Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease

Background: Arrhythmias in adult congenital heart disease (ACHD) are responsible for the majority of hospital admissions and 20–25% of late deaths. Since need for further cardiac operations is frequent in ACHD, concomitant arrhythmia surgery represents a strategic treatment modality.Material and Met...

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Autores principales:	Giulia Poretti, Stiljan Hoxha, Antonio Segreto, Gardellini Jacopo, Camilla Sandrini, Giuseppe Faggian, Alessandro Varrica, Massimo Chessa, Alessandro Giamberti, Giovanni Battista Luciani
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	congenital heart surgery arrhythmias cryoablation adult congenital heart disease complex congenital heart disease Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/0dbf93e9564149a1bc68ea7593d5ea25
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spelling	oai:doaj.org-article:0dbf93e9564149a1bc68ea7593d5ea252021-12-03T05:46:33ZPreliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease2297-055X10.3389/fcvm.2021.770221https://doaj.org/article/0dbf93e9564149a1bc68ea7593d5ea252021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.770221/fullhttps://doaj.org/toc/2297-055XBackground: Arrhythmias in adult congenital heart disease (ACHD) are responsible for the majority of hospital admissions and 20–25% of late deaths. Since need for further cardiac operations is frequent in ACHD, concomitant arrhythmia surgery represents a strategic treatment modality.Material and Methods: A two-center retrospective study was undertaken on cryoablation of supraventricular arrhythmias in 25 conescutive ACHD patients (16/9, M/F, median age 38.5 years, IQR 38–60) operated between 01/2017 and 12/2020. Nineteen (76%) had undergone one or more previous cardiac operations and 8 (32%) one or more trans-catheter ablations. Indications included Fontan conversion in seven patients, septal defect repair in 6, pulmonary valve replacement in 10 and tricuspid surgery in 2. Open-heart cryoablation included: 4 cavotricuspid isthmus ablations, 19 right-sided Maze for atrial tachycardia/flutter, and 2 Cox-Maze III for atrial fibrillation.Results: There were 2 (8%) hospital deaths, unrelated to cryoablation, due to low cardiac output syndrome. There were no intraoperative complications related to cryoablation. Seven (28%) patients required pace-maker implantation due to post-operative atrioventricular block. All patients were discharged on oral antiarrhythmic and anticoagulantion for 6 months. After a median follow-up of 14 months (IQR 7–27) no late mortality was observed. At follow-up, 16/23 (69%) patients are in stable sinus rhythm, 12 without anti-arrhythmic therapy. Two (8.6%) patients had relapse of arrhythmia. Freedom from arrhythmia was 90.9% and cumulative risk of recurrence was 9.6%.Conclusions: Intraoperative cryoablation is safe and effective procedure. Surgical treatment of arrhythmias should always be considered in ACHD, whenever further open-heart repair is needed.Giulia PorettiStiljan HoxhaAntonio SegretoGardellini JacopoCamilla SandriniGiuseppe FaggianAlessandro VarricaMassimo ChessaAlessandro GiambertiGiovanni Battista LucianiFrontiers Media S.A.articlecongenital heart surgeryarrhythmiascryoablationadult congenital heart diseasecomplex congenital heart diseaseDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	congenital heart surgery arrhythmias cryoablation adult congenital heart disease complex congenital heart disease Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	congenital heart surgery arrhythmias cryoablation adult congenital heart disease complex congenital heart disease Diseases of the circulatory (Cardiovascular) system RC666-701 Giulia Poretti Stiljan Hoxha Antonio Segreto Gardellini Jacopo Camilla Sandrini Giuseppe Faggian Alessandro Varrica Massimo Chessa Alessandro Giamberti Giovanni Battista Luciani Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease
description	Background: Arrhythmias in adult congenital heart disease (ACHD) are responsible for the majority of hospital admissions and 20–25% of late deaths. Since need for further cardiac operations is frequent in ACHD, concomitant arrhythmia surgery represents a strategic treatment modality.Material and Methods: A two-center retrospective study was undertaken on cryoablation of supraventricular arrhythmias in 25 conescutive ACHD patients (16/9, M/F, median age 38.5 years, IQR 38–60) operated between 01/2017 and 12/2020. Nineteen (76%) had undergone one or more previous cardiac operations and 8 (32%) one or more trans-catheter ablations. Indications included Fontan conversion in seven patients, septal defect repair in 6, pulmonary valve replacement in 10 and tricuspid surgery in 2. Open-heart cryoablation included: 4 cavotricuspid isthmus ablations, 19 right-sided Maze for atrial tachycardia/flutter, and 2 Cox-Maze III for atrial fibrillation.Results: There were 2 (8%) hospital deaths, unrelated to cryoablation, due to low cardiac output syndrome. There were no intraoperative complications related to cryoablation. Seven (28%) patients required pace-maker implantation due to post-operative atrioventricular block. All patients were discharged on oral antiarrhythmic and anticoagulantion for 6 months. After a median follow-up of 14 months (IQR 7–27) no late mortality was observed. At follow-up, 16/23 (69%) patients are in stable sinus rhythm, 12 without anti-arrhythmic therapy. Two (8.6%) patients had relapse of arrhythmia. Freedom from arrhythmia was 90.9% and cumulative risk of recurrence was 9.6%.Conclusions: Intraoperative cryoablation is safe and effective procedure. Surgical treatment of arrhythmias should always be considered in ACHD, whenever further open-heart repair is needed.
format	article
author	Giulia Poretti Stiljan Hoxha Antonio Segreto Gardellini Jacopo Camilla Sandrini Giuseppe Faggian Alessandro Varrica Massimo Chessa Alessandro Giamberti Giovanni Battista Luciani
author_facet	Giulia Poretti Stiljan Hoxha Antonio Segreto Gardellini Jacopo Camilla Sandrini Giuseppe Faggian Alessandro Varrica Massimo Chessa Alessandro Giamberti Giovanni Battista Luciani
author_sort	Giulia Poretti
title	Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease
title_short	Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease
title_full	Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease
title_fullStr	Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease
title_full_unstemmed	Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease
title_sort	preliminary results of cryoablation for surgical treatment of arrhythmias in adults with congenital heart disease
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/0dbf93e9564149a1bc68ea7593d5ea25
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Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease

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