title: Surgery for supraventricular tachycardia and congenital heart defects: long-term efficacy of the combined approach in adult patients.
abstract: OBJECTIVE
  Supraventricular arrhythmias are a major cause of morbidity and mortality in adult patients with congenital heart disease (CHD). Intraoperative ablation offers an alternative for patients who failed ablation procedures or are requiring concomitant surgical intervention. We present our long-term results with the surgical treatment of arrhythmias in adults with CHD (ACHD) undergoing elective cardiac surgery and the clinical predictors for arrhythmia recurrence.
  
  
  RESULTS
  Between 2002 and 2013, 80 consecutive patients with CHD, mean age of 39 years, underwent intraoperative ablation with monopolar irrigated radiofrequency during cardiac surgery procedures. Significant clinical predictors of arrhythmia recurrence were determined by univariate analysis. We performed 47 right-sided Maze procedures, and 33 Cox-Maze III procedures. In 75 survivors, the ablation was effective immediately. Over an average follow-up period of 72 months (12-155 months), arrhythmias recurred in nine (20%) patients after right-sided Maze, and in six (19%) patients after Cox-Maze III. Eleven patients were controlled with medical therapy, three underwent catheter ablation of the arrhythmia, and one required a permanent pacemaker. Preoperative arrhythmia length ≥3 years (P ≤ 0.001), tetralogy of Fallot (P ≤ 0.006), and preoperative atrial fibrillation (P ≤ 0.016) were associated with recurrence arrhythmia. Conversely, NYHA class <3 (P ≤ 0.047) was associated with a lower risk of recurrence.
  
  
  CONCLUSIONS
  Surgical treatment of unresponsive supraventricular arrhythmia during concomitant cardiac surgery in ACHD is a safe and effective procedure. Freedom from arrhythmias recurrence is 75% after 6 years of follow-up. Long-term recurrence of arrhythmia in these patients seems to be strongly correlated to preoperative arrhythmia duration.
authors.affiliation: Department of Congenital Cardiac Surgery and GUCH Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato M.se MI, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giamberti
authors.affiliation: Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato M.se MI, Italy.
authors.forename: Francesca R
authors.initials: FR
authors.lastname: Pluchinotta
authors.affiliation: Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato M.se MI, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Chessa
authors.affiliation: Department of Congenital Cardiac Surgery and GUCH Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato M.se MI, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Varrica
authors.affiliation: Department of Electrophysiology, IRCCS Policlinico San Donato, San Donato M.se MI, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Vitale
authors.affiliation: Department of Congenital Cardiac Surgery and GUCH Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato M.se MI, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
authors.affiliation: Department of Electrophysiology, IRCCS Policlinico San Donato, San Donato M.se MI, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato M.se MI, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adults with congenital heart disease; Arrhythmia; Cardiac surgery; Congenital heart disease