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Arrhythmic complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

Published online by Cambridge University Press:  01 December 2008

Barbara J. Deal
Affiliation:
From the Division of Cardiology, Children’s Memorial Hospital, and the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Constantine Mavroudis*
Affiliation:
From the Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, and the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Jeffrey Phillip Jacobs
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Division of Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates (CSA), Saint Petersburg and Tampa, Florida, United States of America
Melanie Gevitz
Affiliation:
From the Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, and the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Carl Lewis Backer
Affiliation:
From the Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, and the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
*
Correspondence to: Dr Constantine Mavroudis, Division of Cardiovascular-Thoracic Surgery-M/C #22, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614, United States of America. Tel: 773 880 4378; Fax: 773 880 3054; E-mail: cmavroudis@childrensmemorial.org

Abstract

A detailed hierarchal nomenclature of arrhythmias is offered with definition of its applications to diagnosis and complications. The conceptual and organizational approach to discussion of arrhythmias employs the following sequence: location – mechanism – aetiology – duration. The classification of arrhythmias is heuristically divided into an anatomical hierarchy: atrial, junctional, ventricular, or atrioventricular. Mechanisms are most simplistically classified as either reentrant, such as macro-reentrant atrial tachycardia, previously described as atrial flutter, or focal, such as automatic or micro-reentrant tachycardia, for example, junctional ectopic tachycardia. The aetiology of arrhythmias can be either iatrogenic, such as postsurgical, or non-iatrogenic, such as genetic or congenital, and in many cases is multi-factorial. Assigning an aetiology to an arrhythmia is distinct from understanding the mechanism of the arrhythmia, yet assignment of a possible aetiology of an arrhythmia may have important therapeutic implications in certain clinical settings. For example, postoperative atrial arrhythmias in patients after cardiac transplantation may be harbingers of rejection or consequent to remediable imbalances of electrolytes. The duration, frequency of, and time to occurrence of arrhythmia are temporal measures that further refine arrhythmia definition, and may offer insight into ascription of aetiology. Finally, arrhythmias do not occur in a void, but interact with other organ systems. Arrhythmias not only can result from perturbations of other organ systems, such as renal failure, but can produce dysfunction in other organ systems due to haemodynamic compromise or embolic phenomena.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2008

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