Arrhythmia burden in congenitally corrected transposition of the great arteries: Does treatment pathway matter?

Abstract

Background: There are limited data comparing arrhythmia burden of patients with congenitally corrected transposition of the great arteries (cc-TGA) undergoing anatomic repair, physiologic repair, and nonsurgical management.

Objective: We aimed to examine the difference in rate of bradyarrhythmias and tachyarrhythmias in patients with cc-TGA stratified by treatment pathway.

Methods: A retrospective cohort study was conducted including all patients with cc-TGA observed at Cleveland Clinic Children's (1995-2021).

Results: A total of 170 patients were included with a median follow-up of 11.8 years: 82 with anatomic repair (median age, 1.5 years), 46 with physiologic repair (median age, 25.2 years), and 42 with nonsurgical management (median age, 35.7 years). Heart block/permanent pacemaker implantation occurred in 49 (29%) patients, with higher prevalence in the physiologic repair group compared with anatomic repair and nonsurgical management (50% vs 22% vs 19%; P = .001). Freedom from postoperative complete heart block/permanent pacemaker implantation at 5 years was higher in patients who underwent anatomic repair vs physiologic repair (85% vs 68%; P = .02). Tachyarrhythmias affected 29% of patients, with varying prevalence of atrial fibrillation and atrial flutter based on treatment pathway. Atrial fibrillation was more prevalent in physiologic repair and nonsurgical management groups compared with the anatomic repair group (30% vs 31% vs 0%; P < .0001). Prevalence of atrial flutter was 9.8% vs 13% vs 0% in the anatomic repair, physiologic repair, and nonsurgical management groups, respectively.

Conclusion: Burden and type of arrhythmias in patients with cc-TGA varied on the basis of treatment pathway. Further studies assessing long-term follow-up after anatomic repair are needed to identify the surgical approach that would yield the lowest arrhythmia morbidity.