Open Access

ARTICLE

Improvement in ventricular function with rhythm control of atrial arrhythmias may delay the need for atrioventricular valve surgery in adults with congenital heart disease

Benjamin Zielonka¹, Yuli Y. Kim^2,3, Gregory E. Supple², Sara L. Partington^2,3, Emily S. Ruckdeschel^2,3, Francis E. Marchlinski², David S. Frankel²

1 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
2 Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
3 Division of Cardiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

* Corresponding Author: David S. Frankel, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104. Email: . edu

Congenital Heart Disease 2019, 14(6), 931-938. https://doi.org/10.1111/chd.12833

Abstract

Objective: Atrial arrhythmias and atrioventricular valve regurgitation (AVVR) are common causes of morbidity among adults with congenital heart disease (ACHD). The impact of rhythm control on AVVR in this population is unknown. We sought to determine whether a rhythm control strategy is associated with greater freedom from AV valve surgery than a rate control strategy.
Design: Patients evaluated by both ACHD and electrophysiology specialists at a single academic center were screened for atrial arrhythmias and at least moderate‐severe AVVR. Clinical and electrographic data were abstracted. All echocardiograms were in‐ terpreted by a single echocardiographer blinded to treatment strategy. Patients were followed until AV valve surgery, heart transplantation, death, or last clinical follow‐up.
Results: Rhythm control was attempted in 9 of 24 identified patients. Among these nine patients, arrhythmias were eliminated in three and reduced from persistent to paroxysmal in another three. In the rhythm control group, mean left ventricular ejec‐ tion fraction improved from 54.4 ± 12.4% to 60.0 ± 11.5% (P = .02) and mean right ventricular systolic function increased nearly one grade (P = .02). AVVR did not de‐ crease significantly. No significant change in left or right ventricular systolic function, or AVVR was observed among the 15 patients treated with rate control. Four‐year survival free of AV valve operation and heart transplant was 88% in the rhythm con‐ trol group and 31% in the rate control group (P = .04).
Conclusions: In ACHD patients with atrial arrhythmias and at least moderate‐severe AVVR, a rhythm control strategy was associated with improved biventricular systolic function. This improvement in ventricular function and symptoms may allow valve surgery to be deferred.

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