Postoperative and short-term atrial tachyarrhythmia burdens after transcatheter vs surgical pulmonary valve replacement among congenital heart disease patients

• Published in: Congenital heart disease Vol. 14; no. 5; p. 838
• Main Authors: Wadia, Subeer K, Lluri, Gentian, Aboulhosn, Jamil A, Laks, Hillel, Biniwale, Reshma M, Van Arsdell, Glen S, Levi, Daniel S, Salem, Morris M, Shannon, Kevin M, Moore, Jeremy P
• Format: Journal Article
• Language: English
• Published: United States 01.09.2019
• Subjects: Adolescent; Adult; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Atrial Fibrillation - physiopathology; Cardiac Catheterization; Echocardiography; Female; Follow-Up Studies; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart Defects, Congenital - complications; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - surgery; Heart Rate - physiology; Heart Valve Prosthesis Implantation - methods; Humans; Incidence; Male; Postoperative Complications; Pulmonary Valve - diagnostic imaging; Pulmonary Valve - surgery; Pulmonary Valve Insufficiency - complications; Pulmonary Valve Insufficiency - diagnosis; Pulmonary Valve Insufficiency - surgery; Retrospective Studies; Time Factors; United States - epidemiology; Young Adult; United States; congenital heart disease; pulmonary valve replacement; atrial arrhythmias
• ISSN: 1747-0803
• DOI: 10.1111/chd.12818

We examined the atrial tachyarrhythmia (AT) burden among patients with congenital heart disease (CHD) following transcatheter (TC-) or surgical (S-) pulmonary valve replacement (PVR). This was a retrospective observational study of patients who underwent PVR from 2010 to 2016 at UCLA Medical Center. Patients of all ages who had prior surgical repair for CHD were included. Patients with a history of congenitally corrected transposition of the great arteries, underwent a hybrid PVR procedure, or had permanent atrial fibrillation (AF) without a concomitant ablation were excluded. The primary outcome was a time-to-event analysis of sustained AT. Sustained ATs were defined as focal AT, intra-atrial reentrant tachycardia/atrial flutter, or AF lasting at least 30 seconds or terminating with cardioversion or antitachycardia pacing. Two hundred ninety-seven patients (TC-PVR, n = 168 and S-PVR, n = 129) were included. During a median follow-up of 1.2 years, nine events occurred in TC-PVR group (5%) vs 23 events in S-PVR group (18%). In the propensity adjusted models, the following factors were associated with significant risk of AT after PVR: history of AT, age at valve implantation, severe right atrial enlargement, and S-PVR. In the secondary analysis, TC-PVR was associated with lower adjusted risk of AT events in the postoperative epoch (first 30 days), adjusted IRR 0.31 (0.14-0.97), P = .03, but similar risk in the short-term epoch, adjusted IRR 0.64 (0.14-2.94), P = .57. There was an increased risk of AT in the first 30 days following S-PVR compared to TC-PVR. Additional factors associated with risk of AT events after PVR were a history of AT, age at valve implantation, and severe right atrial enlargement.