RESUMO
We present a case of a 16-year-old girl with AVNRT with 1:1 or 2:1 conduction from the atria to ventricles which was perceived by the patient as two different types of palpitations.
Assuntos
Nó Atrioventricular/fisiopatologia , Fascículo Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Adolescente , Ablação por Cateter , Eletrocardiografia , Eletrofisiologia , Teste de Esforço , Feminino , Humanos , Prognóstico , Taquicardia por Reentrada no Nó Atrioventricular/diagnósticoRESUMO
OBJECTIVE: Early postoperative arrhythmias are a recognized complication of pediatric cardiac surgery. METHODS: Diagnosis and treatment of early postoperative arrhythmias were prospectively analyzed in 402 consecutive patients aged 1 day to 18 years (mean 29.5 months) who underwent operation between January and December 2005 at our institute. All children were admitted to the intensive care unit, and continuous electrocardiogram monitoring was performed. Risk factors, such as age, weight, Aristotle Basic Score, cardiopulmonary bypass time, aortic crossclamp time, and use of deep hypothermia and circulatory arrest, were compared. Statistical analysis using the Student t test, Mann-Whitney U test, or Fisher exact test was performed. Multivariate stepwise logistic regression was used to assess the risk factors of postoperative arrhythmias. RESULTS: Arrhythmias occurred in 57 of 402 patients (14.2%). The most common types of arrhythmia were junctional ectopic tachycardia (21), supraventricular tachycardia (15), and arteriovenous block (6). Risk factors for arrhythmias, such as lower age (P = .0041*), lower body weight (P = .000001*), higher Aristotle Basic Score (P = .000001*), longer cardiopulmonary bypass time (P = .000001*), aortic crossclamp time (P = .000001*), and use of deep hypothermia and circulatory arrest (P = .0188*), were identified in a univariate analysis. In the multivariate stepwise logistic regression, only higher Aristotle Basic Score was statistically significant (P = .000003*) compared with weight (P = .62) and age (P = .40); in the cardiopulmonary bypass group, only longer aortic crossclamp time was statistically significant (P = .007*). CONCLUSION: Lower age, lower body weight, higher Aristotle Basic Score, longer cardiopulmonary bypass time, aortic crossclamp time, and use of deep hypothermia and circulatory arrest are the risk factors for postoperative arrhythmias. Junctional ectopic tachycardia and supraventricular tachycardia were the most common postoperative arrhythmias.
Assuntos
Arritmias Cardíacas/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiopatias Congênitas/cirurgia , Adolescente , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Período Pós-Operatório , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
A case of a 16-year-old girl with left sided accessory pathway is presented. Following adenosine-induced termination of atrio-ventricular reentrant tachycardia the patient developed polymorphic ventricular tachycardia followed by preexcited atrial fibrillation with very rapid ventricular response and syncope. Arrhythmia was terminated by amiodarone infusion. Potential complications after adenosine injection are discussed.