Post-operative arrhythmias in adult patients with congenital heart disease

  • Dr Hideo Fukunaga, Department of Pediatrics, Juntendo University Nerima Hospital, Japan
  • Dr Katsumi Akimoto, Department of Pediatrics and Adolescent Medicine, Juntendo University School of Medicine, Japan
  • Dr Masahiko Kishiro, Department of Pediatrics and Adolescent Medicine, Juntendo University School of Medicine, Japan
  • Prof Toshiaki Shimizu, Department of Pediatrics and Adolescent Medicine, Juntendo University School of Medicine, Japan
  • Dr Shiori Kawasaki, Department of Cardiovascular Surgery, Juntendo University School of Medicine, Japan
  • Prof Shinichi Niijima, Department of Pediatrics, Juntendo University Nerima Hospital, Japan

    • Objective: In the long-term postoperative course of the congenital heart disease (CHD), arrhythmia is one of the most important prognostic factor. The complication of arrhythmia in adult congenital heart disease (ACHD) was examined.
    Methods: For 42 adult patients with CHD (VSD12, TOF11, TGA8, TAPVR4, AVSD1, CoA2, ASR2, PVS1, PDA1) who were received radical operation, we examined incidence of late-onset arrhythmia (LOA) retrospectively.
    Results: 10 patients (23.8%, average 25.0-year-old) had LOA; eight patients (80%) had supraventricular arrhythmia (Af6, PSVT1, APCs1). In TOF, one had APC, VPC and PSVT, one had VT. In TGA, five patients (62.5%) complicated supraventricular arrhythmia; Af in four cases, sick sinus syndrome in one case. All of them received intraatrial switch operations. In VSD, three patients (25%) complicated arrhythmia; Af in two cases, VPCs in one case. In these cases, residual shunt or atrioventricular valve regurgitation caused atrial overload.
    Conclusions: In this study, we speculate the risk factors for LOS are as follows, atrial pressure overload, intraatrial switch operations, residual ventricular shunt, recurrent surgical infiltration and long incision line. In our hospital, right ventricle incision line was 1cm or less at present and this minimization was efficacious for the arrhythmia prevention. In the future, the number of ACHD patients will increase inevitably, therefore medical care system following though there life period is needed by cooperation among pediatrician, physician and surgeons.