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Long-term follow-up of dysrhythmias following the Mustard procedure
Insights
Protecting the sinoatrial node (SAN) during the Mustard procedure initially improved sinus rhythm. However, late dysrhythmias, including brady- and tachydysrhythmias, remain a significant postoperative problem.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
Background:
- The Mustard procedure is a palliative surgery for complex congenital heart defects.
- Dysrhythmias post-Mustard procedure have been linked to sinoatrial node (SAN) function.
Purpose of the Study:
- To evaluate the long-term efficacy of surgical modifications aimed at protecting the SAN during the Mustard procedure.
- To assess the incidence and types of dysrhythmias in patients undergoing the Mustard procedure over an extended follow-up period.
Main Methods:
- Retrospective analysis of electrocardiograms (ECGs) from three groups of patients operated on between 1965 and 1977.
- Patients were categorized based on surgical modifications implemented to protect the SAN.
- Dysrhythmias were classified as passive, active, or atrioventricular (AV) conduction defects.
Main Results:
- Groups with SAN protection (B and C) showed a significantly higher incidence of sinus rhythm (80%) in the first 2 years compared to the unprotected group (A, 27%).
- After 8 years, sinus rhythm decreased to less than 50% in all groups.
- Both brady- and tachydysrhythmias were prevalent, with 6% of patients requiring pacemaker insertion for sick sinus syndrome.
Conclusions:
- While initial SAN protection improves early sinus rhythm, late-occurring dysrhythmias persist as a significant challenge in postoperative Mustard patients.
- Long-term surveillance for dysrhythmias is crucial for patients who have undergone the Mustard procedure.
Abstract:
Earlier reports have suggested that the incidence of dysrhythmias after the Mustard procedure can be reduced if the sinoatrial node (SAN) is protected during surgery. To determine if these initial differences continue after longer follow-up, we examined all ECGs available for three groups of patients operated upon from January, 1965, through December, 1977. Group A included 37 patients who survived the operation prior to January, 1972, when surgical modifications were initiated to protect the SAN; group B included 44 patients available for follow-up who were operated upon from 1972 through 1974; and group C consisted of the 39 patients available for follow-up operated upon from 1975 to 1977. Dysrhythmias were classified as passive (failure of initiation or propagation of the SAN impulse), active (atrial flutter or supraventricular tachycardia), or atrioventricular (AV) conduction defects. Results were expressed as the incidence per number of different rhythms during follow-up intervals. The incidence of sinus rhythm in groups B and C (80%) was much greater than in group A (27%) during the first 2 years. However, after 8 years, less than 50% of the rhythms were sinus. Both brady- and tachydysrhythmias were common. Seven patients (6%) required pacemaker insertion for symptomatic sick sinus syndrome. Therefore despite efforts to protect the sinus node, late occurring dysrhythmias remain a significant problem in the postoperative Mustard patient.