Skip to main content Accessibility help
×
Home

Arrhythmias after surgery for complete transposition: Do they matter?

  • John E. Deanfield (a1), Seamus Cullen (a1) and Marc Gewillig (a1)

Summary

Concern about long-term complications after intraatrial repair of complete transposition has been used as an argument in favor of “anatomic” repair by the arterial switch operation. Late arrhythmias, including loss of sinus rhythm and the development of supraventricular tachycardias, particularly atrial flutter, are widely reported after intraatrial repair. Despite modifications of technique, the electrophysiologic substrate for arrhythmia results from the extensive atrial surgery required. Arrhythmias occur, even in the “modern surgical era” after both Mustard and Senning operations, are progressive, and appear to be inevitable. The circulation after an intraatrial repair is more vulnerable to the effects of excessive tachycardia, and this may place the patient at risk from sudden cardiac death. Current attempts at individual stratification of risk are disappointing using even aggressive electrophysiologic approaches, and a combined assessment involving hemodynamics is likely to be necessary. The electrophysiologic and arrhythmic consequences of the arterial switch operation have been less extensively researched but, as might be expected, are quite different from those seen after intraatrial repair. The atrial activation sequence is relatively undisturbed, and sinus nodal dysfunction and supraventricular arrhythmia are uncommon. Ventricular extrasystoles are the arrhythmia most consistently found during the short follow-up currently available. In the longer term, myocardial ischemia, hemodynamic disturbances and autonomic imbalance may predispose to late arrhythmia. Current evidence would suggest that the lack of clinically significant arrhythmia and the restoration of the left ventricle to the systemic circulation are significant advantages of the arterial switch operation over intraatrial repair procedures.

Copyright

Corresponding author

Dr. John E. Deanfield Consultant Cardiologist, Thoracic Unit, The Hospital for Sick Children, Great Ormond Street, London WCIN 3JH, United Kingdom

References

Hide All
1.Flinn, CJ, Wolfe, GS, Dick, M, Campbell, RM, Borkat, G, Casta, A, Hordof, AL, Hougen, TJ, Kavey, RE, Kugler, J, Liebman, J, Greenhouse, J, Hees, P. Cardiac rhythm after the Mustard operation for complete TGA. New Eng J Med 1984; 310: 16351638.
2.Gillette, PC, Kugler, JD, Garson, A, Gutgesell, HP, Duff, DF, McNamara, DG. Mechanisms of cardiac arrhythmias after the Mustard operation for TGA. Am J Cardiol 1980; 45: 11251130.
3.Hayes, CJ, Gersony, WM. Arrhythmias after the Mustard operation for TGA: A longterm study. J Am Coll Cardiol 1986; 7: 133137.
4.Williams, WG, Trusler, GA, Kirklin, JW, Blackstone, EH, Coles, JG, Izukara, T, Freedom, RM. Early and late results of a protocol for simple transposition leading to an atrial switch (Mustard) repair. J Thorac Cardiovasc Surg 1988; 95: 717726.
5.Southall, DP, Johnston, F, Shinebourne, EA, Johnstone, PGB. 24-hour electrocardiographic study of heart rate and rhythm patterns in population of healthy children. Br Heart J 1981; 45: 281291.
6.Deanfield, JE, Camm, J, Macartney, F, Cartwright, T, Douglas, J, Drew, J, de Leval, M, Stark, J. Arrhythmia and late mortality after Mustard and Senning operation for transposition of the great arteries: an eight year prospective study. J Thorac Cardiovasc Surg 1988; 96: 569576.
7.Southall, DP, Keeton, BR, Leanage, R, Lam, L, Joseph, MC, Anderson, RH, Lincoln, CR, Shinebourne, EA. Cardiac rhythm and conduction before and after Mustard's operation for complete TGA. Br Heart J 1980; 32: 2132.
8.El-Said, GM, Rosenberg, HS, Huilins, CE, Hailman, GL, Cooley, DA, McNamara, DC. Dysrhythmias after Mustard operation for TGA. Am J Cardiol 1972; 30: 526532.
9.Vetter, VL, Tanner, CS, Horowitz, LN. Electrophysiologic consequences of the Mustard repair of d-transposition of the great arteries. J Am Coil Cardiol 1987; 10: 12651273.
10.Ullal, RR, Anderson, RH, Lincoln, C. Mustard's operation modified to avoid dysrhythmias and pulmonary and systemic venous obstruction. J Thorac Cardiovasc Surg 1979; 78: 431439.
11.Scheaut, W, Lin, CY, de la Fuente, D, Arculla, R, Reploglue, R. Avoiding post-operative dysrhythmias and venous obstruction following Mustard's operation. Ann Thorac Surg 1974; 18: 142155.
12.Byrum, CJ, Bove, EL, Sondheimer, HM, Kavey, REW, Blackman, MS. Hemodynamic and electrophysiologic results of the Senning procedure for TGA. Am J Cardiol 1986; 58: 138142.
13.Turina, M, Siebenmann, R, Nussbaumer, P, Senning, A. Long-term outlook after atrial correction of transposition of the great arteries. J Thorac Cardiovasc Surg 1988; 95: 828835.
14.Griffin, M, Cartwright, T, Choi, J, Deanfield, JE. Determinants of cardiac reserve following intra-atrial repair of transposition of the great arteries. Circulation 1987; 7 (Suppl IV): IV 289 (Abstract).
15.Vetter, VL, Tanner, CS. Electrophysiologic consequences of switch repair of d-transposition of the great arteries. J Am Coll Cardiol 1988; 12: 229237.
16.Martin, RP, Radley-Smith, R, Yacoub, MH. Arrhythmias before and after anatomic correction of transposition of the great arteries. J Am Coll Cardiol 1987; 10: 200204.
17.Wernovsky, G, Hougen, TJ, Walsh, EP, Sholler, GF, Colan, SD, Sanders, SP, Parness, IA, Keane, JF, Mayer, JE, Jonas, RA, Castañeda, AR, Lang, P. Midterm results after the arterial switch operation for transposition of the great arteries with intact ventricular septum: clinical, hemodynamic, echocardiographic, and electrophysiologic data. Circulation 1988; 77: 13331344.
18.Sidi, D, Planché, C, Kachanee, J, Brunianx, J, Villain, E, Le Bidois, J, Piechaud, JF, Lacour-Gayet, F. Anatomic correction of simple TGA in 50 neonates. Circulation 1987; 75: 429435.
19.Quaegebeur, JM, Rolmer, J, Ottenkamp, J, Buis, T, Kirklin, JW, Blackstone, EH, Brom, AG. The arterial switch operation: An eight year experience. J Thorac Cardiovasc Surg 1986; 92: 361384.
20.Vogel, M, Smalihorn, JF, Benson, LN, Gilday, RM, Williams, WG. Assessment of myocardial perfusion during stress and at rest in patients with TGA after arterial repair. Circulation 1987; 76(Suppl IV): IV 265 (Abstract).
21.Paillole, C, Sidi, D, Kachaner, J, Planch, C, Beiot, JP, Villain, E, Lebidois, J, Piechaud, JF, Pedroni, E. Fate of pulmonary artery after anatomic correction of simpie transposition of great arteries in newborn infants. Circulation 1988; 78: 870876.
22.Maeta, GJ, Magiel, NM, Myers, G, Barnett, PS, Schaeed, JW, Weiss, JS, Leisch, M, Singer, DH. Heart rate variability and sudden death secondary to coronary artery disease during ambulatory electrocardiographic monitoring. Am J Cardiol 1987; 60: 8689.
23.Kleiger, RE, Miller, P, Bigger, TJ, Moss, AJ and the Multicenter Post-Infarction Research Group. Decreased heart rate variability and its association with increased mortality after acute myocardiai infarction. Am J Cardiol 1987; 59: 256262.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed