Author + information
- Alexander C. Egbe,
- Samuel Asirvatham,
- Suraj Kapa,
- Heidi Connolly and
- Naser Ammash
Background: Few data exist on direct current cardioversion (DCCV) in adult patients with congenital heart disease (CHD).
Methods: This was a retrospective case-control study of 279 adults with CHD and 279 adults without CHD (control group) who had elective DCCV for atrial arrhythmias at the Mayo Clinic Cardioversion Unit from 2001 through 2013. Control patients were matched by sex and arrhythmia type. Our objective was to compare DCCV procedural failure (failure to terminate the presenting arrhythmia) and arrhythmia recurrence between CHD and non-CHD patients
Results: In the CHD group (mean age, 55±20 years; 166 [59%] were men), the most common diagnosis was Fontan physiology (61; 22%). Transesophageal echocardiography (TEE) was performed before DCCV in 216 patients (77%); 162 (58%) had atrial flutter, and 117 (42%) had atrial fibrillation. Patients in the control group were older (mean age, 72±14 years; P<.001). Procedural failure occurred in 38 patients (14%) in the CHD group and in 20 (7%) in the non-CHD group (P=.01). There were no deaths or thromboembolic complications. The CHD group had a higher rate of arrhythmia recurrence (83% vs 66% at 60 months, P=.001). The multivariable risk factors for procedural failure were Fontan palliation and spontaneous echocardiographic contrast; the risk factors for arrhythmia recurrence were Fontan palliation and atrial fibrillation. When Fontan patients were excluded from the analysis, the outcome of DCCV (failure and recurrence rates) was similar for the CHD and non-CHD groups despite the age difference between the cohorts.
Conclusions: Outcomes after DCCV were similar for CHD and non-CHD patients, with the exception of Fontan patients. DCCV is safe in adults with CHD when performed in a specialized unit with safety precautions such as verification of adequacy of anticoagulation and frequent use of TEE to exclude intracardiac thrombus before DCCV.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 10:30 a.m.-10:40 a.m.
Session Title: Congenital Heart Disease: To the Third Decade and Beyond
Abstract Category: 11. Congenital Heart Disease: Therapy
Presentation Number: 1131M-07
- 2017 American College of Cardiology Foundation