Document Detail

Twin AV node and induced supraventricular tachycardia in Fontan palliation patients.
MedLine Citation:
PMID:  15679642     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The coexistence of two distinct atrioventricular (AV) nodes has been described in congenital heart disease requiring Fontan type palliation. The purpose of this study was to evaluate the occurrence of twin AV node according to anatomical subgroups, and to determine its relation to tachycardia. METHODS: From 2001 to 2003, we performed an electrophysiologic (EP) study upon 52 consecutive patients who had undergone cardiac catheterization after Fontan completion. Atrial pacing was performed at three or more different atrial sites. RESULTS: In 10/52 patients, two different QRS complexes were recorded at different pacing sites, suggesting twin AV node (9/20 in right isomerism, 1/8 discordance AV connections, 0/24 other complex anomalies). AV reciprocating tachycardia (AVRT), presumably involving two AV nodes and a connecting sling, was induced in 6 of 10 patients who had twin AV node (4/6 used posterior AV node as an antegrade limb, 2/6 used an anterior AV node as an antegrade limb). Heterotaxy syndrome (P < 0.001) and complete AV septal defect (P = 0.002) were found to be risk factors for twin AV node. Junctional tachycardia (JT; HR > 150/min) with either VA dissociation (7/9) or second degree VA block (2/9) were induced by pacing or isoproterenol infusion in 9/52 patients. CONCLUSION: JT induction was associated with a twin AV node (P = 0.04), or a history of early postoperative junctional ectopic tachycardia (P = 0.02). A complicated AV node conduction system such as twin AV node was frequent in heterotaxy syndrome. Both AVRT and JT with VA block may be important causes of tachyarrhythmia in this patient group.
Eun-Jung Bae; Chung-Il Noh; Jung-Yun Choi; Yong-Soo Yun; Woong-Han Kim; Jeong-Ryul Lee; Yong-Jin Kim
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  28     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-01-31     Completed Date:  2005-06-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  126-34     Citation Subset:  IM    
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.
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MeSH Terms
Atrioventricular Node / abnormalities*
Chi-Square Distribution
Child, Preschool
Electrophysiologic Techniques, Cardiac
Fontan Procedure*
Heart Catheterization*
Heart Defects, Congenital / physiopathology,  surgery*
Palliative Care
Postoperative Complications / physiopathology*
Risk Factors
Tachycardia, Supraventricular / physiopathology*

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