Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Int J Cardiol. 2013 Oct 30;169(2):139-44. doi: 10.1016/j.ijcard.2013.08.087. Epub 2013 Sep 8.
Little is known about the clinical impact of arrhythmias after surgery for congenital heart disease (CHD) in adults. Therefore, we investigated the prevalence of in-hospital arrhythmias after CHD surgery and their impact on clinical outcome.
This was a multicenter retrospective study and included adults who underwent congenital cardiac surgery between January 2009 and December 2011. Clinical events were defined as all cause mortality, heart failure (HF) requiring medical treatment, thrombo-embolic event, major infections and permanent pacemaker (PM) implantation.
Overall, 419 patients were included (mean age 38 ± 14 years, 55% male). Arrhythmias occurred in 134 patients (32%) and included supraventricular tachycardia (SVT, n = 100), bradycardias (n = 47) and ventricular tachycardia (VT, n = 19). In multivariate analysis age ≥40 years at surgery (OR 2.48, 95% Cl 1.40-4.60, P = 0.003), NYHA class ≥ II (OR 2.42, 95% Cl 1.18-4.67, P = 0.009), significant subpulmonary AV-valve regurgitation (OR 2.84, 95% Cl 1.19-6.72, P = 0.018), coronary bypass time (OR 1.35/60 minute increase, 95% Cl 1.06-1.82, P = 0.019) and CK-MB (OR 1.05 per 10 U/L increase, 95% Cl 1.01-1.09, P = 0.021) were associated with in-hospital arrhythmias. Overall, 58 clinical events occurred in 55 patients (13%) and included in the majority of the cases permanent PM implantation (5%), HF (4%) and death (2%). In-hospital arrhythmias were independently associated with clinical events (OR 7.80, 95% CI 2.41-25.54, P = 0.001).
Arrhythmias are highly prevalent after congenital heart surgery in adults and are associated with worse clinical outcome. Older and symptomatic patients with significant valvular heart disease at baseline are at risk of in-hospital arrhythmias.
成人先天性心脏病（CHD）手术后心律失常的临床影响知之甚少。因此，我们研究了 CHD 手术后住院期间心律失常的发生率及其对临床结局的影响。
这是一项多中心回顾性研究，纳入 2009 年 1 月至 2011 年 12 月期间接受先天性心脏手术的成人患者。临床事件定义为全因死亡率、需要药物治疗的心力衰竭（HF）、血栓栓塞事件、重大感染和永久性起搏器（PM）植入。
共有 419 例患者入选（平均年龄 38±14 岁，55%为男性）。134 例患者发生心律失常（32%），包括室上性心动过速（SVT，n=100）、心动过缓（n=47）和室性心动过速（VT，n=19）。多变量分析显示，手术时年龄≥40 岁（OR 2.48，95%CI 1.40-4.60，P=0.003）、NYHA 分级≥Ⅱ级（OR 2.42，95%CI 1.18-4.67，P=0.009）、显著的肺动脉瓣下 AV 瓣反流（OR 2.84，95%CI 1.19-6.72，P=0.018）、冠状动脉旁路移植时间（OR 每增加 60 分钟 1.35，95%CI 1.06-1.82，P=0.019）和 CK-MB（OR 每增加 10U/L 1.05，95%CI 1.01-1.09，P=0.021）与住院期间心律失常相关。共有 55 例患者（13%）发生 58 例临床事件，包括大多数永久性 PM 植入（5%）、HF（4%）和死亡（2%）。住院期间心律失常与临床事件独立相关（OR 7.80，95%CI 2.41-25.54，P=0.001）。
成人先天性心脏病手术后心律失常发生率较高，与临床结局较差相关。基线时年龄较大且有症状、有显著瓣膜性心脏病的患者发生住院期间心律失常的风险较高。
