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Arrhythmias in transposition of the great arteries after the Mustard operation
Insights
Patients with Transposition of the Great Arteries (TGA) after Mustard operation frequently experience rhythm and conduction disorders. This study evaluated 87 survivors, finding significant sinus node dysfunction and atrioventricular block, though symptoms were rare.
Area of Science:
- Cardiology
- Electrophysiology
- Pediatric Cardiac Surgery
Background:
- Rhythm and conduction disorders are commonly reported in patients with Transposition of the Great Arteries (TGA) following the Mustard operation.
- A comprehensive understanding of the long-term electrophysiologic consequences of the Mustard operation is crucial for patient management.
Purpose of the Study:
- To systematically evaluate the electrophysiologic function in a cohort of survivors who underwent the Mustard operation.
- To determine the prevalence of sinus node dysfunction, atrioventricular block, and arrhythmias in TGA patients post-Mustard procedure.
Main Methods:
- Review of surface electrocardiograms in 87 patients.
- Holter monitoring in 26 patients, exercise electrocardiograms in 21 patients.
- Invasive electrophysiologic studies in 61 patients.
Main Results:
- Surface ECGs revealed sinus node dysfunction in 27% and atrioventricular block in 16%.
- Holter monitoring showed higher rates: sinus node dysfunction (58%), atrioventricular block (27%), and ectopy (77% combined).
- Overall assessment indicated sinus node dysfunction in 47%, ectopy in 34%, and atrioventricular block in 23% of patients, with only 30% showing no arrhythmias.
Conclusions:
- A significant proportion of Transposition of the Great Arteries survivors after the Mustard operation exhibit electrophysiologic abnormalities.
- Sinus node dysfunction and atrioventricular conduction disturbances are prevalent, even in asymptomatic patients.
- Regular electrophysiologic monitoring is warranted for these patients.
Abstract:
Disorders of rhythm or conduction in patients with transposition of the great arteries (TGA) after the Mustard operation have been widely reported. This study provides a systematic evaluation of the electrophysiologic function of 87 survivors of the Mustard operation at a single institution. Surface electrocardiograms were reviewed in all 87 patients, Holter monitoring data in 26 patients, exercise electrocardiograms in 21 patients, and invasive electrophysiologic data in 61 patients. Surface electrocardiograms showed normal sinus rhythm in 52%, sinus node dysfunction in 27%, and atrioventricular block in 16%. Holter monitoring was obtained in an unselected subgroup of 26 patients who had a mean age of 12 years and a mean interval from operation of 9 years. Sinus node dysfunction was found in 58%, atrioventricular block in 27% ventricular ectopy in 50%, supraventricular ectopy in 27%, and no abnormalities in only 8%. Intracardiac electrophysiologic evaluation showed a high frequency of abnormal sinus node recovery times and suboptimal response of the atrioventricular-conduction system to rapid atrial pacing. When all modalities used in this study were considered, sinus node dysfunction occurred in 47%, ectopy in 34% and atrioventricular block in 23%. Although only 30% of patients had no evidence of arrhythmia, symptoms of rhythm or conduction disturbances were rare.