Laura E Murray1, Andrew H Smith2, English C Flack3, Kim Crum3, Jill Owen3, Prince J Kannankeril3. 1. Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: laura.e.murray@vanderbilt.edu. 2. Department of Pediatrics, Thomas P. Graham Jr. Division of Cardiology, Nashville, Tennessee,; Division of Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. 3. Department of Pediatrics, Thomas P. Graham Jr. Division of Cardiology, Nashville, Tennessee.
Abstract
BACKGROUND: Complete heart block (CHB) is a major complication that occurs after congenital heart surgery. We hypothesized that genetic and clinical factors are associated with the development of postoperative CHB and recovery of atrioventricular (AV) conduction. OBJECTIVE: The purpose of this study was to identify predictors of CHB and recovery after congenital heart surgery. METHODS: Patients undergoing congenital heart surgery at our institution from September 2007 through June 2015 were prospectively enrolled in a parent study of postoperative arrhythmias. Patients with onset of CHB within 48 hours postoperatively were included in the study. Daily rhythm assessment was performed until demonstration of 1:1 conduction or pacemaker implantation. RESULTS: Of 1199 subjects enrolled, 56 (4.7%) developed postoperative CHB. In multivariate analysis, preoperative digoxin exposure (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.4), aortic cross-clamp time (OR 1.08, 95% CI 1.04-1.11), ventricular septal defect closure (OR 2.2, 95% CI 1.2-4.1), and a common polymorphism in the gene encoding connexin-40 (GJA5 rs10465885 TT genotype; OR 2.1, 95% CI 1.2-3.8) were independently associated with postoperative CHB. Junctional acceleration (JA) (OR 4.0, 95% CI 1.1-15.1) and intermittent conduction noted during complete AV block (OR 9.1, 95% CI 1.0-80) were independently associated with 1:1 AV conduction recovery. Use of a multivariate model including both JA and intermittent conduction demonstrated good discrimination with a positive predictive value of 86% (95% CI 67%-96%) in predicting 1:1 conduction recovery. CONCLUSION: Preoperative factors, including a missense polymorphism in GJA5, are independently associated with increased risk for CHB. JA and intermittent conduction may prove useful in predicting recovery of AV conduction among patients with CHB after congenital heart surgery. Copyright Â
BACKGROUND: Complete heart block (CHB) is a major complication that occurs after congenital heart surgery. We hypothesized that genetic and clinical factors are associated with the development of postoperative CHB and recovery of atrioventricular (AV) conduction. OBJECTIVE: The purpose of this study was to identify predictors of CHB and recovery after congenital heart surgery. METHODS:Patients undergoing congenital heart surgery at our institution from September 2007 through June 2015 were prospectively enrolled in a parent study of postoperative arrhythmias. Patients with onset of CHB within 48 hours postoperatively were included in the study. Daily rhythm assessment was performed until demonstration of 1:1 conduction or pacemaker implantation. RESULTS: Of 1199 subjects enrolled, 56 (4.7%) developed postoperative CHB. In multivariate analysis, preoperative digoxin exposure (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.4), aortic cross-clamp time (OR 1.08, 95% CI 1.04-1.11), ventricular septal defect closure (OR 2.2, 95% CI 1.2-4.1), and a common polymorphism in the gene encoding connexin-40 (GJA5rs10465885 TT genotype; OR 2.1, 95% CI 1.2-3.8) were independently associated with postoperative CHB. Junctional acceleration (JA) (OR 4.0, 95% CI 1.1-15.1) and intermittent conduction noted during complete AV block (OR 9.1, 95% CI 1.0-80) were independently associated with 1:1 AV conduction recovery. Use of a multivariate model including both JA and intermittent conduction demonstrated good discrimination with a positive predictive value of 86% (95% CI 67%-96%) in predicting 1:1 conduction recovery. CONCLUSION: Preoperative factors, including a missense polymorphism in GJA5, are independently associated with increased risk for CHB. JA and intermittent conduction may prove useful in predicting recovery of AV conduction among patients with CHB after congenital heart surgery. Copyright Â
Authors: Robert C Wirka; Shamone Gore; David R Van Wagoner; Dan E Arking; Steven A Lubitz; Kathryn L Lunetta; Emelia J Benjamin; Alvaro Alonso; Patrick T Ellinor; John Barnard; Mina K Chung; Jonathan D Smith Journal: Circ Arrhythm Electrophysiol Date: 2010-11-13
Authors: Angela Lin; William T Mahle; Patricio A Frias; Peter S Fischbach; Brian E Kogon; Kirk R Kanter; Paul M Kirshbom Journal: J Thorac Cardiovasc Surg Date: 2010-04-09 Impact factor: 5.209
Authors: Gil J Gross; Christine C Chiu; Robert M Hamilton; Joel A Kirsh; Elizabeth A Stephenson Journal: Heart Rhythm Date: 2006-02-28 Impact factor: 6.343
Authors: B A VanderBrink; C Sellitto; S Saba; M S Link; W Zhu; M K Homoud; N A Estes; D L Paul; P J Wang Journal: J Cardiovasc Electrophysiol Date: 2000-11
Authors: Peter F Aziz; Gerald A Serwer; David J Bradley; Martin J LaPage; Jennifer C Hirsch; Edward L Bove; Richard G Ohye; Macdonald Dick Journal: Pediatr Cardiol Date: 2012-11-22 Impact factor: 1.655
Authors: Woon-Puay Koh; Jian-Min Yuan; Can-Lan Sun; David van den Berg; Adeline Seow; Hin-Peng Lee; Mimi C Yu Journal: Cancer Res Date: 2003-02-01 Impact factor: 12.701
Authors: Sarah R Fuchs; Andrew H Smith; Sara L Van Driest; Kim F Crum; Todd L Edwards; Prince J Kannankeril Journal: Heart Rhythm Date: 2018-12-05 Impact factor: 6.343
Authors: Maully J Shah; Michael J Silka; Jennifer N Avari Silva; Seshadri Balaji; Cheyenne M Beach; Monica N Benjamin; Charles I Berul; Bryan Cannon; Frank Cecchin; Mitchell I Cohen; Aarti S Dalal; Brynn E Dechert; Anne Foster; Roman Gebauer; M Cecilia Gonzalez Corcia; Prince J Kannankeril; Peter P Karpawich; Jeffery J Kim; Mani Ram Krishna; Peter Kubuš; Martin J LaPage; Douglas Y Mah; Lindsey Malloy-Walton; Aya Miyazaki; Kara S Motonaga; Mary C Niu; Melissa Olen; Thomas Paul; Eric Rosenthal; Elizabeth V Saarel; Massimo Stefano Silvetti; Elizabeth A Stephenson; Reina B Tan; John Triedman; Nicholas H Von Bergen; Philip L Wackel Journal: Indian Pacing Electrophysiol J Date: 2021-07-29