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Chronotropic incompetence in young patients with late postoperative atrial flutter: a case-control study
Nitasha Anand1, Brian W McCrindle, Christine C Chiu
1Cardiology Division, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
European Heart Journal
|June 10, 2006
Summary
Late postoperative atrial flutter in children with congenital heart disease (CHD) is linked to chronotropic incompetence, a reduced ability to increase heart rate. Rate-adaptive pacing may help prevent flutter in paced patients.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Congenital Heart Disease
Background:
- Atrial flutter is a significant cause of late postoperative morbidity in congenital heart disease (CHD) patients.
- Sinoatrial node dysfunction is implicated in late postoperative atrial flutter, but pacing strategies have shown inconsistent results.
Purpose of the Study:
- To investigate the association between chronotropic incompetence and late postoperative atrial flutter in pediatric CHD patients.
- To evaluate the effectiveness of pacing strategies in managing atrial flutter in this population.
Main Methods:
- A retrospective case-control study matched 42 CHD patients with late atrial flutter to 42 controls without ectopy.
- Heart rates were assessed using 24-hour Holter monitoring and exercise tests.
- Chronotropic competence was evaluated using the percentage of age-predicted maximum heart rate and chronotropic index.
Main Results:
- Patients with late atrial flutter demonstrated significantly lower average heart rates and a reduced percentage of age-predicted maximum heart rate achieved compared to controls.
- This difference persisted after adjusting for age, sex, pacing, and medication.
- Rate-adaptive pacing and higher programmed maximum atrial pacing rates were associated with a decreased likelihood of atrial flutter in paced patients.
Conclusions:
- Chronotropic incompetence is a significant factor associated with late postoperative atrial flutter in pediatric CHD patients.
- Rate-adaptive pacing appears to be a beneficial strategy for reducing the incidence of atrial flutter in permanently paced CHD patients.
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