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Characterization and Comparison of Rhythm Disturbances after Atrial or Arterial Switch Surgeries for Dextro-Transposition of the Great Arteries – A Long-term Follow-up Study
Session:
Comunicações Orais - Sessão 07 - Cardiopatias congénitas e Cardiologia pediátrica
Speaker:
Catarina Amaral Marques
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.7 Pediatric Cardiology
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Catarina Amaral Marques; Ricardo Alves Pinto; Tânia Proença; Miguel Martins de Carvalho; André Cabrita; João Calvão; Catarina Martins da Costa; Ana Filipa Amador; Cátia Oliveira; Luís Daniel Santos; Ana Isabel Pinho; Miguel Rocha; Pedro Mangas Palma; Helena Santos Moreira; Cristina Cruz
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif">Introduction and Objectives: </span></strong><span style="font-family:"Times New Roman",serif">Dextro-transposition of the great arteries (D-TGA) is a congenital heart disease (CHD) palliated with atrial switch (ATR-S) and, more recently, with arterial switch (ART-S). </span><span style="font-family:"Times New Roman",serif">As late complications from ATR-S are expected, novel challenges from ART-S surgery arises. Our aim was to evaluate these patients’ (pts) arrhythmic disturbances after a long-term follow-up.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif">Methods: </span></strong><span style="font-family:"Times New Roman",serif">We retrospectively analyzed D-TGA pts born between 1974 and 2001 and followed in Adult CHD Outpatient Clinic at a tertiary care hospital. Clinical records were used to collect pts data.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif">Results: </span></strong><span style="font-family:"Times New Roman",serif">A total of 79 pts were enrolled with a mean follow-up time after surgery of 27±6 years. Pts median age was 27 years-old and 46% were female. 54% were submitted to ATR-S, while 46% underwent ART-S; median age at intervention was 13 months and 10 days, respectively. Focusing arrhythmic events (Table 1), almost all ART-S pts remained in sinus rhythm versus 64% of ATR-S (p=0.002). The latter presented significantly higher frequencies of arrythmias (41% vs 3%, p < 0.001), mainly atrial flutter or fibrillation (26% vs 0%), as well as bradyarrhythmias (12% vs 0%). Chronotropic incompetence was also more frequent after ATR-S (46% vs 9%, p=0.011). Inversely, intraventricular (IV) conduction disturbances were more frequent after ART-S (54% vs 15%, p < 0.001), the majority due to incomplete right bundle branch block. Cardiac Implantable Electronic Devices (CIED) were implanted in 6 pts (5 pacemakers and 1 implantable cardioverter defibrillator) and 1 patient was submitted to catheter ablation of cavotricuspid isthmus, all of them from ATR-S group. The overall median time to first arrhythmia was 23±9 years.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif">Conclusion: </span></strong><span style="font-family:"Times New Roman",serif">ATR-S presented significantly fewer pts in sinus rhythm and higher rates of chronotropic incompetence, as well as need for CIED. Additionally, ATR-S pts had higher rates of arrhythmia development, namely supraventricular (SV) ones. These findings highlight the advantages of ART-S over ATR-S in reducing SV arrhythmias occurrence. Curiously, IV conduction disturbances, mainly incomplete right bundle brunch block, were more frequent after ART-S. This fact emphasizes the importance of long-term follow-up of all pts, regardless of the initial surgical approach, as ART-S pts were not arrhythmic-free. Our work raises awareness for arrhythmic disturbances in this subgroup of CHD pts, irrespective of surgical strategy adopted.</span></span></span></span></p>
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