Supraventricular tachycardi in patients with right atrial isomerism

Objectives. To clarify the prevalence and mechanism of supraventricular tachycardi in patients with right atrial isomerism. Background. Paired S 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, total of 101 patients (61 male, 40 female) and four fetuses were identified with right atrial isomerism. The diagnosis of supraventricular tachycardi exclude the tachycardi 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 tachycardi 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 tachycardi 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 electrophysiological studies. Reciprocating AV tachycardi could be induced in five and echo beats in one. The tachycardi in three patients was documented as incorporating posterior AV node (antegrade) and an anterior or 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 tachycardi soon after operation. Conclusions. Supraventricular tachycardi 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 safe and effective treatment alternative to eliminate tachycardia.