Surgical treatment of arrhythmias in adults with congenital heart defects

Background: Supraventricular and ventricular arrhythmias are a major cause of morbidity and mortality in adult patients with congenital heart disease (CHD). Intraoperative ablation offers an alternative to the complex surgical Cox-Maze procedure for these patients. We present the results of our preliminary experience with intraoperative monopolar irrigated radiofrequency ablation (IRA) in adults with CHD undergoing elective cardiac surgery. Methods: Since September 2002, 50 adults with a mean age of 39 years with CHD underwent IRA during cardiac surgery. We performed 31 right-sided Maze procedures, 13 Cox-Maze III procedures and 6 right ventricular ablations. In addition, we implanted a pace-maker into 14 patients. Results: Two patients died (2 of 50; 4%) of causes not related to the intraoperative ablation. Over an average follow-up period of 28 months the remaining 48 patients are alive in NYHA class I or II. All patients were discharged on antiarrhythmic oral treatment for 3 months. All patients underwent Holter testing 3 and 6 months after the ablation procedure and five underwent programmed ventricular tachycardia stimulation 6 months postoperatively. Forty-three patients are still in spontaneous sinus rhythm, two are in sinus rhythm on chronic oral antiarrhythmic treatment for recurrence of atrial fibrillation, two are in stable atrial fibrillation, and one has pacemaker rhythm. There were no complications from the IRA. Conclusions: Intraoperative IRA is a safe and effective procedure to control arrhythmic problems in adults with CHD. This procedure should be taken into consideration when transcatheter ablation fails or when elective cardiac surgery is planned.