The Role of Concomitant Arrhythmia Surgery in Patients Undergoing Repair of Congenital Heart Disease

Abstract

Long-term survival after repair of complex congenital heart lesions is associated with the late development of arrhythmias as well as residual hemodynamic abnormalities. Understanding arrhythmias as electromechanical problems provides the basis for surgical intervention to correct the arrhythmia as well as anatomical disturbances. Operative techniques are highly effective in treating atrial reentry tachycardia and atrial fibrillation. Surgery for ventricular tachycardia is less effective: the arrhythmia may be reduced by improving hemodynamics, but a defibrillator may be required. Integration of device therapy into surgery may improve outcomes by preventing bradycardia as a precursor to tachycardia, and optimizing ventricular synchrony.

Arrhythmia Recurrence in Adult Patients with Single Ventricle Physiology Following Surgical Fontan Conversion

“…In the current era, the extra‐cardiac conduit has become the most widely applied variant either for de novo Fontan palliation or for conversion of adult patients with RA‐PA Fontan. The concomitant use of arrhythmia surgery in adult Fontan conversion patients drastically decreases the risk of recurrent arrhythmias as evidenced by the data in this series and that of other investigators 5,10,11 . Fontan conversion with arrhythmia surgery performed at our institution since 2000 is associated with 14% intermediate‐long term arrhythmia recurrence over a mean of 3.3 years of follow‐up.…”

“…2010;5:430-434 comitant use of arrhythmia surgery in adult Fontan conversion patients drastically decreases the risk of recurrent arrhythmias as evidenced by the data in this series and that of other investigators. 5,10,11 Fontan conversion with arrhythmia surgery performed at our institution since 2000 is associated with 14% intermediate-long term arrhythmia recurrence over a mean of 3.3 years of follow-up. Therefore, the arrhythmia risk is not completely eliminated and one would expect that arrhythmia recurrence may increase over time.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…U pacjentów z krążeniem typu Fontana i tachyarytmiami przedsionkowymi często powstają skrzepliny w prawym przedsionku, co wymaga leczenia przeciwzakrzepowego [981]. Operacyjna konwersja do całkowitego zespolenia żylno-płucnego z jednoczesnym chirurgicznym leczeniem arytmii może u niektórych pacjentów zmniejszyć objawy niewydolności serca oraz ograniczyć występowanie nawrotów arytmii [969,982], z małą częstością występowania jawnych klinicznie tachyarytmii przedsionkowych w pierwszych kilku latach po ponownej operacji [983][984][985]. Ablacja przezcewnikowa tachyarytmii przedsionkowych była skuteczna u wybranych pacjentów z krążeniem typu Fontana [986].…”

Tachyarrhythmia in patients with congenital heart disease: inevitable destiny?

“…Im et al reported sinus rhythm without episodes of atrial tachyarrhythmias or pacemaker implantation in 69 % of the patients with right- and left-sided Maze procedure after 5 years of cardiac surgery compared with only 45 % of the patients with a right-sided Maze [ 34 ]. Moreover, recurrences of AF seem to be rare in other studies when antiarrhythmic surgery includes the right and left atrium, suggesting that the left atrium plays a (major) role in the pathophysiology of AF in patients with CHD as well [ 35 ]. Altogether, a concomitant Maze procedure should be considered in CHD patients known with AF who undergo corrective/palliative surgery at adult age.…”