Pediheart: Pediatric Cardiology Today
Jul 17, 2026 · 27 min · 7 segments
This week we review a recent report using data from the IMPACT registry assessing the rates of major adverse events during cath of the pediatric cardiomyopathy patient. How commonly are complications…
Robert PassHost
Alejandro Martinez-HerradaGuest
The work begins reviewing the rarity of cardiomyopathy in children with an incidence of 1 per 100,000.
And they make the point that morbidity and mortality associated with this diagnosis in childhood is substantially higher than in adults.
And they mention that the most common forms of cardiomyopathy are dilated cardiomyopathy, restrictive, hypertrophic, arrhythmogenic right ventricular cardiomyopathy, non-compaction cardiomyopathy, and tachycardia-induced myopathy.
Highlighting the dangers of cardiomyopathy in children, the authors remind that studies have demonstrated that more than 50% of these patients need a heart transplant within five years of diagnosis.
The authors then pivot to discuss how cardiac catheterization can be a helpful tool in assessing these patients because it can elucidate the hemodynamics, potentially allowing us to know if someone is a candidate for orthotopic heart transplant, help in some cases understanding the etiology of the myopathy, or even allow for an endomyocardial biopsy in select patients.
With this as a background, the authors explained that we don't know much about how safe these procedures are in this patient group, and so this was the main rationale for this work, namely to evaluate the prevalence of major adverse events related to cardiac cath and children undergoing cath to assess cardiomyopathy using the IMPACT database.
And the authors also explained that a secondary goal was to compare rates of major adverse events amongst types of cardiomyopathy to see if factors could be identified that are associated with more problems at the time of catheterization.
The authors used the Impact Registry database over a nine-year period from April 2016 to December 2024 and studied patients less than or equal to 18 years of age with a diagnosis of cardiomyopathy.
And anyone who was getting an intervention at the time of the cath, aside from a biopsy, was excluded, as were patients who had a transplant.
And anyone who's participated in the IMPACT trial well knows that this database is very broad.
And if I may editorialize, though it is a wealth of information, it is also very challenging to participate due to the very cumbersome and voluminous data requirements Though, of course, it allows for wonderful works like the one we're presently reviewing.
The authors review the data collected, and it is massive in its detail regarding the diagnosis, the procedure, and even things like the presence of a genetic syndrome like trisomy 21 or Turner syndrome.
The primary outcome of this study was the rate of major adverse event during or before discharge, and these included many, many event types.
And I'll just mention a handful from the list that the authors provide, including things like cardiac arrest, arrhythmia, new heart valve regurgitation, tamponade, bleeding, air embolus, stroke, bundle branch block, and many, many others.
The authors reviewed the statistical methodology looking for associations between adverse events and outcomes.
The authors explain that after filtering out all patients who met exclusion criteria, there were 4,932 procedures that met inclusion criteria, with girls accounting for 47.6% of the cohort and a median age of 10, with the youngest median age of four years in the non-compaction cardiomyopathy group.
Dilated cardiomyopathy was the most common type of myopathy in this group, constituting 53%, followed by hypertrophic cardiomyopathy at 18%.
The authors review some of the more important aspects of these patients, including the fact that 35% had heart failure at the time of the procedure, 29% arrhythmias, and 29% pulmonary vascular disease, with 6% having renal disease, 14% of these patients were intubated before the procedure, and nearly 6% were on ECMO.
34% of these were outpatient procedures and the procedure was considered elective in 73% with general anesthesia used in about three quarters.
The work begins reviewing the rarity of cardiomyopathy in children with an incidence of 1 per 100,000.
And they make the point that morbidity and mortality associated with this diagnosis in childhood is substantially higher than in adults.
And they mention that the most common forms of cardiomyopathy are dilated cardiomyopathy, restrictive, hypertrophic, arrhythmogenic right ventricular cardiomyopathy, non-compaction cardiomyopathy, and tachycardia-induced myopathy.
Highlighting the dangers of cardiomyopathy in children, the authors remind that studies have demonstrated that more than 50% of these patients need a heart transplant within five years of diagnosis.
The authors then pivot to discuss how cardiac catheterization can be a helpful tool in assessing these patients because it can elucidate the hemodynamics, potentially allowing us to know if someone is a candidate for orthotopic heart transplant, help in some cases understanding the etiology of the myopathy, or even allow for an endomyocardial biopsy in select patients.
With this as a background, the authors explained that we don't know much about how safe these procedures are in this patient group, and so this was the main rationale for this work, namely to evaluate the prevalence of major adverse events related to cardiac cath and children undergoing cath to assess cardiomyopathy using the IMPACT database.
And the authors also explained that a secondary goal was to compare rates of major adverse events amongst types of cardiomyopathy to see if factors could be identified that are associated with more problems at the time of catheterization.
The authors used the Impact Registry database over a nine-year period from April 2016 to December 2024 and studied patients less than or equal to 18 years of age with a diagnosis of cardiomyopathy.
And anyone who was getting an intervention at the time of the cath, aside from a biopsy, was excluded, as were patients who had a transplant.
And anyone who's participated in the IMPACT trial well knows that this database is very broad.
And if I may editorialize, though it is a wealth of information, it is also very challenging to participate due to the very cumbersome and voluminous data requirements Though, of course, it allows for wonderful works like the one we're presently reviewing.
The authors review the data collected, and it is massive in its detail regarding the diagnosis, the procedure, and even things like the presence of a genetic syndrome like trisomy 21 or Turner syndrome.
The primary outcome of this study was the rate of major adverse event during or before discharge, and these included many, many event types.
And I'll just mention a handful from the list that the authors provide, including things like cardiac arrest, arrhythmia, new heart valve regurgitation, tamponade, bleeding, air embolus, stroke, bundle branch block, and many, many others.
The authors reviewed the statistical methodology looking for associations between adverse events and outcomes.
The authors explain that after filtering out all patients who met exclusion criteria, there were 4,932 procedures that met inclusion criteria, with girls accounting for 47.6% of the cohort and a median age of 10, with the youngest median age of four years in the non-compaction cardiomyopathy group.
Dilated cardiomyopathy was the most common type of myopathy in this group, constituting 53%, followed by hypertrophic cardiomyopathy at 18%.
The authors review some of the more important aspects of these patients, including the fact that 35% had heart failure at the time of the procedure, 29% arrhythmias, and 29% pulmonary vascular disease, with 6% having renal disease, 14% of these patients were intubated before the procedure, and nearly 6% were on ECMO.
34% of these were outpatient procedures and the procedure was considered elective in 73% with general anesthesia used in about three quarters.
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