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Arrhythmia burden in congenitally corrected transposition of the great arteries: Does treatment pathway matter?
Iqbal El Assaad1, Brendan J Burke1, Kaleigh Cummins2
1Division of Cardiology and Cardiovascular Medicine, Children's Institute Department of Heart, Vascular and Thoracic, Cleveland Clinic Children's, Cleveland, Ohio.
Insights
Arrhythmia burden in patients with congenitally corrected transposition of the great arteries (cc-TGA) differs significantly based on treatment. Anatomic repair may offer better outcomes regarding heart block and atrial fibrillation compared to other pathways.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Limited data exists comparing arrhythmia burden in patients with congenitally corrected transposition of the great arteries (cc-TGA) across different management strategies.
- Understanding these differences is crucial for optimizing patient care and long-term outcomes.
Purpose of the Study:
- To investigate the comparative rates of bradyarrhythmias and tachyarrhythmias in patients with cc-TGA.
- Stratification was performed based on treatment pathway: anatomic repair, physiologic repair, or nonsurgical management.
Main Methods:
- A retrospective cohort study was conducted at Cleveland Clinic Children's from 1995 to 2021.
- Included were all patients diagnosed with cc-TGA.
- Data on arrhythmias and treatment pathways were analyzed.
Main Results:
- Of 170 patients (median follow-up 11.8 years), 49% experienced heart block/pacemaker implantation, with higher rates in physiologic repair (50%) vs. anatomic repair (22%) and nonsurgical (19%) groups.
- Freedom from heart block at 5 years was higher with anatomic repair (85%) vs. physiologic repair (68%).
- Atrial fibrillation was more prevalent in physiologic repair (30%) and nonsurgical (31%) groups compared to anatomic repair (0%).
Conclusions:
- The type and burden of arrhythmias in cc-TGA patients are significantly influenced by their treatment pathway.
- Anatomic repair appears to be associated with lower rates of heart block and atrial fibrillation.
- Further long-term follow-up studies are needed to determine the optimal surgical approach for minimizing arrhythmia morbidity.
Background:
There are limited data comparing arrhythmia burden of patients with congenitally corrected transposition of the great arteries (cc-TGA) undergoing anatomic repair, physiologic repair, and nonsurgical management.
Objective:
We aimed to examine the difference in rate of bradyarrhythmias and tachyarrhythmias in patients with cc-TGA stratified by treatment pathway.
Methods:
A retrospective cohort study was conducted including all patients with cc-TGA observed at Cleveland Clinic Children's (1995-2021).
Results:
A total of 170 patients were included with a median follow-up of 11.8 years: 82 with anatomic repair (median age, 1.5 years), 46 with physiologic repair (median age, 25.2 years), and 42 with nonsurgical management (median age, 35.7 years). Heart block/permanent pacemaker implantation occurred in 49 (29%) patients, with higher prevalence in the physiologic repair group compared with anatomic repair and nonsurgical management (50% vs 22% vs 19%; P = .001). Freedom from postoperative complete heart block/permanent pacemaker implantation at 5 years was higher in patients who underwent anatomic repair vs physiologic repair (85% vs 68%; P = .02). Tachyarrhythmias affected 29% of patients, with varying prevalence of atrial fibrillation and atrial flutter based on treatment pathway. Atrial fibrillation was more prevalent in physiologic repair and nonsurgical management groups compared with the anatomic repair group (30% vs 31% vs 0%; P < .0001). Prevalence of atrial flutter was 9.8% vs 13% vs 0% in the anatomic repair, physiologic repair, and nonsurgical management groups, respectively.
Conclusion:
Burden and type of arrhythmias in patients with cc-TGA varied on the basis of treatment pathway. Further studies assessing long-term follow-up after anatomic repair are needed to identify the surgical approach that would yield the lowest arrhythmia morbidity.
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