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Ventricular arrhythmias after correction of ventricular septal defects: importance of surgical approach
L Houyel1, G Vaksmann, A Fournier
1Department of Pediatric Cardiology, Sainte-Justine Hospital, Montreal, Quebec, Canada.
Insights
Right atriotomy repair of ventricular septal defects reduces right bundle branch block but not atrioventricular block. Ventricular arrhythmias are common post-surgery, regardless of approach.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postoperative ventricular septal defect (VSD) management requires understanding long-term complications.
- Surgical approach may influence the incidence of conduction disturbances and arrhythmias.
Purpose of the Study:
- To compare conduction disturbances and ventricular arrhythmias after VSD repair using right atriotomy versus right ventriculotomy.
- To identify factors influencing arrhythmia prevalence post-VSD surgery.
Main Methods:
- 100 patients with repaired VSD underwent ECG and 24-hour ambulatory ECG monitoring.
- Patients were divided into two groups: 50 repaired by right atriotomy (Group 1) and 50 by right ventriculotomy (Group 2).
- Comparison of arrhythmia prevalence, conduction disturbances, and correlation with clinical factors.
Main Results:
- Complete right bundle branch block was less frequent with right atriotomy (20% vs. 50%, p<0.05).
- Ventricular arrhythmias (modified Lown grade ≥2) were less prevalent in Group 1 (30% vs. 48%, p=0.05).
- Arrhythmia prevalence increased with follow-up duration, and age at evaluation/surgery; right atriotomy did not prevent late atrioventricular block.
Conclusions:
- Right atriotomy for VSD repair reduces right bundle branch block but not the risk of late atrioventricular block.
- Ventricular arrhythmias are common after VSD surgical closure, irrespective of the surgical approach.
- The prevalence of ventricular arrhythmias post-VSD repair is comparable to that seen after tetralogy of Fallot repair.
Abstract:
To compare the prevalence of conduction disturbances and ventricular arrhythmias in cases of postoperative ventricular septal defect, 100 patients (50 with repair by right atriotomy, group 1; and 50 with repair by right ventriculotomy, group 2) underwent complete evaluation including an electrocardiogram (ECG) and 24 h ambulatory ECG monitoring. The two groups were comparable except for a shorter follow-up duration (7 +/- 3 versus 12.4 +/- 7 years) and a younger age at evaluation (12.4 +/- 5 versus 16.9 +/- 7 years) in group 1. Complete right bundle branch block was less frequent in group 1 than in group 2 (20% versus 50%, p less than 0.05) but three of the four patients with complete atrioventricular (AV) block detected on ambulatory monitoring were in group 1. Six patients had significant supraventricular arrhythmias, all well tolerated. Ambulatory monitoring revealed significant ventricular arrhythmias (modified Lown grade 2 or higher) in 39 patients, with a lower prevalence in group 1 (30% versus 48%, p = 0.05). No correlation was found between prevalence of ventricular arrhythmias and right ventricular systolic pressure, cardiopulmonary bypass duration, presence of a synthetic patch, previous pulmonary artery banding, presence of complete right bundle branch block and cardiomegaly on chest X-ray film. Prevalence of ventricular arrhythmias increased with follow-up duration, age at evaluation and age at surgery. These were always well tolerated and did not warrant treatment. Thus, right atriotomy reduces the prevalence of right bundle branch block but does not prevent late AV block. Ventricular arrhythmias are frequent after surgical closure of ventricular septal defect whatever the surgical approach and their prevalence is not statistically different from that in postoperative tetralogy of Fallot.(ABSTRACT TRUNCATED AT 250 WORDS)