has shifted to higher risk groups and outcomes that impact long-term morbidity and mortality, such as left ventricular (LV) dysfunction. We sought to examine the perioperative factors associated with LV dysfunction in patients with D-TGA and ventricular septal defects (VSD) after ASO. A retrospective study was made of all patients with D-TGA/VSD who underwent ASO/VSD closure from 2001 to 2011. Patients with prematurity, L-looped ventricles, and straddling atrioventricular valves were excluded. The primary endpoint was moderate or severe LV dysfunction measured by echocardiogram 2 months or more after surgery. A total of 112 patients underwent ASO/VSD closure at a median age of 5 days. Median time of follow-up was 6.5 months, with no mortality noted. Six patients (8%) were noted to have at least moderate LV dysfunction. Risk factors were heart block requiring pacemaker placement (p < 0.001) and length of intensive care unit admission (p = 0.04). All 6 patients with heart block had an epicardial lead on the right ventricular free wall; 4 had moderate or severe LV dysfunction and underwent upgrade to cardiac resynchronization therapy (CRT); median time from initial pacemaker to CRT was 5 months. With a median follow-up of 5 months after CRT, LV function improved to normal (2 patients) or mild dysfunction (2 patients). Left ventricular dysfunction after surgical repair for D-TGA/VSD is low, with heart block and pacemaker insertion playing a significant role. The LV function improved after patients were upgraded to a CRT device.
    The Annals of thoracic surgery 08/2013; 96(3). DOI:10.1016/j.athoracsur.2013.05.082 · 3.65 Impact Factor
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    ABSTRACT: Background Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart disease patients is hampered by poor long-term lead survival. Lead extraction is technically difficult and carries substantial morbidity. We sought to determine the outcomes of ICD leads in pediatric and congenital heart disease patients. Methods and Results The Pediatric Lead Extractability and Survival Evaluation (PLEASE) is a 24-center international registry. Pediatric and congenital heart disease patients with ICD lead implantations from 2005 to 2010 were eligible. Study subjects comprised 878 ICD patients (44% congenital heart disease). Mean +/- SD age at implantation was 18.6 +/- 9.8 years. Of the 965 total leads, 54% were thin (7F), of which 57% were Fidelis, and 23% were coated with expanded polytetrafluoroethylene. There were 139 ICD lead failures (14%) in 132 patients (15%) at a mean lead age of 2.0 +/- 1.4 years, causing shocks in 53 patients (40%). Independent predictors of lead failure included younger implantation age and Fidelis leads. Actuarial analysis showed an incremental risk of lead failure with younger age at implantation: <8 years compared with >18 years (P=0.015). The actuarial yearly failure rate was 2.3% for non-Fidelis and 9.1% for Fidelis leads. Extraction was performed on 143 leads (80% thin, 7% expanded polytetrafluoroethylene coated), with lead age as the only independent predictor for advanced extraction techniques. There were 6 major extraction complications (4%) but no procedural mortality. Conclusions This study demonstrates that ICD leads in children and congenital heart disease patients have an age-related suboptimal performance, further compounded by a high failure rate of Fidelis leads. Advanced extraction techniques were common and correlated with older lead age. Clinical Trial Registration URL: . Unique identifier: NCT00335036.
    Circulation 06/2013; 127(24):2393-2402. DOI:10.1161/CIRCULATIONAHA.112.001120 · 14.95 Impact Factor
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    ABSTRACT: BACKGROUND: -Ventricular arrhythmia related sudden cardiac arrest in infants with structurally normal hearts is rare. There have been no previously published reports of infants less than 3 months of age with ventricular fibrillation in which a primary diagnosis could not be defined. METHODS AND RESULTS: -Retrospective chart review of 3 unrelated infants less than 2 months of age from 3 different tertiary care centers within the United States and Australia. All 3 infants survived sudden cardiac arrest secondary to multiple episodes of polymorphic ventricular tachycardia and ventricular fibrillation. Each infant demonstrated unique and transient ECG findings consisting of ST changes and QRS widening prior to arrhythmia onset that have not been previously reported. Amiodarone, sedation, sodium channel blocking agents and/or ventricular pacing were effective in suppressing acute events. Despite thorough investigation including genetic testing, the etiology of the ventricular arrhythmias in each of these infants remains unclear. CONCLUSIONS: -This is the first report of idiopathic ventricular fibrillation in young infants preceded by stereotypical transient ECG changes. These findings may represent a new, potentially treatable cause of sudden infant death. Recognition of these prodromal changes may be important in future management and survival of these infants.
    Circulation Arrhythmia and Electrophysiology 06/2013; 6(4). DOI:10.1161/CIRCEP.113.000444 · 5.42 Impact Factor
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    ABSTRACT: BACKGROUND: Accessory pathways (APs) with intermittent preexcitation (IPX) are thought to be of lower risk, but there are reports of IPX patients presenting with rapidly conducted atrial fibrillation. METHODS: Retrospective study performed on patients with preexcitation who underwent an electro-physiological study (EPS). IPX was defined as loss of the delta wave on electrocardiogram prior to EPS. Patients with IPX were compared with those with persistent preexcitation (PPX) or suppression of the delta wave on exercise test (IPX-ET). Congenital heart disease and prior ablations were excluded. RESULTS: Of 328 patients with preexcitation, 41 (12.5%) had IPX. Patients with IPX or PPX were similar in age (12.9 years vs 13.0 years, P = 0.8) and AP location (left-sided 54% vs 50%, P = 0.7; septal 32% vs 35%, P = 0.4). Testing on isoproterenol was performed in 17 (41%) IPX and 41 (14%) PPX patients. Although IPX patients had a longer median refractory period compared to PPX patients (340 ms vs 310 ms, P = 0.001), the incidence of APs with refractory periods ≤250 ms was similar (10% vs 12%, P = 1.0). Exercise tests were performed on 208 patients and 24 (12%) had IPX-ET. Compared with IPX patients, IPX-ET had similar median AP refractory periods (320 ms, P = 0.4) and incidence of APs with refractory periods ≤250 ms (13%, P = 1.0). CONCLUSION: Patients with IPX had longer AP refractory periods than those with PPX, but the incidence of pathways with refractory periods ≤250 ms was not significantly different. The finding of IPX on a baseline electrocardiogram does not rule out potentially high-risk pathways.
    Pacing and Clinical Electrophysiology 04/2013; 36(9). DOI:10.1111/pace.12144 · 1.25 Impact Factor
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    Journal of the American College of Cardiology 03/2013; 61(10). DOI:10.1016/S0735-1097(13)60413-1 · 15.34 Impact Factor
  • European Heart Journal 02/2013; 34(8):624-624. DOI:10.1093/eurheartj/eht002 · 14.72 Impact Factor
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    ABSTRACT: BACKGROUND: An increasing number of adults with congenital heart disease (CHD) require implantable cardioverter-defibrillators (ICDs), yet little is known about their impact on psychological well being and sexual function. OBJECTIVE: We sought to assess shock-related anxiety in adults with CHD, and its association with depression and sexual function. METHODS: A prospective multicenter cross-sectional study was conducted on adult CHD patients with (ICD(+)) and without (ICD(-)) ICDs. The Florida Shock Anxiety Scale (FSAS) was administered to ICD(+) patients and the Beck Depression Inventory-II to all patients. Men completed the Sexual Health Inventory for Men and women the Female Sexual Function Index. RESULTS: A total of 180 adults with CHD (ICD(+) n=70; ICD(-) n=110), median age 32 years (27-40), 44% female, were enrolled. The complexity of CHD was classified as mild in 32 (18%), moderate in 93 (52%), and severe in 54 (30%) subjects. In ICD recipients, a high level of shock-related anxiety was identified (FSAS score 16, IQR 12-23.5), which was slightly higher than the median score for ICD recipients in the general population (p=0.057). A higher level of shock-related anxiety was associated with poorer sexual function scores in both men (ρ=-0.480, p<0.001) and women (ρ=-0.512, p<0.01). It was also associated with self-reported depressive symptomatology (ρ=0.536, p<0.001). CONCLUSION: Adults with CHD and ICDs demonstrate a high level of shock-related anxiety, which is associated with lower sexual functioning scores in men and women. These results underscore the need for increased clinical attention related to ICD-related shock anxiety and impaired sexual function in this population.
    Heart rhythm: the official journal of the Heart Rhythm Society 02/2013; 10(6). DOI:10.1016/j.hrthm.2013.02.016 · 4.92 Impact Factor

Publication Stats

3k Citations
563.99 Total Impact Points


  • 2003–2015
    • Boston Children's Hospital
      • Department of Pediatrics
      Boston, Massachusetts, United States
  • 2014
    • NYU Langone Medical Center
      New York, New York, United States
    • American College of Cardiology
      Washington, Washington, D.C., United States
  • 2007–2014
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2011–2013
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2002–2008
    • Harvard Medical School
      • Department of Pediatrics
      Boston, Massachusetts, United States
  • 1999–2004
    • University of Washington Seattle
      • Department of Pediatrics
      Seattle, Washington, United States
  • 2001
    • Seattle Children's Hospital
      • Division of Cardiology
      Seattle, Washington, United States
    • Children's Heart Center
      Las Vegas, Nevada, United States