Cardiac rhythm and symptomatic XXXX in right @entity4032 .

@entity1 @entity4710 @entity1165 @entity944 @entity591 @entity956 @entity4032 @entity943 @entity6015
BACKGROUND: The conduction system in right @entity4032 may be complicated by the presence of paired sinus nodes and twin atrioventricular nodes. With a large cohort of @entity1 and @entity1 with right @entity4032 , we sought to investigate the nature of atrial rhythm, its prevalence, factors predisposing @entity1 to symptomatic @entity943 , and the relation of @entity943 to long-term morbidity and mortality. METHODS: Standard 12-lead baseline electrocardiograms were performed in 110 @entity1 and @entity1 with right @entity4032 at a median age of 1 day, and their clinical records were reviewed. The type, timing, and precipitating factors of symptomatic @entity943 that occurred in 15 @entity1 , among a cohort of 85 @entity1 who had or were awaiting surgical interventions, were noted. RESULTS: All @entity1 except 1 had a sinus rhythm with intact atrioventricular conduction. Of these, 87% (95/109) had single P-wave morphology, whereas 13% (14/109) had multiple P-wave morphologies. For @entity1 with a single P-wave morphology, the frontal P-wave axis was between 0 degrees and 90 degrees in 62% (59/95), 90 degrees and 180 degrees in 23% (22/95), and superior in 15% (14/95). There was no relation between either P-wave axis or morphology and cardiac anatomy. Symptomatic @entity943 occurred in 15 of 85 @entity1 (18%); 11 of the 15 @entity1 had @entity4710 , and 1 @entity1 each had @entity591 , @entity956 , @entity1165 , and @entity6015 . The @entity943 occurred before surgery in 4 @entity1 , early after surgery in 5 @entity1 , and late after surgery in 6 @entity1 . Although 3 of the 7 @entity1 who died suddenly had a history of symptomatic @entity943 , @entity943 was the documented cause of mortality in only 1 of the 32 fatalities (3.1%). Freedom from @entity943 at 1, 5, 10, 15, and 20 years was 93% +/- 3%, 86% +/- 4%, 80% +/- 6%, 73% +/- 9%, and 48% +/- 15% (mean +/- SE), respectively. No risk factors for symptomatic @entity943 were identified by means of logistic regression. CONCLUSIONS: The atrial pacemaker varies in location within and between @entity1 with right @entity4032 . Although symptomatic @entity943 are not uncommon, they do not seem to relate to the overall high mortality rate and occurrence of @entity944 in this @entity1 group. Nonetheless, detailed assessment and aggressive management of @entity943 once they occur are warranted because of the precarious single ventricular hemodynamics.
