Concomitant arrhythmia surgery in patients with congenital heart disease.

OBJECTIVES

Atrial tachyarrhythmia, including atrial fibrillation (AF), atrial flutter (AFL) and intra-atrial reentrant tachycardia (IART), occur frequently in patients with congenital heart disease (CHD), who may undergo multiple surgical procedures throughout life. However, data on the effectiveness of concomitant arrhythmia surgery in CHD patients are scarce.

METHODS

Outcome of concomitant arrhythmia surgery for AF or AFL/IART was examined in 66 successive patients [31 men (47%); age at surgery: 56 ± 14 (24-78) years] with various CHD.

RESULTS

Concomitant arrhythmia surgery was performed in patients with a history of only AF (n = 46, 70%), only AFL/IART (n = 6, 9%) or a combination of AF and AFL/IART (n = 14, 21%). Median follow-up after arrhythmia surgery was 2 (1-4) years. AF reoccurred in 40 patients (67%), of whom 13 (22%) only had early recurrences; none of the patients with only AFL or IART prior to arrhythmia surgery developed AF after arrhythmia surgery. Recurrence-free survival of late AF was 4.6 years and differed according to the type of AF prior to surgery. Late recurrence-free survival at 3-year follow-up was 71% for paroxysmal AF, 45% for persistent AF and 20% for long-standing persistent AF (P = 0.047). Age at arrhythmia surgery was an independent predictor for late AF recurrence (odds ratio 1.05, P = 0.006). AFL/IART occurred in 17 patients (26%) after arrhythmia surgery, which was de novo in 11 patients (17%).

CONCLUSIONS

Arrhythmia surgery in CHD patients results in freedom from late AF recurrence for a small majority of patients after median follow-up of 2 years. (Long-standing) persistent AF and older age at arrhythmia surgery are related to higher recurrence rates.