Supraventricular tachycardia in patients with right atrial isomerism

Mei Hwan Wu, Jou Kou Wang, Jiunn Lee Lin, Ling Ping Lai, Hung Chi Lue, Ming Lon Young, Fon Jou Hsieh

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Objectives. To clarify the prevalence and mechanism of supraventricular tachycardia in patients with fight atrial isomerism. Background. Paired SA and dual atrioventricular (AV) nodes have been described in patients with right atrial isomerism. However, the clinical significance remains unclear. Methods. From 1987 to 1996, a total of 101 patients (61 male, 40 female) and four fetuses were identified with right atrial isomerism. The diagnosis of supraventricular tachycardia exclude the tachycardia with prolonged QRS duration or AV dissociation, and primary atrial tachycardia. Results. The median follow-up duration was 38 months (range 0.2-270 months). Supraventricular tachycardia was documented in 25 patients (24.8%) and one fetus (25%) (onset age ranged from prenatal to 14 years old; median 4 years old). Actuarial Kaplan-Meier analysis revealed that the probability of being free from tachycardia was 67% and 50% at 6 and 10 years of age, respectively. These tachycardias could be converted by vagal maneuvers in one, verapamil in seven, propranolol in four, digoxin in two, procainamide in one, and rapid pacing in five. Spontaneous conversion was noted in six (including the fetus). Seven cases had received electrophysiologicaI studies. Reciprocating AV tachycardia could be induced in five and echo beats in one. The tachycardia in three patients was documented as incorporating a posterior AV node (antegrade) and an anterior or a lateral AV node (retrograde). Two of them received radiofrequency ablation. Successful ablation in both was obtained by delivering energy during tachycardia, aimed at the earliest retrograde atrial activity and accompanied by junctional ectopic rhythm. The patient with echo beats developed tachycardia soon after operation. Conclusions. Supraventricular tachycardia is common in patients with right atrial isomerism and can occur during the prenatal stage. Drugs to slow conduction through the AV node may help to terminate the tachycardia. Radiofrequency ablation is a safe and effective treatment alternative to eliminate tachycardia.

Original languageEnglish
Pages (from-to)773-779
Number of pages7
JournalJournal of the American College of Cardiology
Volume32
Issue number3
DOIs
Publication statusPublished - Sep 1 1998
Externally publishedYes

Fingerprint

Heterotaxy Syndrome
Supraventricular Tachycardia
Patient Rights
Tachycardia
Atrioventricular Node
Fetus
Reciprocating Tachycardia
Isomerism
Procainamide
Heart Block
Digoxin
Kaplan-Meier Estimate
Verapamil
Age of Onset
Propranolol

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Supraventricular tachycardia in patients with right atrial isomerism. / Wu, Mei Hwan; Wang, Jou Kou; Lin, Jiunn Lee; Lai, Ling Ping; Lue, Hung Chi; Young, Ming Lon; Hsieh, Fon Jou.

In: Journal of the American College of Cardiology, Vol. 32, No. 3, 01.09.1998, p. 773-779.

Research output: Contribution to journalArticle

Wu, Mei Hwan ; Wang, Jou Kou ; Lin, Jiunn Lee ; Lai, Ling Ping ; Lue, Hung Chi ; Young, Ming Lon ; Hsieh, Fon Jou. / Supraventricular tachycardia in patients with right atrial isomerism. In: Journal of the American College of Cardiology. 1998 ; Vol. 32, No. 3. pp. 773-779.
@article{3783c0c23ee34e899f062349e0a8a3ae,
title = "Supraventricular tachycardia in patients with right atrial isomerism",
abstract = "Objectives. To clarify the prevalence and mechanism of supraventricular tachycardia in patients with fight atrial isomerism. Background. Paired SA and dual atrioventricular (AV) nodes have been described in patients with right atrial isomerism. However, the clinical significance remains unclear. Methods. From 1987 to 1996, a total of 101 patients (61 male, 40 female) and four fetuses were identified with right atrial isomerism. The diagnosis of supraventricular tachycardia exclude the tachycardia with prolonged QRS duration or AV dissociation, and primary atrial tachycardia. Results. The median follow-up duration was 38 months (range 0.2-270 months). Supraventricular tachycardia was documented in 25 patients (24.8{\%}) and one fetus (25{\%}) (onset age ranged from prenatal to 14 years old; median 4 years old). Actuarial Kaplan-Meier analysis revealed that the probability of being free from tachycardia was 67{\%} and 50{\%} at 6 and 10 years of age, respectively. These tachycardias could be converted by vagal maneuvers in one, verapamil in seven, propranolol in four, digoxin in two, procainamide in one, and rapid pacing in five. Spontaneous conversion was noted in six (including the fetus). Seven cases had received electrophysiologicaI studies. Reciprocating AV tachycardia could be induced in five and echo beats in one. The tachycardia in three patients was documented as incorporating a posterior AV node (antegrade) and an anterior or a lateral AV node (retrograde). Two of them received radiofrequency ablation. Successful ablation in both was obtained by delivering energy during tachycardia, aimed at the earliest retrograde atrial activity and accompanied by junctional ectopic rhythm. The patient with echo beats developed tachycardia soon after operation. Conclusions. Supraventricular tachycardia is common in patients with right atrial isomerism and can occur during the prenatal stage. Drugs to slow conduction through the AV node may help to terminate the tachycardia. Radiofrequency ablation is a safe and effective treatment alternative to eliminate tachycardia.",
author = "Wu, {Mei Hwan} and Wang, {Jou Kou} and Lin, {Jiunn Lee} and Lai, {Ling Ping} and Lue, {Hung Chi} and Young, {Ming Lon} and Hsieh, {Fon Jou}",
year = "1998",
month = "9",
day = "1",
doi = "10.1016/S0735-1097(98)00307-6",
language = "English",
volume = "32",
pages = "773--779",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "3",

}

TY - JOUR

T1 - Supraventricular tachycardia in patients with right atrial isomerism

AU - Wu, Mei Hwan

AU - Wang, Jou Kou

AU - Lin, Jiunn Lee

AU - Lai, Ling Ping

AU - Lue, Hung Chi

AU - Young, Ming Lon

AU - Hsieh, Fon Jou

PY - 1998/9/1

Y1 - 1998/9/1

N2 - Objectives. To clarify the prevalence and mechanism of supraventricular tachycardia in patients with fight atrial isomerism. Background. Paired SA and dual atrioventricular (AV) nodes have been described in patients with right atrial isomerism. However, the clinical significance remains unclear. Methods. From 1987 to 1996, a total of 101 patients (61 male, 40 female) and four fetuses were identified with right atrial isomerism. The diagnosis of supraventricular tachycardia exclude the tachycardia with prolonged QRS duration or AV dissociation, and primary atrial tachycardia. Results. The median follow-up duration was 38 months (range 0.2-270 months). Supraventricular tachycardia was documented in 25 patients (24.8%) and one fetus (25%) (onset age ranged from prenatal to 14 years old; median 4 years old). Actuarial Kaplan-Meier analysis revealed that the probability of being free from tachycardia was 67% and 50% at 6 and 10 years of age, respectively. These tachycardias could be converted by vagal maneuvers in one, verapamil in seven, propranolol in four, digoxin in two, procainamide in one, and rapid pacing in five. Spontaneous conversion was noted in six (including the fetus). Seven cases had received electrophysiologicaI studies. Reciprocating AV tachycardia could be induced in five and echo beats in one. The tachycardia in three patients was documented as incorporating a posterior AV node (antegrade) and an anterior or a lateral AV node (retrograde). Two of them received radiofrequency ablation. Successful ablation in both was obtained by delivering energy during tachycardia, aimed at the earliest retrograde atrial activity and accompanied by junctional ectopic rhythm. The patient with echo beats developed tachycardia soon after operation. Conclusions. Supraventricular tachycardia is common in patients with right atrial isomerism and can occur during the prenatal stage. Drugs to slow conduction through the AV node may help to terminate the tachycardia. Radiofrequency ablation is a safe and effective treatment alternative to eliminate tachycardia.

AB - Objectives. To clarify the prevalence and mechanism of supraventricular tachycardia in patients with fight atrial isomerism. Background. Paired SA and dual atrioventricular (AV) nodes have been described in patients with right atrial isomerism. However, the clinical significance remains unclear. Methods. From 1987 to 1996, a total of 101 patients (61 male, 40 female) and four fetuses were identified with right atrial isomerism. The diagnosis of supraventricular tachycardia exclude the tachycardia with prolonged QRS duration or AV dissociation, and primary atrial tachycardia. Results. The median follow-up duration was 38 months (range 0.2-270 months). Supraventricular tachycardia was documented in 25 patients (24.8%) and one fetus (25%) (onset age ranged from prenatal to 14 years old; median 4 years old). Actuarial Kaplan-Meier analysis revealed that the probability of being free from tachycardia was 67% and 50% at 6 and 10 years of age, respectively. These tachycardias could be converted by vagal maneuvers in one, verapamil in seven, propranolol in four, digoxin in two, procainamide in one, and rapid pacing in five. Spontaneous conversion was noted in six (including the fetus). Seven cases had received electrophysiologicaI studies. Reciprocating AV tachycardia could be induced in five and echo beats in one. The tachycardia in three patients was documented as incorporating a posterior AV node (antegrade) and an anterior or a lateral AV node (retrograde). Two of them received radiofrequency ablation. Successful ablation in both was obtained by delivering energy during tachycardia, aimed at the earliest retrograde atrial activity and accompanied by junctional ectopic rhythm. The patient with echo beats developed tachycardia soon after operation. Conclusions. Supraventricular tachycardia is common in patients with right atrial isomerism and can occur during the prenatal stage. Drugs to slow conduction through the AV node may help to terminate the tachycardia. Radiofrequency ablation is a safe and effective treatment alternative to eliminate tachycardia.

UR - http://www.scopus.com/inward/record.url?scp=0031667046&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031667046&partnerID=8YFLogxK

U2 - 10.1016/S0735-1097(98)00307-6

DO - 10.1016/S0735-1097(98)00307-6

M3 - Article

C2 - 9741526

AN - SCOPUS:0031667046

VL - 32

SP - 773

EP - 779

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 3

ER -