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Congenital heart disease tied to sudden cardiac arrest

NEW YORK (Reuters Health) – Subaortic ventricular systolic dysfunction was the dominant predictor of sudden cardiac arrest in a study of adult survivors of repaired congenital heart disease.

In an April 5 online paper in the American Journal of Cardiology, Dr. Jose Maria Oliver of La Paz University Hospital, Madrid, and colleagues note that although sudden cardiac arrest is among leading causes of death in these patients, little is known about determinants.

To gain more information, the researchers reviewed data on 936 adults with previously repaired congenital heart disease whom they’d been following for an average of nine years. The mean age at first examination was 21.

Among the most common congenital defects were tetralogy of Fallot (216), coarctation of the aorta (157), and transposition complexes (99).

During 8,387 person-years, 22 patients had sudden cardiac arrests (2.6 per 1,000 person-years), including two who had appropriate shocks for ventricular fibrillation from devices that had been implanted prophylactically. Fifteen patients died, but five were successfully resuscitated and were given implantable cardioverter-defibrillators.

The highest incidence of sudden cardiac arrest was in patients with transposition complexes (10 per 1,000 person-years).

Independent predictors included age at initial examination and severely impaired subaortic ventricular systolic function. In fact, 23% of the latter group sustained a sudden arrest, compared to only 0.7% of patients in whom function was decreased but not severely.

“There is controversy as to whether patients with congenital heart disease and severe subaortic ventricular systolic dysfunction should undergo prophylactic implantable cardioverter- defibrillator implantation,” the researchers wrote. “Our data support the consideration of primary prevention strategies in these patients.”

Dr. Oliver did not respond to requests for comments.


Am J Cardiol 2012.