Advantages and disadvantages of one-stage and two-stage surgery for arrhythmias and Ebstein's anomaly☆

Abstract

One-stage and two-stage surgery of arrhythmias and Ebstein's anomaly are highly effective. First step of surgery of combined pathology reduces cardiopulmonary bypass time, complications and mortality while performing the second step of congenital heart defect surgery. However, simultaneous approach (one-step surgery) is better in terms of arrhythmia elimination.

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

“…471,484 Although many patients continued to experience recurrence, these episodes were better tolerated and were of limited duration. 471,484 Because of the potential risk of proarrhythmia, dofetilide is usually a second-line medication after failure of beta blockers and sotalol. Initiation of oral dofetilide is recommended during 72-hour inpatient monitoring.…”

“…Successful surgical ablation of accessory pathways has been reported in 92% to 100%. 483,484 In a series of patients undergoing right atrial maze procedures or isthmus ablation for atrial flutter/fibrillation in association with repair of Ebstein anomaly, freedom from recurrent flutter/fibrillation was 75% during 34 months of follow-up. 483 In a comparison study of combined operative arrhythmia surgery with repair, versus catheter ablation followed by surgical repair, the combined approach was effective in 94% of cases versus 76% of patients treated with the catheter approach alone.…”

“…483 In a comparison study of combined operative arrhythmia surgery with repair, versus catheter ablation followed by surgical repair, the combined approach was effective in 94% of cases versus 76% of patients treated with the catheter approach alone. 484 In a series of patients undergoing repair of Ebstein anomaly, patients who underwent preoperative EP study with intraoperative ablation of arrhythmia substrate had lower risk of SCD than patients without arrhythmia intervention. 479 In patients with Ebstein anomaly undergoing planned surgical intervention, an integrated approach of arrhythmia intervention has been demonstrated to be safe and effective.…”

Ebstein’s Anomaly

“…14,53,56 This can be accomplished without an increase in operative mortality and with freedom from arrhythmia recurrence in 75% of patients with atrial flutter or fibrillation and in up to 100% of patients with accessory pathway-mediated tachycardia or atrioventricular nodal reentry tachycardia. 55,70 Symptomatic neonates with Ebstein's anomaly have a poor prognosis. Marked cardiac enlargement, advanced echocardiographic severity score, cyanosis, and severe regurgitation of the tricuspid valve all predict neonatal death without surgery.…”

Case report of accessory pathway ablation in an infant with corrected transposition of great arteries

“…Показаниями для РЧА у детей данной возрастной категории служили жизне-угрожающий непрерывно-рецидивирующий характер аритмии, длительная неэффективная антиаритмическая терапия препаратами в мак-симальной терапевтической дозировке и разви-тие аритмогенной кардиомиопатии [1][2][3][4]. Кро-ме того, незначительная клиническая манифес-тация сопутствующего врожденного порока сердца (ВПС), а также малая травматичность и высокая эффективность делают метод РЧА более предпочтительным у данной категории пациентов [5]. Наиболее сложными для интер-венционного лечения являются случаи, когда нарушения ритма сердца сочетаются с ВПС.…”