Ventricular arrhythmias and sudden death in adults after a Mustard operation for transposition of the great arteries

被引：123

作者：

Schwerzmann, Markus ^{[2
]}

Salehian, Omid ^{[3
]}

Harris, Louise ^{[1
]}

Siu, Samuel C. ^{[4
]}

Williams, William G. ^{[1
]}

Webb, Gary D. ^{[5
]}

Colman, Jack M. ^{[1
]}

Redington, Andrew ^{[1
]}

Silversides, Candice K. ^{[1
]}

机构：

[1] Univ Toronto, Toronto Gen Hosp, Toronto Congenital Cardiac Ctr Adults, Univ Hlth Network,Div Cardiol, Toronto, ON M5G 2N2, Canada

[2] Univ Bern, Inselspital, Dept Cardiol, Grown Up Congenital Heart Dis Program, CH-3010 Bern, Switzerland

[3] McMaster Univ, Med Ctr, Div Cardiol, Hamilton, ON, Canada

[4] Univ Western Ontario, Div Cardiol, London, ON, Canada

[5] Univ Penn, Dept Med, Philadelphia Adult Congenital Heart Ctr, Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

来源：

EUROPEAN HEART JOURNAL | 2009年 / 30卷 / 15期

基金：

瑞士国家科学基金会;

关键词：

Transposition of great vessels; Tachyarrhythmias; Survival; CONGENITAL HEART-DISEASE; CARDIOVASCULAR MAGNETIC-RESONANCE; ATRIAL REDIRECTION SURGERY; SYSTEMIC RIGHT VENTRICLE; QRS PROLONGATION; REPAIR; RISK; PREVALENCE; MORTALITY;

D O I：

10.1093/eurheartj/ehp179

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

To examine the prevalence of sustained ventricular tachycardia (VT) and sudden death (SD) in adults with atrial repair of transposition of the great arteries (TGA) and to determine associated risk factors. In a single-centre review, we studied the outcome of 149 adults (mean age 28 +/- 7 years) who had undergone a Mustard operation for TGA. During a mean follow-up of 9 +/- 6 years, sustained VT and/or SD occurred in 9% (13/149) of the cohort. Sustained VT/SD was more likely to occur in patients with associated anatomic lesions [hazard ratio (HR) 4.9, 95% CI 1.5-16.0], with NYHA class >= III (HR 9.8, 95% CI 3.0-31.6) and with an impaired subaortic right ventricular (RV) ejection fraction (EF) (HR 2.2, 95% CI 1.2-4.0 per 10% decrease in EF). There was an inverse correlation between the RV-EF and both age and QRS duration. Patients with a QRS duration >= 140 ms were at highest risk of sustained VT/SD (HR 13.6, 95% CI 2.9-63.4). Atrial tachyarrhythmia was detected in 66 (44%) patients, but was not a statistically significant predictor of sustained VT/SD in our adult population (HR 2.7, 95% CI 0.6-13.0). Sustained VT/SD in adults after a Mustard operation for TGA are more common than previously described. Age, systemic ventricular function, and QRS duration are interrelated and are associated with VT/SD. A QRS duration >= 140 ms helps to identify the high risk patient.

引用

页码：1873 / 1879

页数：7

共 25 条

[1] Late gadolinium enhancement cardiovascular magnetic resonance of the systemic right ventricle in adults with previous atrial redirection surgery for transposition of the great arteries [J].