Prevalence and Treatment Outcomes of Arrhythmias in Patients with Single Ventricle Physiology over the Age of 40 Years

Abstract

Background: Arrhythmias are a well known complication in patients with single ventricle physiology (SVP). However, there is still a lack of data regarding arrhythmias in older patients. The aim of this study was to analyze arrhythmia type and frequency, treatment and recurrence rates in patients with SVP over the age of 40 years. Methods: Data was obtained retrospectively from clinical records. All patients > 40 years with SVP with arrhythmias between 2005 and 2018 were included in the study. Treatment was classified as medical, interventional (electrophysiological studies (EPS) in combination with catheter ablation) or direct current cardioversion (DCCV). Results: Altogether, 29 patients (11 female; mean 47.5 ± 4.6 years) with 85 arrhythmia episodes were identified. The median follow-up time was 6.3 years. Cavo-tricuspid (CTI) and non-CTI related intra-atrial reentrant tachycardia (IART) and atrial fibrillation (AF) were most common (48.2% and 37.6%, respectively). In total, 18 EPS/ablations were performed in 9 patients and 52 DCCVs in 20 patients. Acute success was 98% for DCCV and 72.2% for EPS/ablation. Recurrence rate was high (70% for DCCV and 55% for EPS). AT recurrences occurred after a median of 8 and 2.5 months, respectively. On multivariate analyses, age was the only risk factor for arrhythmia recurrence (HR 0.58, 95% C.I. 0.43–0.78, p < 0.0001). Pacemaker implantation was necessary in seven patients (AV block n = 4, sinus node dysfunction n = 3) and one patient received an ICD for secondary prophylaxis. Sudden death occurred in three patients. Conclusions: The most common arrhythmias in patients with SVP > 40 years are IART and AF. Arrhythmia recurrence following EPS or DCCV is frequent. Older age is an independent risk factor for arrhythmia recurrence.

Pregnancy Outcomes in Women after the Fontan Procedure

“…According to the published data, an arrhythmia occurs, similarly to our observations, in 8.1-31.5% of patients [16,20,21]. Women after the Fontan procedure are prone to arrhythmia development not only due to the atrial surgical scars, sinus node disease, or altered and injured atrial tissue organization but also as a result of typical changes in the pregnant state, i.e., hyperdynamic circulation, myocardial stretch, or hormonal changes (progesterone increase) [1,13,16,22,23].…”

Safety and efficacy of cardioneuroablation for vagal bradycardia in a single arm prospective study

“…The 2018 ACC/AHA/HRS guidelines and 2021 ESC Guidelines recommend that pacemaker implantation should be considered in vagal bradycardia patients with syncope when they develop sinus arrest and/or high atrioventricular block after CNA and are > 40 years of age (Class I recommendation) 10 , 18 . However, previous studies show that patients with implanted pacemakers still experience recurrent symptoms such as vertigo or fainting, with a recurrence rate of more than 20% 19 , 20 . Additionally, vagal bradycardia often occurs in young and middle-aged patients who are reluctant to receive permanent pacemaker implantation 21 .…”

Use of an electroanatomic mapping system with high-density multipolar mapping catheters to guide transvenous atrial pacing lead implantation in a Fontan patient

“…For patients with single-ventricle physiology who undergo Fontan palliation, atrial arrhythmias and sinus node dysfunction are frequent electrophysiologic sequelae. 1 , 2 Consequently, pacemaker implantation is the most common cardiac procedure in this population, with an atrial lead typically being the most significant. 3 Epicardial pacemaker implantation has been the traditional approach but has disadvantages, including the need for repeat sternotomy or thoracotomy, challenges related to exposing viable atrial tissue, and higher pacing thresholds.…”