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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Predictors of arrhythmias during long-term follow-up of adults with Fontan circulation
Session:
Posters 1 - Écran 5 - Congénitos
Speaker:
Madalena Coutinho Cruz
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.2 Congenital Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Madalena Coutinho Cruz; Ana Figueiredo Agapito; José Alberto Oliveira; Lidia De Sousa; Sérgio Laranjo; André Viveiros Monteiro; António Valentim Gonçalves; Tiago Mendonça; Maria De Fátima Pinto; Mário Martins Oliveira; Rui Cruz Ferreira
Abstract
<p><strong>Introduction: </strong>The Fontan operation has increased the survival of thousands of patients (pts) with complex congenital heart disease (CHD). However, physicians are faced with dealing with long-term complications of the disease and its treatment. Arrhythmias are prevalent in this population, but information about the long-term follow-up (FU) is scarce. We aimed to characterize the arrhythmic events in a population of pts with Fontan circulation.</p> <p><strong>Methods: </strong>All consecutive pts with Fontan circulation referred to a center’s adult CHD outpatient clinic were included. Sustained atrial fibrillation (AF), intra-atrial reentry tachycardia (IART), and ventricular tachyarrhythmias, as well as sinus node disease (SND) and second degree (or higher) heart block (AVB) arising during FU were noted. Predictors of arrhythmias were assessed with logistic regression analysis. Receiver operating curve analysis was used to assess the discrimination of parameters for predicting arrhythmias.</p> <p><strong>Results: </strong>28 pts (42.9% female, mean age at first visit 21.6 ± 2.9 years) were included. The most common heart defects were univentricular heart (15), tricuspid atresia (6) and double outlet right ventricle (4). All pts had additional heart defects, the most common being pulmonary stenosis, malposition of the great arteries and shunts. 28.6% of pts had cyanosis, 7.2% pulmonary hypertension and 3.6% Eisenmenger syndrome. All pts were submitted to surgery during childhood. Mean age at completion of the Fontan circulation was 8.8 ± 5.9 years and the mean number of surgeries per pt was 2.6 ± 1.0. During a mean FU of 8.8 ± 7.5 years, 46.4% of pts experienced arrhythmias (9 IART, 8 AF, 4 SND, 3 AVB), with 10 pts having = 1 type of arrhythmia. Mean age at first arrhythmia was 22.4 ± 7.6 years. 14.3% of pts implanted a permanent pacemaker and 3.6% an implantable cardioverter defibrillator. The presence of arrhythmias was significantly associated with hospitalization for cardiac causes (OR 9.6 95% CI 1.5-62.1 p 0.018). Variables that were associated with the appearance of arrhythmias were: malposition of the great arteries (OR 7.3 95% CI 1.4-38.9 p 0.019), peak exercise double product (DP) (OR 1.0 95% CI 0.9-1.0 p 0.049), recovery DP (OR 1.0 95% CI 0.9-1.0 p 0.049), maximal oxygen uptake (VO2) (OR 0.9 95% CI 0.6-0.9 p 0.030), VO2 at anaerobic threshold (OR 0.6 95% CI 0.4-0.9 p 0.044) and type of Fontan circulation (OR 6.0 95% CI 1.0-35.4 p 0.048 for lateral tunnel-type Fontan). Optimal cut-off values to predict the occurrence of arrythmias were 23430 for peak exercise DP, 14880 for recovery DP, 19.5 for maximal VO2 and 15.3 for VO2 at anaerobic threshold.</p> <p><strong>Conclusion: </strong>In this population of pts with Fontan circulation, arrhythmias were a highly prevalent event and were associated with hospitalization for cardiac causes. This study highlights the importance of exercise testing, as well as type of Fontan circulation to predict the occurrence of arrhythmias.</p>
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