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Different characteristics of postoperative atrial tachyarrhythmias between congenital and non-congenital heart disease

  • Masateru Kondo
  • Koji FukudaEmail author
  • Yuji Wakayama
  • Makoto Nakano
  • Yuhi Hasebe
  • Hiroyuki Satake
  • Masato Segawa
  • Michinori Hirano
  • Hiroaki Shimokawa
Article
  • 14 Downloads

Abstract

Purpose

The chance of encountering tachyarrhythmias has been increasing in adult congenital heart disease (CHD) patients with previous open-heart surgery, along with the improvement of their longevity. However, the characteristics of these arrhythmias remain to be elucidated.

Methods

We examined the characteristics of atrial tachyarrhythmias (ATs) in 26 consecutive CHD patients (M/F 17/9) referred for catheter ablation and compared them with 16 non-CHD patients with cardiac surgery (M/F 11/5).

Results

The CHD group was younger and had a longer period from cardiac surgery until the occurrence of ATs compared with the non-CHD group (44.8 ± 19.5 vs. 67.6 ± 12.5 years old, and 23.3 ± 13.2 vs. 6.3 ± 4.9 years, respectively, both P < 0.05). Multiple ATs were equally induced in both groups, 12 in CHD (46.1%) and 5 in non-CHD (31.3%). Although the prevalence of macro-reentrant ATs (cavo-tricuspid isthmus-dependent atrial flutter (AFL) or intra-atrial reentrant tachycardia (IART)) was comparable, the mechanisms were different between the 2 groups (AFL and IART), 34% and 27% in CHD and 71% and 24% in non-CHD, respectively. Furthermore, focal AT (FAT) was noted in 9 patients (34.6%) in CHD but none in non-CHD (P < 0.05). Electroanatomical mapping showed that the surface area and low-voltage area (LVA) of the right atrium were significantly larger in CHD than in non-CHD (197.1 ± 56.4 vs. 132.4 ± 41.2 cm2, and 40.8 ± 33.3 vs. 13.6 ± 9.0 cm2, respectively, both P < 0.05). Ten out of 14 FATs (71.4%) were highly associated with LVA, especially near the crista terminalis.

Conclusions

The development of ATs in CHD patients could be associated with large atrial remodeling, resulting in complicated ATs.

Keywords

Atrial tachyarrythmias Congenital heart disease Catheter ablation 

Notes

Acknowledgments

The authors thank Osamu Adachi MD, PhD, Yoshikatsu Saiki MD, PhD, Masato Kimura MD, PhD, Yoshitaka Kimura, MD, PhD, and Keita Miki, MD, for their kind contributions.

Compliance with ethical standards

The present study was approved by the Tohoku University Institutional Review Board (No. 2015-1-106).

Conflict of interest

The authors declare that they have no conflict of interest.

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan

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