Early postoperative tachyarrhythmias in adult congenital heart surgery: an eight-year review at a tertiary university hospital in Thailand

Abstract

Background: Tachyarrhythmias are a common and significant complication following surgery for adult congenital heart disease (CHD), adversely affecting morbidity. This study aimed to assess the incidence, characteristics, and risk factors of early postoperative tachyarrhythmias in adults undergoing CHD surgery.

Methods: We conducted a retrospective cohort study at Siriraj Hospital, Bangkok, Thailand, including 311 adult patients who underwent elective CHD surgeries from March 2013 to November 2020. We analyzed demographic and surgical data, focusing on new-onset tachyarrhythmias requiring interventions such as antiarrhythmic drugs or cardioversion.

Results: The patient cohort had a median age of 34 years (range, 18-78 years), with 34.7% male, predominantly diagnosed with atrial and ventricular septal defects (54.7%), and severe pulmonary regurgitation post-tetralogy of Fallot repair (22.2%). Postoperative tachyarrhythmias occurred in 12.9% of patients, with atrial fibrillation (AF; 67.5%) and atrial flutter (AFL; 14.5%) being the most frequent. Independent risk factors for tachyarrhythmias included older age [adjusted odds ratio (OR) =1.26 per 5-year increment; 95% confidence interval (CI): 1.12-1.42; P<0.001] and left atrial enlargement (adjusted OR=2.78; 95% CI: 1.31-5.85; P=0.007).

Conclusions: Early postoperative tachyarrhythmias are prevalent in adults undergoing CHD surgery, with advanced age and left atrial enlargement as significant risk factors. These findings underscore the importance of early detection and management of septal defects and advocate for enhanced screening and healthcare strategies to reduce postoperative complications in this population.

Keywords: Congenital heart disease (CHD); atrial fibrillation (AF); cardiac surgery; postoperative complications; tachyarrhythmias.

Figure 1

Proportional distribution of postoperative arrhythmias by type of adult CHD surgery. N represents the number of patients within each diagnosis category who developed tachyarrhythmias, excluding those who did not develop tachyarrhythmias. SoV, sinus of Valsalva; ccTGA, congenitally-corrected transposition of great arteries; PR, pulmonary regurgitation; TOF, tetralogy of Fallot; VSD, ventricular septal defect; ASD, atrial septal defect; AF, atrial fibrillation; AFL, atrial flutter; SVT, supraventricular tachycardia; AVNRT, atrioventricular nodal reentrant tachycardia; VT, ventricular tachycardia; CHD, congenital heart disease.

Figure 2

Timing and types of tachyarrhythmias by patient age and type of adult CHD surgery. SoV, sinus of Valsalva; ccTGA, congenitally-corrected transposition of great arteries; PR, pulmonary regurgitation; TOF, tetralogy of Fallot; VSD, ventricular septal defect; ASD, atrial septal defect; AF, atrial fibrillation; AFL, atrial flutter; SVT, supraventricular tachycardia; AVNRT, atrioventricular nodal reentrant tachycardia; VT, ventricular tachycardia; CHD, congenital heart disease.

Figure 3

ROC curve for predicting postoperative tachyarrhythmias. The blue line represents the actual ROC curve of the test. The green line represents the line of no discrimination, indicating a test with no diagnostic ability. ROC, receiver operative characteristic.