Prophylactic Atrial Arrhythmia Surgical Procedures With Congenital Heart Operations: Review and Recommendations

Mavroudis, Constantine; Stulak, John M.; Ad, Niv; Siegel, Allison; Giamberti, Alessandro; Harris, Louise; Backer, Carl L.; Tsao, Sabrina; Dearani, Joseph A.; Weerasena, Nihal; Deal, Barbara J.

doi:10.1016/j.athoracsur.2014.07.026

Cited by 33 publications

(38 citation statements)

References 79 publications

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“…Of these defects, more than 25% of patients with right heart obstructive lesions, Ebstein anomaly, and univentricular hearts undergo reoperations (10,32). Patients with ASDs may present for intervention in adulthood (1,6,8). Clearly, a surgical intervention that reduces the risk of later arrhythmia development by the inclusion of successful prophylactic arrhythmia surgery should result in improved quality of life for a significant number of patients (1).…”

Section: Arrhythmias and Congenital Heart Diseasementioning

confidence: 99%

“…Patients with ASDs may present for intervention in adulthood (1,6,8). Clearly, a surgical intervention that reduces the risk of later arrhythmia development by the inclusion of successful prophylactic arrhythmia surgery should result in improved quality of life for a significant number of patients (1).…”

Section: Arrhythmias and Congenital Heart Diseasementioning

confidence: 99%

“…The surgical community has not reached unanimity of opinion as to what constitutes a standard prophylactic maze procedure (1,(17)(18)(19)(20)(21). While the operation was conceived to be complication-free owing to the lesions being placed in areas that theoretically do not interfere with normal sinus rhythm mechanism and one-toone conduction, the reality is that there have been reported cases of sinus node dysfunction resulting in nodal rhythm following maze procedures (21,22).…”

Section: Introductionmentioning

confidence: 99%

“…The idea that prophylactic arrhythmia surgery should be incorporated into reparative open heart procedures stems from the reality that many patients with specific congenital cardiac anatomic substrates are subject to atrial arrhythmia development in the course of their lives, which will impact negatively on ventricular function, physical well being, and long-term survival (1)(2)(3). Patients presenting later in life with any form of atrial septal defect (ASD) have a 30% to 50% incidence of atrial arrhythmias [mostly atrial fibrillation (AF)] with or without operative repair (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…These considerations are important in light of the fact that prophylactic arrhythmia therapy may be performed without advanced knowledge that the patient in question will actually develop an arrhythmia during the course of his or her life. Invocation of bioethical principles of nonmaleficence, beneficence, patient autonomy, and justice all come to mind and apply (1,(23)(24)(25). The idea is to establish the historic incidence of these arrhythmias, identify the arrhythmia (right-sided, left-sided, both right and left sided) and offer a safe, effective, and complication-free prophylactic procedure (4,22,(26)(27)(28).…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic arrhythmia surgery in association with congenital heart disease

Mavroudis

Deal

2016

Transl. Pediatr.

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Certain congenital heart anomalies make patients more susceptible to arrhythmia development throughout their lives. This poses the question whether prophylactic arrhythmia surgery should be incorporated into reparative open heart procedures for congenital heart disease. There is currently no consensus on what constitutes a standard prophylactic procedure, owing to the questions that remain regarding lesions to be performed; energy sources to use; proximity of energy source or incisions to coronary arteries, sinoatrial node, atrioventricular node; circumstances for right atrial, left atrial, or biatrial appendectomy; and whether to perform a right, left, or biatrial maze procedure. These considerations are important because prophylactic arrhythmia procedures are performed without knowing if the patient will actually develop an arrhythmia in his or her lifetime. By reviewing and summarizing the literature, congenital heart disease patients who are at risk for developing atrial arrhythmias can be identified and lesion sets can be suggested in an effort to standardize experimental protocols for prophylactic arrhythmia surgery.

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