Tags

Type your tag names separated by a space and hit enter

Surgery for arrhythmias in children.
Int J Cardiol. 2004 Dec; 97 Suppl 1:39-51.IJ

Abstract

BACKGROUND

Transcatheter radiofrequency ablation to treat supraventricular and ventricular arrhythmias has supplanted routine surgical ablative therapy and redefined its role. A small population of arrhythmia patients now requires surgical ablation: those who have failed catheter ablation, patients with concomitant congenital heart disease in association with arrhythmias, those with atrial fibrillation and very young patients for whom transcatheter techniques are prohibitive because of small size, cyanosis or distorted anatomy.

METHODS

From July 1992 through August 2003, 133 patients underwent arrhythmia surgery at Children's Memorial Hospital, 50% (67/133) in association with Fontan conversion (FC), 22% (28/133) with concomitant initial Fontan (IF) procedure and 28% (38/133) for various arrhythmias (MISC) in patients with (36/38, 95%) or without (2/38, 5%) associated structural heart disease. Mean age at surgery in the FC group was 20+/-7.6 years (median 19 years), and in the IF group and the MISC group, mean ages were 8.1+/-8.9 (median 4.2) years and 16.4+/-10.9 (median 11.3) years, respectively.

RESULTS

There were three operative (3/133, 2.6%; 1 FC, 2 MISC) and three late deaths (2 FC, 1 MISC). Four patients in the FC group had progressive ventricular failure and underwent successful cardiac transplantation. Follow-up data are available for non-transplant, surviving patients and reveal 11 incidences of persistent arrhythmia recurrence and 2 new-onset arrhythmias. Five of the 11 recurrences occurred early in our series of FC patients, when isthmus block interruption of arrhythmia foci was performed. Four additional recurrences occurred later in the FC series, two post-maze and two post-Cox-maze III. In the MISC group, there were two recurrences. Atrial reentry tachycardia (ART) recurred in a patient with no structural heart disease and accessory connection-mediated tachycardia recurred in a child who underwent concomitant initial Fontan. Two patients had ventricular tachycardia inducible at postoperative studies (2/7, 29%), but no clinical recurrence. Two new-onset tachycardias occurred, one child developed ART post-surgical ablation of accessory connections and one patient with inducible ventricular tachycardia developed ART 5 years postoperatively.

CONCLUSION

Variations in atrial and ventricular anatomy that may limit the catheter approach can be addressed surgically. Patient size or anatomic complexity should not be limiting factors in the combined surgical arrhythmia approach. Incorporation of arrhythmia therapy into planned surgical revision should be considered.

Authors+Show Affiliations

Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614, USA. cmavroudis@childrensmemorial.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15590078

Citation

Mavroudis, Constantine, et al. "Surgery for Arrhythmias in Children." International Journal of Cardiology, vol. 97 Suppl 1, 2004, pp. 39-51.
Mavroudis C, Deal BJ, Backer CL. Surgery for arrhythmias in children. Int J Cardiol. 2004;97 Suppl 1:39-51.
Mavroudis, C., Deal, B. J., & Backer, C. L. (2004). Surgery for arrhythmias in children. International Journal of Cardiology, 97 Suppl 1, 39-51.
Mavroudis C, Deal BJ, Backer CL. Surgery for Arrhythmias in Children. Int J Cardiol. 2004;97 Suppl 1:39-51. PubMed PMID: 15590078.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgery for arrhythmias in children. AU - Mavroudis,Constantine, AU - Deal,Barbara J, AU - Backer,Carl L, PY - 2004/12/14/pubmed PY - 2005/5/4/medline PY - 2004/12/14/entrez SP - 39 EP - 51 JF - International journal of cardiology JO - Int J Cardiol VL - 97 Suppl 1 N2 - BACKGROUND: Transcatheter radiofrequency ablation to treat supraventricular and ventricular arrhythmias has supplanted routine surgical ablative therapy and redefined its role. A small population of arrhythmia patients now requires surgical ablation: those who have failed catheter ablation, patients with concomitant congenital heart disease in association with arrhythmias, those with atrial fibrillation and very young patients for whom transcatheter techniques are prohibitive because of small size, cyanosis or distorted anatomy. METHODS: From July 1992 through August 2003, 133 patients underwent arrhythmia surgery at Children's Memorial Hospital, 50% (67/133) in association with Fontan conversion (FC), 22% (28/133) with concomitant initial Fontan (IF) procedure and 28% (38/133) for various arrhythmias (MISC) in patients with (36/38, 95%) or without (2/38, 5%) associated structural heart disease. Mean age at surgery in the FC group was 20+/-7.6 years (median 19 years), and in the IF group and the MISC group, mean ages were 8.1+/-8.9 (median 4.2) years and 16.4+/-10.9 (median 11.3) years, respectively. RESULTS: There were three operative (3/133, 2.6%; 1 FC, 2 MISC) and three late deaths (2 FC, 1 MISC). Four patients in the FC group had progressive ventricular failure and underwent successful cardiac transplantation. Follow-up data are available for non-transplant, surviving patients and reveal 11 incidences of persistent arrhythmia recurrence and 2 new-onset arrhythmias. Five of the 11 recurrences occurred early in our series of FC patients, when isthmus block interruption of arrhythmia foci was performed. Four additional recurrences occurred later in the FC series, two post-maze and two post-Cox-maze III. In the MISC group, there were two recurrences. Atrial reentry tachycardia (ART) recurred in a patient with no structural heart disease and accessory connection-mediated tachycardia recurred in a child who underwent concomitant initial Fontan. Two patients had ventricular tachycardia inducible at postoperative studies (2/7, 29%), but no clinical recurrence. Two new-onset tachycardias occurred, one child developed ART post-surgical ablation of accessory connections and one patient with inducible ventricular tachycardia developed ART 5 years postoperatively. CONCLUSION: Variations in atrial and ventricular anatomy that may limit the catheter approach can be addressed surgically. Patient size or anatomic complexity should not be limiting factors in the combined surgical arrhythmia approach. Incorporation of arrhythmia therapy into planned surgical revision should be considered. SN - 0167-5273 UR - https://www.unboundmedicine.com/medline/citation/15590078/Surgery_for_arrhythmias_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(04)00602-3 DB - PRIME DP - Unbound Medicine ER -