Arrhythmias in adult patients after total correction of tetralogy of Fallot (RCD code: V-2B.0)

Agnieszka Żygadło, Lidia Tomkiewicz-Pajak, Natalia Dłużniewska, Maria Olszowska, Piotr Podolec

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Abstract


Improvement of the long‑term survival of patients with Tetralogy of Fallot has been observed in the last few years. Among the late complication arrhythmias are detected most frequently. The aim of this study was to estimate the frequency of atrial and ventricular arrhythmias in the group of 53 adult tetralogy patients.
Mean age was 29 years, 21 patients (39,6%) were women. In 4 cases (7,5%) palliative pulmonary‑systemic shunt was performed. Average age of total surgical correction was 6,55 years. Significant ventricular arrhythmias were present in 15 patients (28,3%). 9 (17%) had relevant atrial arrhythmias. Patients with atrial arrhythmia were older (35,4 vs 27,7 years). Older were also patients with ventricular arrhythmias (34,7 vs 26,4 years). Group with atrial arrhythmia used more digoxin (p=0,002) and diuretics (p = 0,021). 3 patients on oral anticoagulants had atrial flutter. Similar data was collected in group with ventricular arrhythmias (diuretics p = 0,0053). There was a high incidence of coexisting ventricular and atrial arrhythmias (p=0,0057). Left ventricular enlargement was present in patients with atrial (p = 0,002) and ventricular (p = 0,027) arrhythmias. Right atrium area and left atrium diameter were greater in group with supraventricular
arrhythmias (31,6 vs 21,6 cm2 and 40,4 vs 34,3 mm; respectively). Ventricular arrhythmias were associated with greater right (27,8 vs 21,0 cm2) and left atrium areas (18,5 vs 15,1 cm2).
Younger age at the time of corrective surgery is associated with lower frequency of arrhythmias in adults. Arrhythmias however remain one of the most significant problems in this group of patients. Close observation in centers specialized in Grown‑Up Congenital Heart Defects and management of symptoms seems to be the best option in long‑term follow‑up. JRCD 2013; 1 (4): 10–15

 


Keywords


Grown‑Up Congenital Heart Defects, supraventricular arrhythmia, ventricular arrhythmia

References


Report of the British Cardiac Society Working Party. Grown-up congenital heart (GUCH) disease: current needs and provision of service for adolescents and adults with congenital heart disease in the UK. Heart 2002; 88(Suppl I):1–14.

Khairy P, Aboulhosn J, Gurvitz MZ et al: Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation. 2010; 122(9):868-75.

Bouchardy J, Therrien J, Pilote L et al: Arrhythmias in Adults With Congenital Heart Disease. Circulation 2009; 120: 1679-1686.

Walsh EP, Cecchin F: Arrhythmias in Adult Patients With Congenital Heart Disease. Circulation 2007; 115: 534-545.

Roos-Hesselink J, Perlroth MG, McGhie J et al: Atrial Arrhythmias in Adults After Repair of Tetralogy of Fallot. Correlations With Clinical, Exercise, and Echocardiographic Findings. Circulation 1995; 91: 2214-2219.

Murphy JG, Gersh BJ, Mair DD et al: Long-Term Outcome in Patients Undergoing Surgical Repair of Tetralogy of Fallot. N Engl J Med 1993; 329:593-599.

Trojnarska O, Siniawski A, Gwizdała A et al: Dorośli pacjenci z wadami wrodzonymi serca - nadkomorowe zaburzenia rytmu. Folia Cardiol. 2005; 12 (7): 510–519.

Diller GP, Breithardt G, Baumgartner H: Congenital Heart Defects in Adulthood. Dtsch Arztebl Int. 2011; 108(26): 452–459.

Diller GP, Kempny A, Liodakis E et al: Left ventricular longitudinal function predicts life-threatening ventricular arrhythmia and death in adults with repaired tetralogy of Fallot. Circulation 2012;125(20):2440-6.

Le Gloan L, Guerin P, Mercier LA et al: Clinical assessment of arrhythmias in tetralogy of Fallot. Expert Rev Cardiovasc Ther. 2010; 8(2):189-97.

Le Gloan L, Khairy P: Management of arrhythmias in patients with tetralogy of Fallot. Curr Opin Cardiol. 2011; 26(1):60-5.

Zipes DP, Camm AJ, Borggrefe M et al: ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 385-484.

Otto CM, Schwaegler RG, Freeman RV: Echocardiography Review Guide: Companion to the Textbook of Clinical Echocardiography: Expert Consult: Online and Print, 2e; Elseviere 2011.

Lang RM, Bierig M, Richard B et al: Recommendations for chamber quantification. Eur J Echocardiography 2006; 7:79-108.

Rudski LG, Lai WW, Afilalo J et al: Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713.

Lancellotti P, Tribouilloy Ch, Hagendorff A et al.: European Association of Echocardiography recommendations for the assessment of valvular regurgitation. European Journal of Echocardiography 2010; 11: 223–244, 307-332.

Kędziora P, Stańczyk J: Komorowe zaburzenia rytmu serca i turbulencja rytmu zatokowego u dzieci. Przegląd Pediatryczny 2010; 40 (4): 243-248.

Miyamura H, Kanazawa N, Fukuda J et al.: Long-term postoperative status of tetralogy of Fallot. Jpn Circ J. 1986; 50: 855-858.

Waien SA, Liu PP, Ross BL et al.: Serial follow-up of adults with repaired tetralogy of Fallot. J Am Coll Cardiol. 1992; 20: 295-300.

Villafañe J, Feinstein JA, Jenkins KJ et al.: Hot Topics In Tetralogy Of Fallot. J Am Coll Cardiol. 2013; 13: 0735-1097.

Herringa J, Van der Kuip DAM, Hofman A.: Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006; 27 (8): 949-953.

Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG.: Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995;155(5):469-73.

Gatzoulis MA, Balaji S, Webber SA et al.: Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet. 2000; 16; 356(9234):975-81.




DOI: http://dx.doi.org/10.20418%2Fjrcd.vol1no4.64

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