Open Access

ARTICLE

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

by

1 Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California
2 Division of Cardiothoracic Surgery, UCLA Mattel Children’s Hospital, Los Angeles, California
3 Division of Pediatric Cardiology, Mattel Children’s Hospital at UCLA, Los Angeles, California

* Corresponding Author: Jeremy P. Moore, MD, MSc, Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, 100 Medical Plaza, Suite 760, Los Angeles, CA 90095. Email:

Congenital Heart Disease 2019, 14(5), 838-845. https://doi.org/10.1111/chd.12818

Abstract

Objective: We examined the atrial tachyarrhythmia (AT) burden among patients with congenital heart disease (CHD) following transcatheter (TC‐) or surgical (S‐) pulmo‐ nary valve replacement (PVR).
Design/Setting: This was a retrospective observational study of patients who under‐ went PVR from 2010 to 2016 at UCLA Medical Center.
Patients: 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.
Outcome Measures: 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 anti‐ tachycardia pacing.
Results: 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.
Conclusion: 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.

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