Arrhythmias in congenital heart defects

Area of Science:

• Cardiology
• Pediatric Cardiology
• Cardiac Surgery

Background:

• Congenital heart defects (CHDs) are structural abnormalities present at birth.
• Surgical correction is often necessary, but can lead to long-term complications.
• Late arrhythmias are a known concern following surgical interventions for CHDs.

Purpose of the Study:

• To evaluate the incidence and severity of late arrhythmias in patients with predisposing CHDs.
• To assess arrhythmias related to specific CHD anatomy or surgical procedures.
• To determine the need for medical or interventional treatment for these arrhythmias.

Main Methods:

• Retrospective long-term study of 158 patients with surgically corrected CHDs.
• Patients were divided into five groups based on their specific CHD and surgical history.
• Evaluated were arrhythmia incidence, type, and management requirements.

Main Results:

• Highest incidence of arrhythmias (68.5%) observed after physiological correction of D-transposition of the great arteries (dTGA), with frequent need for medication or pacemakers.
• Other groups showed significant arrhythmia rates: hypoplastic left heart syndrome (HLHS) post-Fontan (40%), tetralogy of Fallot (ToF) (31.1%), atrial septal defect (ASD) sinus venosus type (25.7%), and congenitally corrected L-transposition (ccL-TGA) (25%).
• Arrhythmia incidence increased over time (p < 0.05), though most were asymptomatic and untreated.

Conclusions:

• Late arrhythmias after CHD surgery are generally not severe in childhood.
• These rhythm disturbances can become a significant clinical issue as patients transition to adulthood.
• Understanding the arrhythmogenic substrate of high-risk CHDs is crucial for long-term patient management.