Decreased Incidence Of Postoperative Arrhythmia Following Sinus Venosus Atrial Septal Defect Repair. A Single Institution Experience
Jason R. Imundo, MD, Khushboo Parikh, MD, Marnie O'Donnell, PA, Joseph B. Clark, MD, John L. Myers, MD.
Penn State Health Children's Hospital, Hershey, PA, USA.
Objective(s): We aim to describe our experience with postoperative arrhythmias following surgical repair of sinus venosus ASD in a single-institution series.
Methods: All patients who underwent surgical repair of sinus venosus ASD at our institution from 2000-2014. Clinical outcomes were evaluated with a focus on the occurrence of sinus node dysfunction, atrial and ventricular tachyarrhythmias, and atrioventricular block.
Results: Study group included 59 patients with a median age at surgery of 9.1 years (11 days-72.6 years). Anatomy was classified as superior vena cava type (n=52), inferior vena cava type (n=6), and combined (n=1). Surgical technique included single-patch repair (n=52), double-patch repair (n=1), Warden’s procedure (n=5), and primary suture closure (n=1). One patient underwent a concomitant Maze procedure. Median postoperative length of stay was 3 days (range 2-8 days). There were no deaths. Follow-up was complete for 54 patients (93%) with a median duration of 2.6 years (range 15 days-15.8 years). Postoperative rhythm disturbances occurred in 4 patients (6.7%), all with single-patch repair, and included two patients with transient low atrial rhythm, one patient with first and type 1 second degree heart block, and one patient with late onset ectopic atrial tachycardia at 7.6 years following surgery. One patient had low atrial rhythm preoperatively and atrial fibrillation at the latest follow up. Sinus node dysfunction was not evident in any patient.
Conclusions: Postoperative arrhythmias are uncommon following repair of sinus venosus ASD. The zero incidence of sinus node dysfunction in this series may be attributable to avoidance of the two-patch repair.