P843Predictive factors for postoperative atrial arrhythmias in adults with Ebstein's anomaly


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Abstract

Purpose: Surgical anti-arrhythmic procedure (Maze) has been known to be effective in adults with Ebstein's anomaly, although the recurrence of atrial tachyarrhythmia after surgery is not unusual. The aim of this study was to assess the useful predictors for the post-operative atrial tachyarrhythmias in adults with Ebstein's anomaly.Methods: Twenty patients (pts) with Ebstein's anomaly and severe tricuspid regurgitation were studied before and after surgery (8 pts; tricuspid valve repair, 11 pts; replacement). Biventricular dimensions, functions and both atrial volume were studied by using Doppler Echocardiography before and after surgery. Comparison was made between pts with post-operative atrial tachyarrhythmias and those without post-operative atrial tachyarrhythmias.Results: Ten of the 20 pts had pre-operative atrial tachyarrhythmias and 6 of them had post-operative atrial tachyarrhythmias during the follow-up periods after surgery (3.1±1.1 years). Other ten had no atrial tachyarrhythmias before and after surgery. The mean age of 20 pts was 35.0 ± 15.2 years (range 19 - 65 years.9 male). Regarding tricuspid valve repair, Carpentier's procedure was performed and the RA and the RV were plicated longitudinally. 16 pts underwent MAZE procedure (15pts; right-sided Maze and 6 of them; prophylactic Maze, 1pt; full Maze). There were significantly increased RV Tei index, reduced TAPSE amplitude, reduced S wave velocity, and reduced E wave velocity suggesting impaired RV function in postoperative arrhythmic group compared to those in non-arrhythmic group (0.58+/-0.3 vs 0.52+/- 0.5 P<0.01, 9.4+/-1.5 vs 13.5+/-4.5 P<0.05, 4.3+/-0.57 vs 8.9+/-1.9 P<0.01, 3.4+/-1.1 vs 7.4+/-2.4 P<0.01, respectively). In a logistic analysis, postoperative RV TDI E was the most useful predictor for postoperative atrial tachyarrhythmias (P<0.05, odds ratio 0.19, 95%CI 0.04-0.92).Conclusions: Impaired RV hemodynamically substrates post-operative atrial tachyarrhythmias in adults with Ebstein's anomaly. Reduced RV TDI E wave is one of the most sensitive predictors for postoperative atrial tachyarrhythmias.

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