Arrhythmias after surgery for complete transposition: Do they matter?

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Electrophysiology

Background:

• Intraatrial repair for complete transposition of the great arteries (TGA) is associated with significant long-term arrhythmias.
• The extensive atrial surgery in intraatrial repair creates an electrophysiologic substrate for progressive arrhythmias, including atrial flutter.
• These arrhythmias increase vulnerability to tachycardia and potential sudden cardiac death.

Purpose of the Study:

• To compare the electrophysiologic and arrhythmic consequences of intraatrial repair versus the arterial switch operation in TGA.
• To evaluate the long-term outcomes and advantages of the arterial switch operation.

Main Methods:

• Review of electrophysiologic and arrhythmic data from patients undergoing intraatrial repair (Mustard/Senning) and arterial switch operation.
• Analysis of arrhythmia incidence, type, and progression.
• Assessment of hemodynamic factors and risk stratification.

Main Results:

• Intraatrial repair is consistently associated with late arrhythmias, including loss of sinus rhythm and supraventricular tachycardias.
• The arterial switch operation shows fewer sinus nodal dysfunctions and supraventricular arrhythmias, with ventricular extrasystoles being the most common.
• Restoration of left ventricular systemic circulation is a key advantage of the arterial switch.

Conclusions:

• The arterial switch operation demonstrates a significantly lower incidence of clinically significant arrhythmias compared to intraatrial repair.
• The preservation of normal atrial activation and left ventricular function are major benefits of the arterial switch.
• Current evidence favors the arterial switch operation for improved long-term outcomes in TGA patients.