Focal atrial tachycardia originating from the pulmonary vein with onset later than 3 years of age might have a better prognosis, possibly converting in adolescence.

Two cases of focal atrial tachycardia probably originating from the pulmonary vein with onset later than 3 years of age are presented. Both cases had associated variable atrioventricular conduction and showed no signs of heart failure, and they converted to sinus rhythm at the time of puberty. In cases of focal atrial tachycardia originating from the pulmonary vein with onset later than 3 years of age, drug therapy may be effective. Even if drug therapy is not effective, changes in the autonomic nervous system are reflected strongly in the pulmonary veins, so that changes in autonomic nervous system regulation with growth might terminate focal atrial tachycardia. Therefore, focal atrial tachycardia originating from the pulmonary vein with onset later than 3 years of age might have a better prognosis.

The mid-term outcome of Fontan conversion compared with primary total cavopulmonary connection.

BACKGROUND: The indication of Fontan conversion (FC) from atriopulmonary connection (APC) to total cavopulmonary connection (TCPC) is unclear. We sought to analyze the mid-term outcome of prophylactic and therapeutic Fontan conversion compared with that of primary TCPC. METHODS: Patients with a univentricular heart who underwent cardiac catheterization at >18 years of age between July 2005 and July 2019 were included and divided into three groups: symptomatic APC patients who underwent therapeutic FC (t-FC, n = 13), asymptomatic APC patients after prophylactic FC (p-FC, n = 15), and patients who had primary TCPC procedure (pTCPC, n = 24). RESULTS: The mean last follow up was at the age of 32.0 ± 7.8, 26.8 ± 3.8, and 27.3 ± 7 years (p = 0.07) in t-FC, p-FC, and pTCPC, respectively. There was no late death. All of t-FC and 12 (80%) of p-FC cases underwent concomitant arrhythmic surgery. Consequently, five and four patients in t-FC and p-FC groups required pacemaker implantations mostly due to sinus node dysfunction. Thromboembolism was seen in 2 cases in both t-FC (15%) and p-FC (13%), and 1 case in pTCPC (4%) (p = 0.50). The last cardiac catheterization was performed at the age of 29.5 ± 8.5, 24.6 ± 3.8, and 26.3 ± 7.1 years (p = 0.11) in t-FC, p-FC, and pTCPC patients, respectively. There was no significant difference in central venous pressure, aortic pressure, and cardiac index among the three groups. There was no late supraventricular tachyarrhythmic event seen in t-FC and p-FC, whereas two patients in pTCPC had newly developed atrial flutter. CONCLUSIONS: FC is a safe and feasible procedure to bring APC patients back onto the same track of primary TCPC patients in terms of hemodynamics as well as arrhythmia. The antiarrhythmic procedure should be carefully chosen because sinus node dysfunction can frequently occur and FC itself would reduce the risk of arrhythmia.

Atropine-induced monomorphic ventricular tachycardia in an adolescent: A rare case.

A 13-year-old girl had a history of episodic palpitations lasting for approximately 5 min since the first grade of junior high school. She was noticed to have tachycardia during auscultation at a school-based health screening program. Since non-sustained ventricular tachycardia of the left bundle branch block type was induced by a triple master exercise load at a local doctor's clinic, she was referred to our pediatric cardiology department for further management. Tachycardia could not be induced by programmed stimulation in an electrophysiological study, although ventricular tachycardia was induced by atrial high frequency pacing with intravenous injection of atropine under continuous isoproterenol infusion. .