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Arrhythmia surgery in patients with and without congenital heart disease.
Ann Thorac Surg. 2008 Sep; 86(3):857-68; discussion 857-68.AT

Abstract

BACKGROUND

Arrhythmia surgery has favorably impacted the clinical course of debilitating atrial and ventricular arrhythmias in patients with and without congenital heart disease. This study reviews arrhythmia mechanisms and documents long-term outcome of patients undergoing arrhythmia operations alone or associated with congenital heart repairs. The analysis excludes Fontan conversion patients.

METHODS

Between 1987 and 2007, arrhythmia operations were done in 11 patients without associated congenital heart disease and in 89 along with congenital heart repairs. Mean age was 15.9 +/- 12.5 years (range, 7 days-48 years); 7 were infants (mean age, 23 +/- 16 days). Resternotomy was performed in 65 (65%). Two functional ventricles were present in 67 patients; 33 had 1 functional ventricle. Arrhythmias included macro-reentrant atrial tachycardia in 45, atrial fibrillation in 11, accessory connections in 19, atrioventricular nodal reentry tachycardia in 6, focal atrial tachycardia in 6, and ventricular tachycardia in 13.

RESULTS

Operative mortality was 3 (3.0%) due to advanced associated congenital heart disease. There were 4 late deaths (4.0%) and 2 late cardiac transplants (2.0%). Freedom from arrhythmia recurrence at 1 and 10 years was 94% and 85% for atrial arrhythmias, and 85% and 68% for ventricular arrhythmias, respectively.

CONCLUSIONS

Successful surgical therapy for atrial arrhythmias can be performed safely with a high freedom from recurrence rate in patients with and without associated congenital heart disease. Surgical ablation for ventricular arrhythmias is less predictive. Complexity of the underlying congenital heart disease and hemodynamic status may contribute to potential arrhythmia recurrence or new onset arrhythmia manifestation.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18721574

Citation

Mavroudis, Constantine, et al. "Arrhythmia Surgery in Patients With and Without Congenital Heart Disease." The Annals of Thoracic Surgery, vol. 86, no. 3, 2008, pp. 857-68; discussion 857-68.
Mavroudis C, Deal BJ, Backer CL, et al. Arrhythmia surgery in patients with and without congenital heart disease. Ann Thorac Surg. 2008;86(3):857-68; discussion 857-68.
Mavroudis, C., Deal, B. J., Backer, C. L., & Tsao, S. (2008). Arrhythmia surgery in patients with and without congenital heart disease. The Annals of Thoracic Surgery, 86(3), 857-68; discussion 857-68. https://doi.org/10.1016/j.athoracsur.2008.04.087
Mavroudis C, et al. Arrhythmia Surgery in Patients With and Without Congenital Heart Disease. Ann Thorac Surg. 2008;86(3):857-68; discussion 857-68. PubMed PMID: 18721574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arrhythmia surgery in patients with and without congenital heart disease. AU - Mavroudis,Constantine, AU - Deal,Barbara J, AU - Backer,Carl L, AU - Tsao,Sabrina, PY - 2008/01/24/received PY - 2008/04/22/revised PY - 2008/04/23/accepted PY - 2008/8/30/pubmed PY - 2008/9/20/medline PY - 2008/8/30/entrez SP - 857-68; discussion 857-68 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 86 IS - 3 N2 - BACKGROUND: Arrhythmia surgery has favorably impacted the clinical course of debilitating atrial and ventricular arrhythmias in patients with and without congenital heart disease. This study reviews arrhythmia mechanisms and documents long-term outcome of patients undergoing arrhythmia operations alone or associated with congenital heart repairs. The analysis excludes Fontan conversion patients. METHODS: Between 1987 and 2007, arrhythmia operations were done in 11 patients without associated congenital heart disease and in 89 along with congenital heart repairs. Mean age was 15.9 +/- 12.5 years (range, 7 days-48 years); 7 were infants (mean age, 23 +/- 16 days). Resternotomy was performed in 65 (65%). Two functional ventricles were present in 67 patients; 33 had 1 functional ventricle. Arrhythmias included macro-reentrant atrial tachycardia in 45, atrial fibrillation in 11, accessory connections in 19, atrioventricular nodal reentry tachycardia in 6, focal atrial tachycardia in 6, and ventricular tachycardia in 13. RESULTS: Operative mortality was 3 (3.0%) due to advanced associated congenital heart disease. There were 4 late deaths (4.0%) and 2 late cardiac transplants (2.0%). Freedom from arrhythmia recurrence at 1 and 10 years was 94% and 85% for atrial arrhythmias, and 85% and 68% for ventricular arrhythmias, respectively. CONCLUSIONS: Successful surgical therapy for atrial arrhythmias can be performed safely with a high freedom from recurrence rate in patients with and without associated congenital heart disease. Surgical ablation for ventricular arrhythmias is less predictive. Complexity of the underlying congenital heart disease and hemodynamic status may contribute to potential arrhythmia recurrence or new onset arrhythmia manifestation. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/18721574/Arrhythmia_surgery_in_patients_with_and_without_congenital_heart_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(08)00918-1 DB - PRIME DP - Unbound Medicine ER -