![]() ![]() Standard 2- and 4-chamber cine images were imported into post-processing software (CVi42, Circle Cardiovascular Imaging Inc., Calgary, Canada). Briefly, ventricular assessment was performed using electrocardiographically gated, balanced steady-state free precession (bSSFP) cine CMR in vertical and horizontal ventricular long-axis planes. Automated atrial CMR measurements are easily obtained from standard CMRs and have the potential to serve as noninvasive predictors of adverse outcomes in rTOF.ĬMR studies were performed using GE HDxT 1.5 Tesla scanners (Medical Systems, Milwaukee, Wisconsin) or Siemens Sola 1.5 Tesla scanners (AG, Munich, Germany). Older age at the time of repair and a diagnosis of pulmonary atresia were associated with a larger RACI. ![]() ![]() ROC analysis demonstrated RACI to be the best overall predictor of a high-risk Importance Factor Score (AUC 0.73, p = 0.03). Patients with a high-risk Importance Factor Score (>2) had a significantly larger minimum RA volume ( p = 0.04) and RACI ( p = 0.03) compared to those with scores ≤2. Patients were risk-stratified using a previously validated Importance Factor Score for the prediction of life-threatening arrhythmias in rTOF. A novel parameter, termed the Right Atrioventricular Coupling Index (RACI), was defined as the ratio of RA end-diastolic volume to right ventricle (RV) end-diastolic volume. Automated contours of the left and right atria (LA and RA) were performed. This was a retrospective single-center study with the objective of investigating the use of atrial measurements obtained via CMR for predicting outcomes in rTOF patients. SSS occurring spontaneously or as a result of necessary drug therapy, with heart rate less than 40 bpm when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented.Atrial size and function have been recognized as markers of diastolic function, and diastolic dysfunction has been identified as a predictor of adverse outcomes in repaired tetralogy of Fallot (rTOF). In some patients, bradycardia is iatrogenic and will occur as a consequence of essential long-term drug therapy of a type and dosage for which there are no acceptable alternatives. SSS with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. 5 Furthermore, there is no definitive way to distinguish patients with atrial fibrillation associated with sick sinus syndrome from patients with atrial fibrillation and normal sinus function this distinction is clinically important because treating atrial fibrillation with cardioversion or medications can have catastrophic consequences if the sinus node is inadequate. 2 If the patient is asymptomatic when ECG or ambulatory monitoring is performed, the dysrhythmias of the syndrome are often not present. 5 Symptoms of sick sinus syndrome may be variable, intermittent, and difficult to associate with ECG changes. 9 Some symptoms of patients with sick sinus syndrome (e.g., fatigue, irritability, memory loss, lightheadedness, palpitations, cognitive defects) are present in several other disorders that occur in elderly patients and may be misdiagnosed as those of senile dementia. The condition often goes undetected in the early stages because only sinus bradycardia may be present at its origin. The diagnosis of sick sinus syndrome may be difficult because of the slow and erratic course of the syndrome. ![]()
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