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Arrhythmias in Adult Congenital Patients With Bodily Isomerism

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Abstract

There are an increasing number of adults with congenital heart disease, some of whom have bodily isomerism. Bodily isomerism or heterotaxy is a unique clinical entity associated with congenital malformations of the heart which further increases the risk for future cardiovascular complications. We aimed to investigate the frequency of arrhythmias in adults with bodily isomerism. We utilized the 2012 iteration of the Nationwide Inpatient Sample to identify adult inpatient admissions associated with arrhythmias in patients with isomerism. Data regarding demographics, comorbidities, and various procedures were collected and compared between those with and without isomerism. A total of 6,907,109 admissions were analyzed with a total of 861 being associated isomerism. The frequency of arrhythmias was greater in those with isomerism (20.8 vs. 15.4 %). Those with isomerism were also more five times more likely to undergo invasive electrophysiology studies. Length and cost of hospitalization for patients with arrhythmias also tended to be greater in those with isomerism. Mortality did not differ between the two groups. Arrhythmias are more prevalent in those with isomerism, with a majority of arrhythmias in isomerism being atrial. Those with isomerism and arrhythmias also tended to have greater length and cost of hospitalization.

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References

  1. Ajiki K, Hayami N, Kasaoka Y, Imai Y, Fujiu K, Murakawa Y (2007) Supraventricular tachycardia originating from the posterior atrioventricular node in the univentricular heart with single atrium. Int Heart J 48:253–259

    Article  PubMed  Google Scholar 

  2. Celik M, Amasyali B, Celik T, Iyisoy A (2012) Heterotaxy syndrome: noncompaction ventricular myocardium and cardiac conduction disturbance. J Cardiovasc Med 13:403–405

    Article  Google Scholar 

  3. Chen Z, Sunni N, A’Atty O, Ward DE, Sutherland GR, Gallagher MM (2012) Successful ablation for atrioventricular nodal reentrant tachycardia in a patient with left atrial isomerism. Pacing Clin Electrophysiol PACE 35:e291–e292

    Article  PubMed  Google Scholar 

  4. Cheung YF, Cheng VY, Yung TC, Chau AK (2002) Cardiac rhythm and symptomatic arrhythmia in right atrial isomerism. Am Heart J 144:159–164

    Article  PubMed  Google Scholar 

  5. Czosek RJ, Anderson J, Connor C, Knilans T (2010) Nodoventricular pathway associated with twin AV nodes: complexity of ablation in single ventricle physiology. J Cardiovasc Electrophysiol 21:936–939

    PubMed  Google Scholar 

  6. Dickinson DF, Wilkinson JL, Anderson KR, Smith A, Ho SY, Anderson RH (1979) The cardiac conduction system in situs ambiguus. Circulation 59:879–885

    Article  CAS  PubMed  Google Scholar 

  7. Epstein MR, Saul JP, Weindling SN, Triedman JK, Walsh EP (2001) Atrioventricular reciprocating tachycardia involving twin atrioventricular nodes in patients with complex congenital heart disease. J Cardiovasc Electrophysiol 12:671–679

    Article  CAS  PubMed  Google Scholar 

  8. Garcia OL, Metha AV, Pickoff AS, Tamer DF, Ferrer PL, Wolff GS, Gelband H (1981) Left isomerism and complete atrioventricular block: a report of six cases. Am J Cardiol 48:1103–1107

    Article  CAS  PubMed  Google Scholar 

  9. Hastreiter AR, Rodriguez-Coronel A (1968) Anomalous inferior vena cava with azygos continuation, high (sinus venosus) atrial septal defect and alterations of sinoatrial rhythm. Am J Cardiol 21:575–581

    Article  CAS  PubMed  Google Scholar 

  10. Ho SY, Seo JW, Brown NA, Cook AC, Fagg NL, Anderson RH (1995) Morphology of the sinus node in human and mouse hearts with isomerism of the atrial appendages. Br Heart J 74:437–442

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Jacobs JP, Anderson RH, Weinberg PM, Walters HL III, Tchervenkov CI, Del Duca D, Franklin RC, Aiello VD, Beland MJ, Colan SD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski B, Stellin G, Elliott MJ (2007) The nomenclature, definition and classification of cardiac structures in the setting of heterotaxy. Cardiol Young 17(Suppl 2):1–28

    PubMed  Google Scholar 

  12. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ (2014) 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol 63:2985–3023

    Article  PubMed  Google Scholar 

  13. Kato Y, Horigome H, Takahashi-Igari M, Sumitomo N, Aonuma K (2012) Tachycardia associated with twin atrioventricular nodes in an infant with heterotaxy and interruption of inferior vena cava. Pacing Clin Electrophysiol PACE 35:e302–e305

    Article  PubMed  Google Scholar 

  14. Loomba RS, Anderson RH (2015) Letter to the editor regarding “Situs inversus with levocardia, infrahepatic interruption of the inferior vena cava, and azygos continuation: a case report”. Surg Radiol Anat. doi:10.1007/s00276-015-1492-x

  15. Loomba RS, Hlavacek AM, Spicer DE, Anderson RH (2015) Isomerism or heterotaxy: Which term leads to better understanding? Cardiol Young 19:1–7. doi:10.1017/S1047951115001122

  16. Loomba RS, Pelech AN, Shah PH, Anderson RH (2015) Determining bronchial morphology for the purposes of segregating so-called heterotaxy. Cardiol Young 10:1–13. doi:10.1017/S1047951115001195

  17. Loomba R, Shah PH, Anderson RH (2015) Fetal magnetic resonance imaging of malformations associated with heterotaxy. Cureus 7:e269

    PubMed  Google Scholar 

  18. Loomba RS, Willes RJ, Kovach JR, Anderson RH (2015) Chronic arrhythmias in the setting of heterotaxy: differences between right and left isomerism. Congenit Heart Dis. doi:10.1111/chd.12288

  19. Momma K, Takao A, Shibata T (1990) Characteristics and natural history of abnormal atrial rhythms in left isomerism. Am J Cardiol 65:231–236

    Article  CAS  PubMed  Google Scholar 

  20. Nagel BH, Williams H, Stewart L, Paul J, Stumper O (2005) Splenic state in surviving patients with visceral heterotaxy. Cardiol Young 15:469–473

    Article  PubMed  Google Scholar 

  21. Pohanka I, Vitek B (1978) The conducting system of the heart in the syndrome of visceral symmetry. Folia Morphol 26:379–388

    CAS  Google Scholar 

  22. Roguin N, Pelled B, Freundlich E, Yahalom M, Riss E (1984) Atrioventricular block in situs ambiguus and left isomerism (polysplenia syndrome). Pacing Clin Electrophysiol PACE 7:18–22

    Article  CAS  PubMed  Google Scholar 

  23. Sakaguchi H, Miyazaki A, Ohuchi H, Kagisaki K (2011) Interventricular dyssynchrony due to unilateral atrioventricular conduction block in a patient with right atrial isomerism and twin atrioventricular nodes. Heart Rhythm Off J Heart Rhythm Soc 8:1072–1075

    Article  Google Scholar 

  24. Sakaguchi H, Miyazaki A, Tamaki W, Satomi K (2012) Intraatrial reentrant circuit in a patient with isomerism of the left atrial appendages and atrioventricular septal defect. Pacing Clin Electrophysiol PACE 35:e299–e301

    Article  PubMed  Google Scholar 

  25. Smith A, Ho SY, Anderson RH, Connell MG, Arnold R, Wilkinson JL, Cook AC (2006) The diverse cardiac morphology seen in hearts with isomerism of the atrial appendages with reference to the disposition of the specialised conduction system. Cardiol Young 16:437–454

    Article  PubMed  Google Scholar 

  26. Toyohara K, Yoshimoto J, Ozaki N, Nakamura Y (2010) Successful catheter ablation of reentrant junctional tachycardia in a patient with asplenia syndrome before total cavo-pulmonary connection. Pacing Clin Electrophysiol PACE 33:e43–e45

    Article  PubMed  Google Scholar 

  27. Uemura H, Ho SY, Devine WA, Anderson RH (1995) Analysis of visceral heterotaxy according to splenic status, appendage morphology, or both. Am J Cardiol 76:846–849

    Article  CAS  PubMed  Google Scholar 

  28. Van Mierop LH, Wiglesworth FW (1962) Isomerism of the cardiac atria in the asplenia syndrome. Lab Investig J Tech Methods Pathol 11:1303–1315

    Google Scholar 

  29. Wren C, Macartney FJ, Deanfield JE (1987) Cardiac rhythm in atrial isomerism. Am J Cardiol 59:1156–1158

    Article  CAS  PubMed  Google Scholar 

  30. Wu MH, Lin JL, Wang JK, Chiu IS, Young ML (1995) Electrophysiological properties of dual atrioventricular nodes in patients with right atrial isomerism. Br Heart J 74:553–555

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Wu MH, Wang JK, Lin JL, Lai LP, Lue HC, Young ML, Hsieh FJ (1998) Supraventricular tachycardia in patients with right atrial isomerism. J Am Coll Cardiol 32:773–779

    Article  CAS  PubMed  Google Scholar 

  32. Wu MH, Wang JK, Lin JL, Lai LP, Lue HC, Hsieh FJ (2001) Cardiac rhythm disturbances in patients with left atrial isomerism. Pacing Clin Electrophysiol PACE 24:1631–1638

    Article  CAS  PubMed  Google Scholar 

  33. Wu MH, Wang JK, Lue HC (2002) Sudden death in patients with right isomerism (asplenism) after palliation. J Pediatr 140:93–96

    Article  PubMed  Google Scholar 

  34. Wu MH, Wang JK, Lin JL, Lin MT, Chiu SN, Chen CA (2008) Long-term outcome of twin atrioventricular node and supraventricular tachycardia in patients with right isomerism of the atrial appendage. Heart Rhythm Off J Heart Rhythm Soc 5:224–229

    Article  Google Scholar 

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Authors and Affiliations

  1. Medical College of Wisconsin, Milwaukee, WI, USA

    Rohit S. Loomba, Navdeep Gupta & Matthew Buelow

  2. Creighton University Medical Center, Omaha, NE, USA

    Saurabh Aggarwal & Venkata Alla

  3. Chicago Medical School, North Chicago, IL, USA

    Rohit R. Arora

  4. Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK

    Robert H. Anderson

Authors
  1. Rohit S. Loomba
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  2. Saurabh Aggarwal
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  3. Navdeep Gupta
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  4. Matthew Buelow
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  5. Venkata Alla
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  6. Rohit R. Arora
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Correspondence to Rohit S. Loomba.

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Loomba, R.S., Aggarwal, S., Gupta, N. et al. Arrhythmias in Adult Congenital Patients With Bodily Isomerism. Pediatr Cardiol 37, 330–337 (2016). https://doi.org/10.1007/s00246-015-1281-7

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  • DOI: https://doi.org/10.1007/s00246-015-1281-7

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