Document Detail

Long-term outcome of twin atrioventricular node and supraventricular tachycardia in patients with right isomerism of the atrial appendage.
MedLine Citation:
PMID:  18242544     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Twin AV nodes and resulting supraventricular tachycardia (SVT) have been described in right atrial isomerism (RAI). OBJECTIVE: We sought to analyze the long-term outcome of patients with RAI with a focus on rhythm disturbances. METHODS: Retrospective study of 257 patients (152 male and 105 female, 1,171 patient-years) with RAI diagnosed between 1980 and 2005. RESULTS: SVT in 68 patients (26%) occurred at various ages from the prenatal period to 15 years and was only significantly associated with balanced ventricles (P = .009). Cardioversion was achieved in by verapamil in 6 of 6 cases (100%), adenosine in 18 of 21 cases (88%) and propranolol in 10 of 12 cases (83%). Electrocardiographic evidence of twin AV nodes, as shown by 2 discrete non-pre-excited QRS complexes, was found in 28 of 44 (64%) patients with more than 2 electrocardiograms, and was more frequent in those with balanced ventricles rather than a dominant ventricle and would increase risk of SVT. Recurrence of SVT was documented in 27 (40%) patients 1 day to 4.5 years after the first episode. However, the occurrence or recurrence of SVT was not associated with increased all-cause or surgical mortality or sudden death. Successful catheter ablation of ventriculoatrial pathways with junctional ectopic tachycardia at radiofrequency energy delivery was obtained in 5 of 6 patients. CONCLUSION: This study showed that twin AV nodes in RAI patients could be disclosed by serial electrocardiograms and that SVT, most likely a twin node tachycardia, was common and tended to recur but could be managed by ablation or medication.
Mei-Hwan Wu; Jou-Kou Wang; Jiunn-Lee Lin; Ming-Tai Lin; Sheun-Nan Chiu; Chun-An Chen
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Publication Detail:
Type:  Journal Article     Date:  2007-10-07
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  5     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-04     Completed Date:  2008-04-29     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  224-9     Citation Subset:  IM    
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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MeSH Terms
Atrial Appendage / abnormalities,  physiopathology*
Atrioventricular Node / abnormalities,  physiopathology*
Catheter Ablation*
Child, Preschool
Electric Countershock
Heart Atria / abnormalities,  physiopathology
Heart Ventricles / physiopathology
Infant, Newborn
Retrospective Studies
Risk Factors
Tachycardia, Supraventricular / physiopathology,  surgery*
Time Factors
Treatment Outcome

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