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2 results

  • Arrhythmias in adult patients after Rastelli surgery: a single-centre experience

  • Sirish Chandra Srinath Patloori, Satoshi Kawada, Praloy Chakraborty, Yawer Saeed, Nathan Denham, Christian Joens, Erwin N. Oechslin, Susan L. Roche, Candice Silversides, Rachel M. Wald, Rafael Alonso-Gonzalez, Sara Thorne, Blandine Mondesert, Paul Khairy, Raja Selvaraj, Krishnakumar Nair
  • Journal:
    Cardiology in the Young , First View
    Published online by Cambridge University Press:
    18 October 2024, pp. 1-5
    • Article
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  • Background:

    Rastelli surgery is used for the correction of several CHDs. Although late-onset cardiac arrhythmias have emerged as a major complication after corrective surgeries, there is a paucity of data on arrhythmias after Rastelli surgery.

    Methods:

    This retrospective cohort study was conducted on patients who had undergone Rastelli surgery and have been followed at the adult CHD clinic at our hospital.

    Results:

    A total of 55 patients (36.4% female, age 22.2 ± 6.4 years) were followed for a median period of 24.2 (20.6–31.0) years. Tachyarrhythmias occurred in 21 (38.4 %) patients (n = 15 for atrial tachycardia, 5 for ventricular tachycardia, and 1 for both atrial and ventricular tachycardia). Older age at surgery was significantly associated with the risk of tachyarrhythmias (P = 0.022). Bradyarrhythmia occurred in 12 (21.8%) patients and consisted of perioperative AV block (n = 5), late AV block (n = 1), and sinus node dysfunction (n = 6). Nine (16.4%) patients underwent catheter ablation. The mechanisms of atrial arrhythmias include cavotricuspid isthmus-dependent and surgical scar-dependent intra-atrial reentrant tachycardias. Among the three patients who underwent ablation for ventricular tachycardia, all circuits were dependent on the scar at the base of the right ventricle to pulmonary artery conduit. Median survival free from any event (arrhythmia, death, or heart failure) was 31.6 (28.1–35.1) years after Rastelli surgery.

    Conclusions:

    The prevalence of arrhythmias late after Rastelli surgery is substantial and increases in the second decade after surgery. Older age at surgery is associated with a higher prevalence of arrhythmias.

  • 34 - Pulmonary embolism

  • from Section 5 - Respiratory emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 223-228

  • Summary

    This chapter discusses the diagnosis, evaluation and management of tachyarrhythmias. Ironically, the classic presentation for tachyarrhythmias mostly consists of non-specific symptoms. Patients may complain of palpitations, chest pain, lightheadedness, dyspnea, or non-specific weakness. Further evaluation will reveal a rapid heart rate on physical examination or on the electrocardiogram (ECG). Patients with unstable tachyarrhythmias present with signs and symptoms of hypoperfusion and hemodynamic compromise while still maintaining a palpable pulse. Patients who do not have a palpable pulse are deemed to be in cardiac arrest and are treated according to Advanced Cardiovascular Life Support (ACLS) guidelines. Once tachyarrhythmia is confirmed, consideration should be given to whether the arrhythmia has an underlying noncardiac etiology such as a toxic ingestion or a metabolic disturbance. The primary goal with a patient in sinus tachycardia (ST) is to treat the underlying condition rather than the tachycardia itself.