Surgical history and arrhythmic outcomes in adults with congenital heart disease and implantable cardioverter-defibrillators
I Ferreira Neves, F Nascimento Ferreira, M Coutinho Cruz, S Laranjo, G Portugal, H Santos, T Rito, T Branco Mano, A Lousinha, B Valente, P Silva Cunha, J D Martins, R Cruz Ferreira, L De Sousa, M Martins OliveiraAbstract
Background/Introduction
Adults with congenital heart disease (ACHD) often undergo multiple cardiac surgeries throughout life. The impact of surgical history on subsequent arrhythmic manifestations and device-related long-term outcomes after implantable cardioverter-defibrillator (ICD) implantation remains poorly defined.
Purpose
To evaluate whether the number and timing of cardiac surgeries are associated with arrhythmic outcomes—including appropriate and inappropriate ICD therapies, new-onset supraventricular tachyarrhythmias (SVT), and need for catheter ablation—during a very long-term follow-up in ACHD patients.
Methods
We retrospectively analyzed ACHD patients with ICDs followed at a tertiary center. Data collected included number of prior surgeries, age at first cardiac intervention, and arrhythmic events (appropriate/inappropriate ICD therapies, SVT, and ablation after ICD implantation). Comparisons between groups were performed using Mann–Whitney U and chi-square or Fisher’s exact tests as appropriate.
Results
Forty-six ACHD patients (42 ± 13.9 years, 54% female) with >10 years follow-up were included. Patients with appropriate ICD therapies (n = 21) and those without (n = 25) had a similar number of prior surgeries (median ranks 24.4 vs. 22.5, p = 0.59) and similar age at first surgery (23.8 vs. 21.7 years, p = 0.28). Only two patients (4.3%) had never undergone cardiac surgery; none of them experienced appropriate ICD therapies during follow-up. No significant associations were found between surgical history and the occurrence of inappropriate therapies. Patients who had undergone catheter ablation (n = 14) were younger at their first surgery than those without ablation (n = 32, p = 0.047). A non-significant trend toward higher surgical burden was observed among patients with supraventricular tachyarrhythmias (n = 18 vs. 28, p = 0.10).
Conclusions
In this ACHD cohort with ICDs, neither the number of prior surgeries nor the age at first repair influenced the occurrence of device therapies. However, younger age at first surgery was associated with a higher likelihood of subsequent ablation, and a tendency toward greater surgical burden was observed in patients with supraventricular tachyarrhythmias. These real world findings are consistent with the fact that early and complex surgical histories reflect a more arrhythmogenic substrate warranting closer long-term follow-up.