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Published on: May 22, 2018
Electrophysiology procedures in adults with congenital heart disease
Peter Ermis1, Wayne Franklin, Jeffrey Kim
1Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA. permis@bcm.edu
Insights
Adults with congenital heart disease (CHD) can safely undergo electrophysiology (EP) procedures at pediatric facilities. This study shows low complication rates for EP interventions in this unique patient population.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Adult Congenital Heart Disease
Background:
- Arrhythmias are a major cause of morbidity and mortality in adults with congenital heart disease (CHD).
- Adult CHD patients are frequently managed at pediatric facilities, yet data on their electrophysiology (EP) procedures are limited.
Purpose of the Study:
- To evaluate the safety and efficacy of electrophysiology (EP) procedures in adults with congenital heart disease (CHD) treated at a freestanding pediatric institution.
Main Methods:
- A retrospective review of all electrophysiology (EP) procedures performed in adults with CHD between January 1, 2006, and December 31, 2010.
- Analysis of patient demographics, diagnoses, procedure types, and complication rates.
Main Results:
- 99 procedures were performed in 87 adults with CHD (mean age 27.1 years).
- Common diagnoses included D-transposition of the great arteries (27%), tetralogy of Fallot (20%), and Rastelli repair (16%).
- Procedures included EP studies (37), pacemakers (38), implantable cardioverter-defibrillators (26), and lead extractions (6), with a 1% major and 7% minor complication rate.
Conclusions:
- Electrophysiology (EP) procedures for adults with congenital heart disease (CHD) can be performed safely and effectively in a freestanding pediatric hospital.
- Low complication rates were observed, highlighting the feasibility of such care with appropriate institutional support for adult CHD programs.
Background:
In adult congenital heart disease (CHD), arrhythmias contribute significantly to morbidity and mortality. Often, these adult patients are treated at a freestanding pediatric facility. Limited data exist looking at this cohort.
Methods:
A retrospective review was performed of all electrophysiology (EP) procedures performed in adults at our institution during a 5-year period from January 1, 2006 through December 31, 2010.
Results:
There were 99 cases performed in a total of 87 adults with CHD during this time period. The mean patient age was 27.1 years (18-51 years). The most common congenital cardiac diagnoses were: 27% with D-transposition of the great arteries (n = 27)-of which 85% (n = 23) have had a previous atrial switch procedure, 20% with tetralogy of Fallot (n = 20), and 16% with previous Rastelli repair (n = 16). Overall, 37 EP studies were performed, with the majority done in patients with complex CHD. There were 74 additional cases. These procedures consisted of: 38 pacemakers (51%), 26 implantable cardiac defibrillators (36%), six laser lead extractions (8%), two loop recorders (3%), and two pocket revisions (3%). During this 5-year period, there was one major complication (1%) and seven minor complications (7%).
Conclusions:
The complex care of adults with CHD requiring EP procedures can be safely and effectively accomplished in a freestanding pediatric hospital with low complications, provided institutional support of an adult CHD program.
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