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TOF
Approximately 10% of patients develop incisional or CTI dependent atrial flutter within the next
35 years after repair. 17 There is usually RBBB in the resting ECG of the majority of patients,
and SVT are conducted with RBBB aberration, but this pattern also occurs in 25% of VT in this
setting. Development of atrial flutter can be an indication of worsening ventricular function and
tricuspid regurgitation, and reassessment for surgical revision may be indicated.
EBSTEINS ANOMALY
Accessory AV and atriofascicular pathways occur in up to 25% of patients and are more often
right-sided and multiple than in patients without the disorder. 18,19 AF, atrial flutter, and AT
may also occur. RBBB is usually present and, in the presence of a right-sided accessory pathway,
ventricular pre-excitation can mask the ECG evidence of RBBB. LBBB tachycardias can be due
to antidromic AVRT or conduction over a bystander accessory pathway. Depending on the
severity of the malformation and the arrhythmia, SVT can produce cyanosis and severe
symptoms or sudden death due to rapid conduction to the ventricles during AF or atrial flutter
when an accessory pathway is present. Preoperative (success rates 7589%, with recurrence
in 3035%) 20,21 or surgical ablation are recommended in the presence of SVT to avoid
recurrent arrhythmias and instability in the perioperative period.