49 * Tachyarrhythmias in adults with previous rastelli repair: mechanistic insights from single center expereince
Bibliographic record
Abstract
Introduction: Late arrhythmias are common in adults undergoing Rastelli repair with a right ventricle (RV) to pulmonary artery (PA) conduit. The mechanism of arrhythmias has not been described. We sought to describe the prevalence, clinical predictors and mechanisms of supraventricular (SVT) and ventricular tachycardia (VT) in this population. Methods: We retrospectively reviewed charts for adults (age >18 years) with discordant ventriculo-arterial connection (d-TGA (and double outlet RV), VSD and pulmonary stenosis (PS) that underwent Rastelli operations who were seen in our clinic. Twenty-nine patients (pts) [median age 28 (IQR 15) yrs, 59% male] were included. Results: Over median post-operative follow-up of 22 (IQR 9) yrs, 10 pts had arrhythmia (SVT=7, VT=1, both= 2). The median age at arrhythmia onset was 28 (IQR 11) yrs. Pts with arrhythmias were older than those without [36 (14) vs 24 (12) yrs, p=0.005] with greater time since surgery [26 (9) vs 19 (7) yrs, p=0.01]. The number of surgical interventions post-Rastelli [2 (2) vs 2 (1)], the LV and RV systolic function at last follow-up, the right ventricular size and systolic pressure, and the severity of pulmonary regurgitation grade were similar between pts with and without arrhythmias. The median follow-up time from arrhythmia onset was 4.5 (IQR 11) yrs. The majority of pts with SVT (7/9) were managed with medications. Two pts with SVT had catheter ablation. Both pts had multiple intra-atrial reentrant tachyarrhythmia (IART) (cavo-tricuspid isthmus dependent and incisional IART); more than one procedure was required to eliminate all IART. Two pts with VT were drug refractory and had ablation. One pt had a macro-reentrant VT around the RV-PA conduit (Figure 1A); the VT terminated during ablation with no recurrence after 9 years. The second pt underwent ablation twice with a focal/micro-reentrant VT- source from scar at the base of RV-PA conduit (Figure 1B) with no recurrence 8 months after the 2nd procedure. Conclusions: Tachyarrhythmias were seen in ≥ 1/3 of adults with Rastelli repair. The prevalence of arrhythmias increased with age. The mechanisms of SVT included CTI-dependent and incisional RA scar IART. The mechanisms of VT were macro-reentrant and focal, both originating around RV-PA conduit junction.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".