Research Article| Volume 166, ISSUE 2, P375-380, June 20, 2013

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The incidence and characteristics of supraventricular tachycardia in left atrial isomerism: A high incidence of atrial fibrillation in young patients

Published:November 15, 2011DOI:



      In left atrial isomerism (LAI), both atria show left atrial morphology. Although bradyarrhythmias are frequent and highly complex in LAI patients, previous studies have reported a low incidence of supraventricular tachycardia (SVT).


      To evaluate the incidence and characteristics of SVT in LAI, we retrospectively evaluated the clinical characteristics of SVTs in 83 patients with LAI (age at last follow-up, 15.3±10.5 years).


      There were 27 SVTs in 19 patients (23%), including nine episodes of atrial fibrillation (AF) and eight non-reentrant SVTs. Sixteen of the 19 patients with SVT had histories of atriotomy, but the three patients with AF or non-reentrant tachycardia had no history of atriotomy. The rates of freedom from SVT were 66% and 59% at ages of 20 and 30 years, respectively; the corresponding rates for freedom from AF were 89% and 74%. In multivariate analysis, the predictors of SVT were age (OR, 1.14; 95% CI, 1.06–1.26; p=0.003) and sinus node dysfunction (SND) (OR, 3.88; 95% CI, 1.57–13.34; p=0.01).


      In patients with LAI, SVTs are common, and AF and non-reentrant SVTs are the major type of SVTs. The incidence of AF was high in young patients with LAI. The lack of anatomical barriers in the atria that allow the formation of macro-reentrant circuits may account for the higher incidence of AF and non-reentrant SVT than macro-reentrant tachycardia. Moreover, the increasing prevalence of SND with age should contribute to a higher incidence of SVT.


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        • Dickinson D.F.
        • Wilkinson J.L.
        • Anderson K.R.
        • Smith A.
        • Ho S.Y.
        • Anderson R.H.
        The cardiac conduction system in situs ambiguus.
        Circulation. 1979; 59: 879-885
        • Smith A.
        • Ho S.Y.
        • Anderson R.H.
        • et al.
        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. 2006; 16: 437-454
        • Wu M.H.
        • Wang J.K.
        • Lin J.L.
        • Lai L.P.
        • Lue H.C.
        • Hsieh F.J.
        Cardiac rhythm disturbances in patients with left atrial isomerism.
        Pacing Clin Electrophysiol. 2001; 24: 1631-1638
        • Momma K.
        • Takao A.
        • Shibata T.
        Characteristics and natural history of abnormal atrial rhythms in left isomerism.
        Am J Cardiol. 1990; 65: 231-236
        • Wren C.
        • Macartney F.J.
        • Deanfield J.E.
        Cardiac rhythm in atrial isomerism.
        Am J Cardiol. 1987; 59: 1156-1158
        • Gilljam T.
        • McCrindle B.W.
        • Smallhorn J.F.
        • Williams W.G.
        • Freedom R.M.
        Outcomes of left atrial isomerism over a 28-year period at a single institution.
        J Am Coll Cardiol. 2000; 36: 908-916
        • Uemura H.
        • Ho S.Y.
        • Devine W.A.
        • Kilpatrick L.L.
        • Anderson R.H.
        Atrial appendages and venoatrial connections in hearts from patients with visceral heterotaxy.
        Ann Thorac Surg. 1995; 60: 561-569
        • Sakaguchi H.
        • Miyazaki A.
        • Tamaki W.
        • Satomi K.
        Intra-atrial reentrant circuit in a patient with isomerism of the left atrial appendages and atrio-ventricular septal defect.
        Pacing Clin Electrophysiol. 2012 Oct; 35: e299-301
        • Bae E.J.
        • Noh C.I.
        • Choi J.Y.
        • et al.
        Late occurrence of adenosine-sensitive focal junctional tachycardia in complex congenital heart disease.
        J Interv Card Electrophysiol. 2005; 12: 115-122
        • Jacobs J.P.
        • Anderson R.H.
        • Weinberg P.M.
        • et al.
        The nomenclature, definition and classification of cardiac structures in the setting of heterotaxy.
        Cardiol Young. 2007; 17: 1-28
        • Ohuchi H.
        • Yasuda K.
        • Hasegawa S.
        • et al.
        Influence of ventricular morphology on aerobic exercise capacity in patients after the Fontan operation.
        J Am Coll Cardiol. 2001; 37: 1967-1974
        • Kirsh J.A.
        • Walsh E.P.
        • Triedman J.K.
        Prevalence of and risk factors for atrial fibrillation and intra-atrial reentrant tachycardia among patients with congenital heart disease.
        Am J Cardiol. 2002; 90: 338-340
        • Ammash N.M.
        • Phillips S.D.
        • Hodge D.O.
        • et al.
        Outcome of direct current cardioversion for atrial arrhythmias in adults with congenital heart disease.
        Int J Cardiol. 2012 Feb 9; 154: 270-274
        • Khairy P.
        • Aboulhosn J.
        • Gurvitz M.Z.
        • et al.
        Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study.
        Circulation. 2010; 122: 868-875
        • Wang T.D.
        • Tseng C.D.
        • Lee Y.T.
        Left isomerism in a middle-aged woman with early-onset atrial fibrillation.
        Int J Cardiol. 1997; 58: 269-272
        • Walsh E.P.
        • Cecchin F.
        Arrhythmias in adult patients with congenital heart disease.
        Circulation. 2007; 115: 534-545
      1. Corradi D, Maestri R, Macchi E, Callegari S. The atria: from morphology to function. J Cardiovasc Electrophysiol 2011;22:223–35.