Surgical treatment of arrhythmias in adults with congenital heart defects
Abstract
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.
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Atrial flutter and fibrillation occur in 14-22% of adults with unoperated atrial septal defects, especially in older patients, and can lead to heart failure.
“Atrial flutter and fibrillation occur in 14-22% of adults with unoperated atrial septal defects, especially in older patients, 971 and can lead to heart failure. 972”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [972]
Cites
Gatzoulis, M. A., Balaji, S., Webber, S. A., Siu, S. C., Hokanson, J. S., Poile, C., Rosenthal, M., Nakazawa, M., Moller, J. H., Gillette, P. C., et al. (2000) · The Lancet · doi:10.1016/s0140-6736(00)02714-8 · Cited by 1,779 · see citing works
Nollert, G., Fischlein, T., Bouterwek, S., Böhmer, C., Klinner, W., & Reichart, B. (1997) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(97)00318-5 · Cited by 761 · see citing works
Nakagawa, H., Yamanashi, W. S., Pitha, J. V., Arruda, M. S., Wang, X., Ohtomo, K., Beckman, K. J., McClelland, J. H., Lazzara, R., & Jackman, W. M. (1995) · Circulation · doi:10.1161/01.cir.91.8.2264 · Cited by 624 · see citing works
Atrial Arrhythmia after Surgical Closure of Atrial Septal Defects in Adults
Gatzoulis, M. Α., Freeman, M. A., Siu, S. C., Webb, G. D., & Harris, L. (1999) · New England Journal of Medicine · doi:10.1056/nejm199903183401103 · Cited by 505 · see citing works
Modification of the maze procedure for atrial flutter and atrial fibrillation
Cox, J. L., Boineau, J. P., Schuessler, R. B., Jaquiss, R. D. B., & Lappas, D. G. (1995) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(95)70244-x · Cited by 501 · see citing works
Modification of the maze procedure for atrial flutter and atrial fibrillation
Cox, J. L., Jaquiss, R. D. B., Schuessler, R. B., & Boineau, J. P. (1995) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(95)70245-8 · Cited by 482 · see citing works
Value of Programmed Ventricular Stimulation After Tetralogy of Fallot Repair
Khairy, P., Landzberg, M. J., Gatzoulis, M. Α., Lucron, H., Lambert, J., Marçon, F., Alexander, M. E., & Walsh, E. P. (2004) · Circulation · doi:10.1161/01.cir.0000126495.11040.bd · Cited by 435 · see citing works
Atrial Arrhythmias in Adults After Repair of Tetralogy of Fallot
Roos‐Hesselink, J. W., Perlroth, M. G., McGhie, J., & Spitaels, S. E. C. (1995) · Circulation · doi:10.1161/01.cir.91.8.2214 · Cited by 245 · see citing works
Atrial Arrhythmias in Adults After Repair of Tetralogy of Fallot
Perloff, J. K., & Natterson, P. D. (1995) · Circulation · doi:10.1161/01.cir.91.8.2118 · Cited by 229 · see citing works
Total cavopulmonary conversion and maze procedure for patients with failure of the Fontan operation
Mavroudis, C. D., Backer, C. L., Deal, B. J., Johnsrude, C. L., & Strasburger, J. F. (2001) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1067/mtc.2001.117840 · Cited by 213 · see citing works
MANAGEMENT OF ADULTS WITH CONGENITAL HEART DISEASE: An Increasing Problem
Somerville, J. (1997) · Annual Review of Medicine · doi:10.1146/annurev.med.48.1.283 · Cited by 188 · see citing works
Berger, F. F., Vogel, M., Kramer, A., Alexi-Meskishvili, V. V., Weng, Y., Lange, P. E., & Hetzer, R. (1999) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(99)00478-6 · Cited by 174 · see citing works
Fontan Conversion To Cavopulmonary Connection And Arrhythmia Circuit Cryoablation
Mavroudis, C. D., Backer, C. L., Deal, B. J., & Johnsrude, C. L. (1998) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(98)70316-2 · Cited by 164 · see citing works
Deanfield, J. E., McKenna, W. J., Presbitero, P., England, D., Graham, G. R., & Hallidie-Smith, K. (1984) · Heart · doi:10.1136/hrt.52.1.77 · Cited by 158 · see citing works
Sie, H. T., Beukema, W. P., Elvan, A., & Misier, A. R. R. (2004) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(03)01466-8 · Cited by 122 · see citing works
Right-Sided Maze Procedure for Right Atrial Arrhythmias in Congenital Heart Disease
Theodoro, D. A., Danielson, G. K., Porter, C.-B. J., & Warnes, C. A. (1998) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(97)01193-4 · Cited by 115 · see citing works
Atrial fibrillation surgery simplified with cryoablation to improve left atrial function
Lee, J. W., Choo, S. J., Kim, K. I., Song, J. K., Kang, D. H., Song, J. M., Song, H., Lee, S. K., & Song, M. G. (2001) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(01)03176-9 · Cited by 99 · see citing works
Kao, J. M., Alejos, J. C., Grant, P. W., Williams, R. G., Shannon, K. M., & Laks, H. (1994) · The Annals of Thoracic Surgery · doi:10.1016/0003-4975(94)91945-3 · Cited by 91 · see citing works
Deal, B. J., Mavroudis, C., Backer, C. L., Buck, S. H., & Johnsrude, C. (2002) · Circulation · doi:10.1161/01.cir.0000025876.82336.26 · Cited by 87 · see citing works
Deal, B. J., Mavroudis, C. D., & Backer, C. L. (2003) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(03)00469-7 · Cited by 80 · see citing works
Brandenburg, R. O., Holmes, D. R., Brandenburg, R. O., & McGoon, D. C. (1983) · The American Journal of Cardiology · doi:10.1016/s0002-9149(83)80048-4 · Cited by 73 · see citing works
Agnoletti, G., Borghi, A., Vignati, G., & Crupi, G. C. (2003) · Heart · doi:10.1136/heart.89.2.193 · Cited by 59 · see citing works
Giamberti, A., Chessa, M., Foresti, S., Abella, R. F., Butera, G., Vincentiis, C. D., Carminati, M., Menicanti, L., & Frigiola, A. (2006) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2006.05.010 · Cited by 52 · see citing works
Surgical Closure of Atrial Septal Defect in Adults
Perloff, J. K. (1995) · New England Journal of Medicine · doi:10.1056/nejm199508243330809 · Cited by 33 · see citing works
The care of adult patients with congenital heart defects: a new challenge.
Chessa, M., Cullen, S., Deanfield, J. E., Frigiola, A., Negura, D. G., Butera, G., Giamberti, A., Bossone, E., & Carminati, M. (2004) · PubMed · Cited by 27 · see citing works
Kopf, G. S., Mello, D. M., Kenney, K. M., Moltedo, J. M., Rollinson, N. L., & Snyder, C. S. (2002) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(02)03775-x · Cited by 18 · see citing works
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Cited by
Sorted by citations
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.08.856 · Cited by 439 · see citing works
Hernández‐Madrid, A., Paul, T., Abrams, D. J., Aziz, P. F., Blom, N. A., Chen, J., Chessa, M., Combes, N., Dagres, N., Diller, G., et al. (2018) · EP Europace · doi:10.1093/europace/eux380 · Cited by 327 · see citing works
2020 Clinical guidelines for Atrial fibrillation and atrial flutter
Arakelyan, M. S., Bockeria, L. A., Vasilieva, E., Sp, G., Golukhova, E. Z., Gorev, M. V., Davtyan, K. V., Drapkina, O. M., Станиславовна, К. Е., Kuchinskaya, Е. А., et al. (2021) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2021-4594 · Cited by 255 · see citing works
2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.09.019 · Cited by 208 · see citing works
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000310 · Cited by 183 · see citing works
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000311 · Cited by 595 · see citing works
Clinical and symptomatological reflections: the fascial system
Bordoni, B., & Zanier, E. (2014) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s68308 · Cited by 100 · see citing works
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.09.019 · Cited by 100 · see citing works
Giamberti, A., Chessa, M., Abella, R. F., Butera, G., Carlucci, C., Nuri, H. A., Frigiola, A., & Ranucci, M. (2009) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2009.05.060 · Cited by 90 · see citing works
Mavroudis, C. D., Stulak, J. M., Ad, N., Siegel, A., Giamberti, A., Harris, L., Backer, C. L., Tsao, S. S. L., Dearani, J. A., Weerasena, N. A., et al. (2014) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2014.07.026 · Cited by 39 · see citing works
Sridhar, A., Giamberti, A., Foresti, S., Cappato, R., García, C. R.-I., Cabrera, N. D., Micheletti, A., Negura, D. G., Bussadori, C. M., Butera, G., et al. (2011) · Cardiology in the Young · doi:10.1017/s1047951111000643 · Cited by 33 · see citing works
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.09.018 · Cited by 32 · see citing works
Transcatheter ablation of arrhythmias associated with congenital heart disease
Szili‐Törok, T., Környei, L., & Jordaens, L. J. L. M. (2008) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-007-9198-6 · Cited by 32 · see citing works
Atrial Tachyarrhythmias and the Cox-maze Procedure in Congenital Heart Disease
Caprarola, S. D., Earing, M. G., Singh, A. K., Tweddell, J. S., & Bartz, P. J. (2012) · Congenital Heart Disease · doi:10.1111/chd.12031 · Cited by 31 · see citing works
A comparative study of thoracoscopic and open surgery of congenital diaphragmatic hernia in neonates
Qin, J., Ren, Y., & Ma, D.-L. (2019) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-019-0938-3 · Cited by 27 · see citing works
Giamberti, A., Chessa, M., Ballotta, A., Varrica, A., Agnetti, A., Frigiola, A., & Ranucci, M. (2011) · PubMed · Cited by 24 · see citing works
Atrial Fibrillation in Patients with Congenital Heart Disease
Moe, T. G., Abrich, V. A., & Rhee, E. K. (2017) · Journal of Atrial Fibrillation · doi:10.4022/jafib.1612 · Cited by 24 · see citing works
Im, Y.-M., Kim, J. B., Yun, S., Lee, J. W., Chung, C. H., Park, J., & Yun, T.-J. (2013) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2012.12.002 · Cited by 22 · see citing works
Surgical ablation of ventricular tachycardia in patients with repaired tetralogy of Fallot†
Caldaroni, F., Rito, M. L., Chessa, M., Varrica, A., Micheletti, A., Pappone, C., & Giamberti, A. (2018) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezy407 · Cited by 21 · see citing works
Long-term results of atrial maze surgery in patients with congenital heart disease
Corcia, M. C. G., Walsh, E. P., & Emani, S. M. (2019) · EP Europace · doi:10.1093/europace/euz056 · Cited by 20 · see citing works
Giamberti, A., Pluchinotta, F., Chessa, M., Varrica, A., Vitale, R., Frigiola, A., Pappone, C., & Ranucci, M. (2016) · Europace · doi:10.1093/europace/euw278 · Cited by 15 · see citing works
Erwachsene mit angeborenen Herzfehlern
SCHMALTZ, A. A., & Bauer, U. M. M. (2013) · Herz · doi:10.1007/s00059-013-3927-7 · Cited by 18 · see citing works
Giamberti, A., Varrica, A., Pomé, G., Micheletti, A., Negura, D. G., Ranucci, M., Carminati, M., Frigiola, A., & Chessa, M. (2016) · European Heart Journal Supplements · doi:10.1093/eurheartj/suw011 · Cited by 13 · see citing works
Prophylactic arrhythmia surgery in association with congenital heart disease
Mavroudis, C. D., & Deal, B. J. (2016) · Translational Pediatrics · doi:10.21037/tp.2016.06.04 · Cited by 12 · see citing works
Decker, J. A., McCormack, J., & Cohen, M. I. (2012) · Cardiology in the Young · doi:10.1017/s1047951112001576 · Cited by 10 · see citing works
Surgical aspects of atrial arrhythmia
Uemura, H. (2016) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-016-0434-6 · Cited by 10 · see citing works
Arrhythmia Surgery for Adults with Congenital Heart Disease.
Deal, B., & Mavroudis, C. (2017) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2017.02.014 · Cited by 6 · see citing works
Outcomes of Atrial Arrhythmia Surgery in Patients With Congenital Heart Disease: A Systematic Review
Houck, C., de Groot, N. D., Kardys, I., Niehot, C., Bogers, A., & Mouws, E. (2020) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.120.016921 · Cited by 6 · see citing works
Recommendations for starting a grown up congenital heart disease (GUCH) unit
Amaral, F., Manso, P. H., Schmidt, A., Sgarbieri, R. N., Vicente, W. V. D. A., Carbone, C., & Somerville, J. (2015) · Brazilian Journal of Cardiovascular Surgery · doi:10.5935/1678-9741.20150037 · Cited by 7 · see citing works
Recent insights into atrial chamber formation
Albu, M., Sedmera, D., & Stainier, D. Y. R. (2025) · Seminars in Cell and Developmental Biology · doi:10.1016/j.semcdb.2025.103664 · Cited by 5 · see citing works
Poretti, G., Hoxha, S., Segreto, A., Gardellini, J., Sandrini, C., Faggian, G. G., Varrica, A., Chessa, M., Giamberti, A., & Luciani, G. B. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.770221 · Cited by 4 · see citing works
Ventricular Tachycardia Ablation in Adult Congenital Heart Disease
Wallet, J., Kimura, Y., & Zeppenfeld, K. (2022) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2022.06.008 · Cited by 4 · see citing works
Concomitant arrhythmia surgery in patients with congenital heart disease
Ramdjan, T. T. T. K., Mouws, E. M. J. P., Kik, C., Roos‐Hesselink, J. W., Bogers, A. J. J. C., & de Groot, N. M. S. (2018) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1093/icvts/ivy181 · Cited by 4 · see citing works
Surgical ablation of atrial arrhythmias: The electrophysiologist's point of view
Sarubbi, B. (2015) · Progress in Pediatric Cardiology · doi:10.1016/j.ppedcard.2015.10.014 · Cited by 2 · see citing works
Surgical treatment of arrhythmias in adults with congenital heart defects
Graham, T. (2009) · Yearbook of Cardiology · doi:10.1016/s0145-4145(08)79442-5 · Cited by 3 · see citing works
Surgical and Transcatheter Management of Arrhythmias
Deal, B. J., & Mavroudis, C. D. (2023) · doi:10.1002/9781119282327.ch42 · Cited by 1 · see citing works
Giamberti, A. (2012) · Springer eBooks · doi:10.1007/978-88-470-2358-1_13
Tadeu, F., Amaral, V., Manso, P. H., Sgarbieri, R. N., de Andrade, W. V., Carbone, C., & Somerville, J. (2015)
Surgery for arrhythmias and congenital heart disease: is the combined approach effective?
Giamberti, A. (2018) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1093/icvts/ivy249
Yamakura, M. U. F. (2012)
Early outcomes of usage of cryoFORM® probe for cryomaze procedure in congenital heart surgery
Altın, H. F., Ballı, Ş., Çiçek, M., Yurdakök, O., Korun, O., Şaşmazel, A., & Aydemir, N. A. (2020) · Cardiology in the Young · doi:10.1017/s1047951120003029
Preoperative Diagnostic Evaluation
Deal, B. J., Hauck, A. L., Tsao, S. S. L., Patel, A., Lee, S., & McElhinney, D. B. (2023) · Wiley eBooks · doi:10.1002/9781119282327.ch4
Surgical Treatment of Arrhythmias and Conduction Disorders
Deal, B. J., & Mavroudis, C. D. (2023) · Springer eBooks · doi:10.1007/978-1-4471-4999-6_143-2
- Authors
- Giamberti, A., Chessa, M., Abella, R., Butera, G., Negura, D., Foresti, S., Carminati, M., Cappato, R., & Frigiola, A.
- Affiliations
- IRCCS Policlinico San Donato (IT)
- Corresponding author
- Giamberti, Alessandro
- ORCID
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-09
- Volume
- 129
- Issue
- 1
- Pages
- 37-41
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2045050762
- Cited by
- 46
- References
- 26
- Citations by year
- 2025: 1 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 7 · 2015: 9 · 2014: 2 · 2013: 2 · 2012: 4
- FWCI
- 0.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- intraoperative radiofrequency ablation, congenital heart disease, supraventricular arrhythmias, ventricular arrhythmias, atrial fibrillation, Cox-Maze III procedure, antiarrhythmic drugs, pacemaker implantation, elective cardiac surgery
- MeSH terms
- Adolescent, Adult, Aged, Arrhythmias, Cardiac, Female, Follow-Up Studies, Heart Defects, Congenital, Humans, Intraoperative Care, Male, Middle Aged, Cardiovascular Surgical Procedures, Treatment Outcome, Catheter Ablation
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