Dysrhythmias after repair of atrial septal defect

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Atrial septal defects (ASDs) are congenital heart conditions often repaired surgically.
• Postoperative cardiac rhythm disturbances are a known complication following cardiac surgery.
• Understanding the long-term incidence and risk factors for dysrhythmias after ASD repair is crucial for patient management.

Purpose of the Study:

• To investigate the incidence and timing of dysrhythmias after surgical repair of isolated secundum atrial septal defects.
• To identify potential risk factors, including the presence of Holt-Oram syndrome, associated with postoperative dysrhythmias.
• To assess the long-term implications of these dysrhythmias, including pacemaker dependency.

Main Methods:

• Retrospective review of postoperative electrocardiograms in 292 patients who underwent isolated secundum ASD repair.
• Comparison of preoperative and postoperative PR intervals.
• Analysis of dysrhythmia occurrence, symptoms, type, and timing relative to surgery.
• Evaluation of the association between dysrhythmias and Holt-Oram syndrome.

Main Results:

• A significant shortening of the PR interval was observed by postoperative day 7 (p <.05).
• Postoperative dysrhythmias occurred in 22% (64/292) of patients, with 7.5% (22/292) experiencing symptomatic events.
• The latest symptomatic dysrhythmia was recorded 17 years post-surgery; 2.4% (7/292) required pacemakers.
• All five patients with Holt-Oram syndrome developed postoperative dysrhythmias, with two being symptomatic.

Conclusions:

• Serious dysrhythmias can manifest years after atrial septal defect repair.
• Patients with Holt-Oram syndrome are at an elevated risk for developing postoperative dysrhythmias.
• Long-term cardiac monitoring is warranted for patients following ASD repair, particularly those with genetic predispositions.