Risk factors for atrial arrhythmia recurrence after atrial arrhythmia surgery with pulmonary valve replacementCentral MessagePerspective
Yuji Tominaga, MD,
Masaki Taira, MD,
Takuji Watanabe, MD,
Moyu Hasegawa, MD,
Ryoto Sakaniwa, MD, MPH, PhD,
Daisuke Yoshioka, MD, PhD,
Kazuo Shimamura, MD, PhD,
Takayoshi Ueno, MD, PhD,
Shigeru Miyagawa, MD, PhD
Affiliations
Yuji Tominaga, MD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
Masaki Taira, MD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Address for reprints: Masaki Taira, MD, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka 565-0871, Japan.
Takuji Watanabe, MD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Moyu Hasegawa, MD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Ryoto Sakaniwa, MD, MPH, PhD
Department of Public Health, Osaka University Graduate School of Medicine, Osaka, Japan
Daisuke Yoshioka, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Kazuo Shimamura, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Takayoshi Ueno, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Shigeru Miyagawa, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Objectives: Atrial arrhythmias are a significant cause of late morbidity and mortality in patients after tetralogy of Fallot repair. However, reports on their recurrence following atrial arrhythmia surgery are limited. We aimed to identify the risk factors for atrial arrhythmia recurrence after pulmonary valve replacement (PVR) and arrhythmia surgery. Methods: We reviewed 74 patients with repaired tetralogy of Fallot who underwent PVR for pulmonary insufficiency at our hospital between 2003 and 2021. Twenty-two patients (mean age, 39 years) underwent PVR and atrial arrhythmia surgery. A modified Cox-maze III was performed in 6 patients with chronic atrial fibrillation, and a right-sided maze was performed in 12 with paroxysmal atrial fibrillation, 3 with atrial flutter, and 1 with atrial tachycardia. Atrial arrhythmia recurrence was defined as any documented sustained atrial tachyarrhythmia requiring intervention. The influence of preoperative parameters on recurrence was assessed with the Cox proportional-hazards model. Results: The median follow-up period was 9.2 years (interquartile range, 4.5-12.4). Cardiac death and redo-PVR due to prosthetic valve dysfunction were not observed. Eleven patients had atrial arrhythmia recurrence after discharge. Atrial arrhythmia recurrence-free rates were 68% at 5 years and 51% at 10 years after PVR and arrhythmia surgery. Multivariable analysis revealed that right atrial volume index (hazard ratio, 1.04; 95% confidence interval, 1.01-1.08, P = .009) was a significant risk factor for atrial arrhythmia recurrence after arrhythmia surgery and PVR. Conclusions: Preoperative right atrial volume index was associated with atrial arrhythmia recurrence, which may assist in planning the timing of atrial arrhythmia surgery and PVR.
