CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
216
AFRICA
ablated successfully the ventricular insertion over the right bundle
potential, leaving the patient with a right bundle branch block on
the surface ECG but otherwise normal His and infraHis conduction.
Unsurprisingly, given the chosen technique, pre-excitation recurred
overnight. The patient requested a six-month period before attempt-
ing a distal insertion RF ablation.
Conclusion:
The case of para-Hissian atrio-fascicular connection
represents an extremely rare finding and a further challenge for the
electrophysiologist in terms of correct diagnosis as well as therapy.
In our patient, a precise diagnosis was done by pacing manoeuvres.
Recurrence after cryo-ablation of the moderator band confirms once
again that this approach is of little long-term success in the setting of
accessory pathways.
1147: ARRHYTHMIAS IN PATIENTS WITH TETRALOGY
OF FALLOT: A NATIONAL DATABASE STUDY
Mei-Hwan Wu
1
, Hui-Chi Chen
2
, Jou-Kou Wang
1
, Chun-Wei Lu
1
,
San-Kuei Huang
3
1
National Taiwan University Hospital, Taiwan
2
Genomics Research Centre, Academia Sinica, Taiwan
3
Bureau of National Health Insurance, Taiwan
Objective:
Tetralogy of Fallot (TOF) is the most common cyanotic
congenital heart disease and the incidence is 0.6/1 000 live births in
Taiwan. Although the surgical outcome is generally good, long-term
morbidity and mortality rates are increasingly recognised. A popula-
tion study from Taiwan, a country with national health insurance,
easily accessible medical care and child health index similar to that
in the USA, would reflect adequately the long-term risk.
Methods:
We retrieved the data of TOF patients from our national
health insurance 2000–2010 database.
Results:
From an average 23 million population, there were 6 073
TOF patients: a prevalence rate of 44.2/100 000 (95% CI: 42.4–45.9)
for the paediatric population (aged
<
18 years) and 9.5/100 000
(95% CI: 9.1–10.0) for adults. Among them, 224 (3.8%) patients had
arrhythmias during the study period spanning 11 years, including
165 (74%) patients with tachycardia and 59 (26%) with bradycardia.
Male dominance was noted for all types of arrhythmias, particularly
for ventricular tachycardia and sudden cardiac death. The mean age
of each type of arrhythmia was oldest for atrial fibrillation (inci-
dence
=
0.7%,
n
=
45, 44.4
±
15.6 years), followed by bradycardia–
tachycardia syndrome (0.07%,
n
=
4, 28.9
±
10.9 years), atrial flutter
(0.18%,
n
=
11, 29.7
±
17.8 years), sick sinus syndrome (0.13%,
n
=
8, 27.9
±
16.6 years), ventricular tachycardia (0.46%,
n
=
28, 24.4
±
15.3 years), supraventricular tachycardia (1.19%,
n
=
72, 16.4
±
15.8), and atrio-ventricular block (0.77%,
n
=
47, 15.8
±
13.9 years).
Arrhythmias intervention was performed in 17 patients during the
study period (RFCA in 12, ICD in three and pacemaker in 26), giving
an annual risk of arrhythmia intervention at 0.028%.
Conclusion
In this Asian national cohort spanning 11 years, arrhyth-
mias occurred in 3.8% of the TOF patients, particularly in males.
Tachycardia accounted for almost three-quarters of the arrhythmias
and was a growing problem during long-term follow up.
1148: DEXTROCARDIA AND ASSOCIATED CARDIAC
MALFORMATIONS: EXPERIENCE FROM A TERTIARY
CENTRE IN SAUDI ARABIA
MuhmmadArif Khan,YahyaAlmasham, AbdurRehmanAlmoukirish,
Omar Galal, Tarek Momenah
Prince Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
Introduction:
Dextrocardia is an abnormal congenital positioning
of the heart in the chest, with the apex pointing towards the right
side. Isolated dextrocardia without other cardiac lesions does not
require treatment. Dextrocardia with situs solitus or situs ambigu-
ous is usually associated with complex congenital heart disease and
requires attention.
Objective:
To determine the frequency of dextrocardia and associ-
ated cardiac defects in children presenting to our service.
Methods: This was a retrospective study. All patients with diagnosed
dextrocardia referred to our tertiary cardiac centre from January 2008
to July 2012 were included in the study and their charts and echocar-
diograms were reviewed.
Results:
A total of 8 648 patients were seen during this period
.
The
number of new patients was 2 657 (30.72%) of the total. Dextrocardia
was found in 30 (0.35%) of the total cohort. Of the dextrocardia
cases, 14 (46.7%) had situs solitus, 14 (46.7%) situs inversus and two
(6.6%) situs ambiguous. The predominance was males, with male-to-
female ratio 60:40. The majority (25, 83.4%) of patients had associ-
ated congenital heart disease while five (16.7%) had no congenital
heart disease. Of those with structural heart defects, 13 (52%) had
situs solitus, 10 (40%) situs inversus, and two (8%) patients were in
the situs ambiguous group.
Conclusion:
The frequency of dextrocardia was 0.35% in our study,
which is in accordance with the rest of the world (0.2–0.8%). In
addition, congenital heart disease was more common in patients with
dextrocardia with situs solitus or situs ambiguous.
1152: RISK OFADVERSE CARDIAC EVENTS IN CHILDREN
AND ADOLESCENTS WITH SEVERE RHEUMATIC LEFT-
SIDED VALVAR LESION
Maria Concepcion Sison, Edison Ty, Cecilienne Acosta, Jonas Del
Rosario, Vincent Aluquin, Olympia Malanyaon, Edison Ty
Philippine General Hospital, University of the Philippines, Philippines
Background:
Rheumatic heart disease (RHD) and rheumatic fever
(RF) continue to be a scourge in developing nations. A number of
patients who need valvar surgery cannot afford the intervention. With
limited resources, government hospitals need to prioritise patients
needing immediate surgery. This study aimed to determine the demo-
graphic and echocardiographic variables that are risk factors for the
development of adverse cardiac events (ACE) in children with severe
rheumatic left-sided valvar lesions.
Methods:
We reviewed 376 echocardiograms of paediatric (
<
19
years old) patients with RHD done at the Philippine General Hospital
from January 2002 to December 2003. Based on the latest echocar-
diograms of 296 patients, they were grouped as to the left-sided
valve most severely affected. Demographic and echocardiographic
parameters of patients with ACE (death, AF, thrombus formation, and
≥
two admission/two-year period) were compared with those without
ACE among patients with the same left-sided valvar lesion. A
p-
value
<
0.05 was considered significant.
Results:
The following factors were found to increase the risk of
ACE: (1) severe mitral stenosis (
p
<
0.0001); (2) severe MR with
concomitant moderate MS, severe TR, LVESD
≥
3.5 cm (RR
=
2.44;
1.27–4.68,
p
=
0.006), or LVEDD
≥
5.5 cm (RR
=
2.19; 1.15-4.14 p
=
0.01); (3) severe AR with an EF
<
60% (RR
=
5; 1.15–21.78,
p
=
0.03),
or LVESD
≥
4.5 cm (RR
=
4.17; 1.17–14.8,
p
=
0.04); and (4) moder-
ate TR or PR in patients with combined severe MR and AR. Patients
with severe MR and ACE were also found to be older (14.35
±
2.42 vs
12.65
±
3.3) and had larger LA size (5.18
±
1.05 vs 3.99
±
1.14). The
absence of PR in patients with combined severe MR and AR conferred
significant freedom (
p
<
0.05) from ACE. Based on these findings,
among the 178 paediatric RHD patients with severe left-sided valvar
lesion/s who were still alive during the time of the study, at least 88
patients (49.4%) were in immediate need of surgery/intervention
.
Conclusion
: The risk of adverse cardiac events in children and
adolescents with RHD appeared to be associated with the severity
and nature of valvar involvement and, depending on the valvar lesion,
on certain demographic and echocardiographic variables, which
could guide the clinician on the timing of surgery.
1155: DILATED CARDIOMYOPATHY WITH SEVERE LEFT
VENTRICULAR SYSTOLIC DYSFUNCTION IN A PATIENT
ON HIGHLY ACTIVE ANTIRETROVIRAL THERAPY
