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Article: Cardiac rhythm and symptomatic arrhythmia in right atrial isomerism

TitleCardiac rhythm and symptomatic arrhythmia in right atrial isomerism
Authors
Issue Date2002
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/ahj
Citation
American Heart Journal, 2002, v. 144 n. 1, p. 159-164 How to Cite?
AbstractBackground. The conduction system in right atrial isomerism may be complicated by the presence of paired sinus nodes and twin atrioventricular nodes. With a large cohort of infants and children with right atrial isomerism, we sought to investigate the nature of atrial rhythm, its prevalence, factors predisposing patients to symptomatic cardiac arrhythmia, and the relation of arrhythmia to long-term morbidity and mortality. Methods. Standard 12-lead baseline electrocardiograms were performed in 110 infants and children with right atrial isomerism at a median age of 1 day, and their clinical records were reviewed. The type, timing, and precipitating factors of symptomatic cardiac arrhythmia that occurred in 15 patients, among a cohort of 85 patients who had or were awaiting surgical interventions, were noted. Results. All patients except 1 had a sinus rhythm with intact atrioventricular conduction. Of these, 87% (95/109) had single P-wave morphology, whereas 13% (14/109) had multiple P-wave morphologies. For patients with a single P-wave morphology, the frontal P-wave axis was between 0 degrees and 90 degrees in 62% (59/95), 90 degrees and 180 degrees in 23% (22/95), and superior in 15% (14/95). There was no relation between either P-wave axis or morphology and cardiac anatomy. Symptomatic cardiac arrhythmia occurred in 15 of 85 patients (18%); 11 of the 15 patients had supraventricular tachycardia, and 1 patient each had atrial tachycardia, atrial flutter, ventricular tachycardia, and congenital complete heart block. The arrhythmias occurred before surgery in 4 patients, early after surgery in 5 patients, and late after surgery in 6 patients. Although 3 of the 7 patients who died suddenly had a history of symptomatic arrhythmia, arrhythmia was the documented cause of mortality in only 1 of the 32 fatalities (3.1%). Freedom from arrhythmia at 1, 5, 10, 15, and 20 years was 93% ± 3%, 86% ± 4%, 80% ± 6%, 73% ± 9%, and 48% ± 15% (mean ± SE), respectively. No risk factors for symptomatic arrhythmia were identified by means of logistic regression. Conclusions. The atrial pacemaker varies in location within and between patients with right atrial isomerism. Although symptomatic cardiac arrhythmias are not uncommon, they do not seem to relate to the overall high mortality rate and occurrence of sudden death in this patient group. Nonetheless, detailed assessment and aggressive management of cardiac arrhythmias once they occur are warranted because of the precarious single ventricular hemodynamics.
Persistent Identifierhttp://hdl.handle.net/10722/170317
ISSN
2015 Impact Factor: 4.332
2015 SCImago Journal Rankings: 3.157
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheung, YFen_US
dc.contributor.authorCheng, VYWen_US
dc.contributor.authorYung, TCen_US
dc.contributor.authorChau, AKTen_US
dc.date.accessioned2012-10-30T06:07:27Z-
dc.date.available2012-10-30T06:07:27Z-
dc.date.issued2002en_US
dc.identifier.citationAmerican Heart Journal, 2002, v. 144 n. 1, p. 159-164en_US
dc.identifier.issn0002-8703en_US
dc.identifier.urihttp://hdl.handle.net/10722/170317-
dc.description.abstractBackground. The conduction system in right atrial isomerism may be complicated by the presence of paired sinus nodes and twin atrioventricular nodes. With a large cohort of infants and children with right atrial isomerism, we sought to investigate the nature of atrial rhythm, its prevalence, factors predisposing patients to symptomatic cardiac arrhythmia, and the relation of arrhythmia to long-term morbidity and mortality. Methods. Standard 12-lead baseline electrocardiograms were performed in 110 infants and children with right atrial isomerism at a median age of 1 day, and their clinical records were reviewed. The type, timing, and precipitating factors of symptomatic cardiac arrhythmia that occurred in 15 patients, among a cohort of 85 patients who had or were awaiting surgical interventions, were noted. Results. All patients except 1 had a sinus rhythm with intact atrioventricular conduction. Of these, 87% (95/109) had single P-wave morphology, whereas 13% (14/109) had multiple P-wave morphologies. For patients with a single P-wave morphology, the frontal P-wave axis was between 0 degrees and 90 degrees in 62% (59/95), 90 degrees and 180 degrees in 23% (22/95), and superior in 15% (14/95). There was no relation between either P-wave axis or morphology and cardiac anatomy. Symptomatic cardiac arrhythmia occurred in 15 of 85 patients (18%); 11 of the 15 patients had supraventricular tachycardia, and 1 patient each had atrial tachycardia, atrial flutter, ventricular tachycardia, and congenital complete heart block. The arrhythmias occurred before surgery in 4 patients, early after surgery in 5 patients, and late after surgery in 6 patients. Although 3 of the 7 patients who died suddenly had a history of symptomatic arrhythmia, arrhythmia was the documented cause of mortality in only 1 of the 32 fatalities (3.1%). Freedom from arrhythmia at 1, 5, 10, 15, and 20 years was 93% ± 3%, 86% ± 4%, 80% ± 6%, 73% ± 9%, and 48% ± 15% (mean ± SE), respectively. No risk factors for symptomatic arrhythmia were identified by means of logistic regression. Conclusions. The atrial pacemaker varies in location within and between patients with right atrial isomerism. Although symptomatic cardiac arrhythmias are not uncommon, they do not seem to relate to the overall high mortality rate and occurrence of sudden death in this patient group. Nonetheless, detailed assessment and aggressive management of cardiac arrhythmias once they occur are warranted because of the precarious single ventricular hemodynamics.en_US
dc.languageengen_US
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/ahjen_US
dc.relation.ispartofAmerican Heart Journalen_US
dc.subject.meshArrhythmias, Cardiac - Physiopathologyen_US
dc.subject.meshAtrioventricular Node - Physiology - Surgeryen_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshCohort Studiesen_US
dc.subject.meshElectrocardiographyen_US
dc.subject.meshHeart Atria - Abnormalities - Surgeryen_US
dc.subject.meshHeart Defects, Congenital - Physiopathology - Surgeryen_US
dc.subject.meshHeart Rate - Physiologyen_US
dc.subject.meshHumansen_US
dc.subject.meshInfanten_US
dc.subject.meshInfant, Newbornen_US
dc.subject.meshLogistic Modelsen_US
dc.titleCardiac rhythm and symptomatic arrhythmia in right atrial isomerismen_US
dc.typeArticleen_US
dc.identifier.emailCheung, YF:xfcheung@hku.hken_US
dc.identifier.authorityCheung, YF=rp00382en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1067/mhj.2002.123108en_US
dc.identifier.pmid12094203-
dc.identifier.scopuseid_2-s2.0-0036301646en_US
dc.identifier.hkuros74826-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036301646&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume144en_US
dc.identifier.issue1en_US
dc.identifier.spage159en_US
dc.identifier.epage164en_US
dc.identifier.isiWOS:000176807900024-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridCheung, YF=7202111067en_US
dc.identifier.scopusauthoridCheng, VYW=7005529517en_US
dc.identifier.scopusauthoridYung, TC=9132842300en_US
dc.identifier.scopusauthoridChau, AKT=35787094400en_US

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