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Arrhythmias in adult patients after Rastelli surgery: a single-centre experience

Published online by Cambridge University Press:  18 October 2024

Sirish Chandra Srinath Patloori ,
Satoshi Kawada ,
Praloy Chakraborty Open the ORCID record for Praloy Chakraborty [Opens in a new window] ,
Yawer Saeed ,
Nathan Denham ,
Christian Joens ,
Erwin N. Oechslin Open the ORCID record for Erwin N. Oechslin [Opens in a new window] ,
Susan L. Roche Open the ORCID record for Susan L. Roche [Opens in a new window] ,
Candice Silversides  and
Rachel M. Wald
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Sirish Chandra Srinath Patloori
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Satoshi Kawada
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Praloy Chakraborty
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Yawer Saeed
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Nathan Denham
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Christian Joens
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Erwin N. Oechslin
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Susan L. Roche
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Candice Silversides
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Rachel M. Wald
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Rafael Alonso-Gonzalez
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Sara Thorne
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Blandine Mondesert
Affiliation:
Adult Congenital Heart Disease Center, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
Paul Khairy
Affiliation:
Adult Congenital Heart Disease Center, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
Raja Selvaraj
Affiliation:
Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Krishnakumar Nair*
Affiliation:
University Health Network Toronto, Peter Munk Cardiac Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
*
Corresponding author: Krishnakumar Nair; Email: [email protected]
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Abstract

Background:

Rastelli surgery is used for the correction of several CHDs. Although late-onset cardiac arrhythmias have emerged as a major complication after corrective surgeries, there is a paucity of data on arrhythmias after Rastelli surgery.

Methods:

This retrospective cohort study was conducted on patients who had undergone Rastelli surgery and have been followed at the adult CHD clinic at our hospital.

Results:

A total of 55 patients (36.4% female, age 22.2 ± 6.4 years) were followed for a median period of 24.2 (20.6–31.0) years. Tachyarrhythmias occurred in 21 (38.4 %) patients (n = 15 for atrial tachycardia, 5 for ventricular tachycardia, and 1 for both atrial and ventricular tachycardia). Older age at surgery was significantly associated with the risk of tachyarrhythmias (P = 0.022). Bradyarrhythmia occurred in 12 (21.8%) patients and consisted of perioperative AV block (n = 5), late AV block (n = 1), and sinus node dysfunction (n = 6). Nine (16.4%) patients underwent catheter ablation. The mechanisms of atrial arrhythmias include cavotricuspid isthmus-dependent and surgical scar-dependent intra-atrial reentrant tachycardias. Among the three patients who underwent ablation for ventricular tachycardia, all circuits were dependent on the scar at the base of the right ventricle to pulmonary artery conduit. Median survival free from any event (arrhythmia, death, or heart failure) was 31.6 (28.1–35.1) years after Rastelli surgery.

Conclusions:

The prevalence of arrhythmias late after Rastelli surgery is substantial and increases in the second decade after surgery. Older age at surgery is associated with a higher prevalence of arrhythmias.

Keywords

Rastelli surgerytachyarrhythmiasintra-atrial reentrant tachycardiasright ventricle-pulmonary artery conduit
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 11 , November 2024 , pp. 2432 - 2436
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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Footnotes

Sirish Chandra Srinath Patloori and Satoshi Kawada contributed equally as first author.

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