Author + information
- Zeliha Koyak,
- Roel C.A. Achterbergh,
- Joris R. de Groot,
- Felix Berger,
- David R. Koolbergen,
- Mark G. Hazekamp,
- Nico A. Blom,
- Berto J. Bouma and
- Barbara J. M Mulder
Little is known about the clinical impact of arrhythmias after surgery for congenital heart disease (CHD) in adults. Therefore, we investigated the prevalence and clinical variables associated with in-hospital arrhythmias after CHD surgery and its impact on clinical outcome.
Adults with congenital cardiac surgery between January 2009 and December 2011 from 2 referral centres were included. Pre-, intra-, and postoperative data were reviewed retrospectively. Clinical events were defined as cardiovascular death (CVD), heart failure (HF) requiring intravenous diuretics, thrombo-embolic event, endocarditis and permanent pacemaker (PM) implantation
Overall, 419 patients were included (mean age at surgery 38±14 years, 55% male). Arrhythmias occurred in 134 patients (32%) and were supraventricular tachycardia (SVT, 25%), bradycardia (11%) and ventricular tachycardia (VT, 5%). In multivariate analysis age ≥40 years at surgery (OR 2.5, 95% Cl 1.4-4.6, P=0.003), NYHA functional class≥ll (OR 2.4, 95% Cl 1.2-4.7, P=0.009), coronary bypass (CBP) time (OR 1.35/60 minute increase, 95% Cl 1.06-1.82, P=0.019), CK-MB max (OR 1.05 per 10 U/L increase, 95% Cl 1.01-1.09, P=0.021) and significant subpulmonary atrioventriculair valve regurgitation (PAVR) (OR 2.8, 95% Cl 1.2-6.7, P=0.018) were associated with in-hospital arrhythmias. Fifty-nine clinical events occurred in 54 patients (13%) and included permanent PM implantation (5%), HF (3%), CVD (3%), endocarditis (2%), thrombo-embolic event (1%) and other (1%). In-hospital arrhythmias were independently associated with clinical events (OR 7.8, 95% Cl 2.4-25.5, P=0.001) and were driven by bradycardias. However, when PM implantation was not considered as a clinical event, SVTs were associated with a more than two fold increased risk of clinical events (P=0.046).
Arrhythmias are highly prevalent (one out of three) after adult congenital heart surgery. Older and symptomatic patients with significant PAVR at baseline are at risk for in-hospital arrhythmias. In hospital arrhythmias, especially SVTs, are highly associated with worse clinical outcome, whereas bradycardias for permanent PM implantation.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: Trends, Knowledge and Outcomes
Abstract Category: 12. Congenital Cardiology Solutions: Adult
Presentation Number: 1161M-140
- 2013 American College of Cardiology Foundation