Author + information
- Takeshi Tsuda,
- Jeanne Baffa,
- Bradley Robinson,
- Rami Kharouf,
- Abdul Bhat and
- Joel Temple
Background: Arterial switch operation (ASO) is commonly indicated for d-loop transposition of the great arteries (d-TGA) in early infancy. Incidence and clinical significance of long-term electrical abnormalities after ASO has not been well studied.
Methods: We retrospectively reviewed medical records of 99 patients (65 male) with d-TGA and Taussig-Bing anomaly who have been followed as outpatients after ASO for more than 1 year (from 1998 to 2015). ECG and echocardiogram were routinely obtained in all patients. Holter ECG, exercise stress test (EST), and electrophysiological study (EPS) were performed in selective patients.
Results: Follow-up period ranged from 1 to 23 years (10.1 ± 6.2). Sinus bradycardia was seen in 5 patients; 2 patents underwent atrial pacemaker implantation. Complete right bundle branch block (CRBBB) was seen in 13 patients, including 10 patients with surgical closure of ventricular septal defect (VSD). Left bundle branch block (LBBB) was noted in 1 patient. Two patients had first-degree AV block, but none developed advanced heart block. Atrial tachycardia (AT) was noted in 2 patients; one patient underwent EPS and electrical ablation. Variable frequency of isolated monomorphic premature ventricular complexes (PVCs) was noted in 12 patients (from < 1 % to 16% of total heart beats by Holter ECG); 1 was found to have non-sustained ventricular tachycardia (NS-VT) with exercise-induced PVCs who complained recurrent chest pain. Three patients developed syncope; 1 with sustained polymorphic VT detected by a loop monitor, 1 with ventricular fibrillation (VF) during exercise secondary to severe obstruction of proximal left coronary artery, and 1 with prolonged sinus pause (15 sec). One with polymorphic VT and the other with VF had an implantable cardioverter defibrillator (ICD) and coronary recanalization surgery with ICD, respectively.
Conclusions: The incidence of electrical abnormalities after ASO is not infrequent and may be underestimated unless specifically investigated. Electrical abnormalities occurred with or without associated coronary artery abnormalities. Long-term surveillance of the electrical abnormalities is warranted after ASO.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: The Story of the Adult Congenital Heart Disease Patient and EP
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1102-023
- 2017 American College of Cardiology Foundation