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Surgery for arrhythmias in children
Constantine Mavroudis1, Barbara J Deal, Carl L Backer
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614, USA. cmavroudis@childrensmemorial.org
International Journal of Cardiology
|December 14, 2004
Summary
Surgical arrhythmia ablation is effective for patients unsuitable for catheter ablation, including those with complex congenital heart disease or failed prior procedures. This approach addresses anatomical challenges, offering a viable treatment option when transcatheter methods are not feasible.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Transcatheter radiofrequency ablation has largely replaced surgical ablation for arrhythmias.
- Surgery remains essential for specific patient groups, including those with failed catheter ablation, congenital heart disease, or anatomical limitations.
- Young patients with small size, cyanosis, or distorted anatomy may also require surgical intervention.
Purpose of the Study:
- To evaluate the efficacy and outcomes of surgical arrhythmia ablation in a specialized patient cohort.
- To assess the role of surgical ablation in patients with complex congenital heart disease and arrhythmias.
- To determine the safety and feasibility of surgical arrhythmia treatment when transcatheter approaches are prohibitive.
Main Methods:
- Retrospective analysis of 133 patients undergoing arrhythmia surgery between July 1992 and August 2003.
- Patients were categorized into Fontan conversion (FC), initial Fontan (IF), and miscellaneous arrhythmia (MISC) groups.
- Surgical procedures included maze procedures and ablation of accessory pathways, often combined with congenital heart defect repair.
Main Results:
- Overall operative mortality was 2.6% (3/133), with 3 late deaths.
- Four FC patients required cardiac transplantation due to progressive ventricular failure.
- Arrhythmia recurrence occurred in 11 non-transplant survivors (11/133), with 2 new-onset arrhythmias.
- Postoperative inducible ventricular tachycardia was noted in 29% (2/7) without clinical recurrence.
Conclusions:
- Surgical arrhythmia ablation effectively addresses anatomical variations that limit catheter-based interventions.
- Patient size and anatomical complexity should not preclude surgical treatment for arrhythmias.
- Integrating arrhythmia surgery into planned cardiac revisions is a recommended strategy for complex cases.