Author + information
- Melissa L. Morello,
- Philip R. Khoury,
- Gruschen Veldtman and
- Richard Czosek
Introduction: Arrhythmias in congenital heart disease (CHD) often signify worsening hemodynamics, resulting in greater morbidity and mortality. Direct current cardioversion (DCCV), though effective, can post significant risk.
Objectives: 1) Describe efficacy of DCCV in patients with and without CHD with arrhythmias treated in a tertiary pediatric cardiac center, and 2) Describe risks for adverse events associated with DCCV.
Methods: In this single-center retrospective series, patients undergoing DCCV Jan 2010 – May 2015 were categorized as pediatric (<18 years) and adult (>18 years). Electronic medical records were reviewed for demographic, arrhythmic and CHD-specific characteristics; acute efficacy; and arrhythmia recurrence within 3 months of DCCV. We used univariate and multivariate analyses to determine risks for complications of DCCV.
Results: We identified 104 patients with 152 discrete DCCV events, median age 17.4 years (0.15-62.2). DCCV efficacy was 89%, 3-month recurrence 46%. There were 24 patients with 52 total complications, median age 17.7 years (0.15-49). Non-life-threatening complications: hypotension and/or bradycardia requiring pacing or medical therapy (12,) worsened/other arrhythmia (16) and myocardial dysfunction (8). Life-threatening complications: CPR (3), ECMO (1) and 30 day all-cause mortality (9). Patient age, duration of arrhythmia, arrhythmic medication, anti-coagulation status and use of echocardiography were not associated with complications. Risks for complications following DCCV: CHD (trend, not significant; p = 0.07), moderate – severe systolic dysfunction (p = <0.01) and >1 shock per DCCV encounter (p = <0.01). Complications are associated with death at end of study (p = <0.01). Adults had earlier time to arrhythmia recurrence within 3 months following DCCV (p = <0.01) compared to those < 18 years, but not a greater complication risk.
Conclusions: DCCV is an effective treatment for arrhythmias but life-threatening complications may arise. Those with CHD, moderate-severe systolic dysfunction and >1 shock at time of therapy are at greatest risk. Back-up hemodynamic support strategies should be rapidly accessible for those at greatest risk.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Atrial Fibrillation and VT: Unique Populations and Solutions
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1151-109
- 2017 American College of Cardiology Foundation