Key result
Concomitant arrhythmia ablation during surgical repair of Ebstein's anomaly eliminated sudden death (0% vs 30% in those without preoperative electrophysiological evaluation).
Why the study?
Does preoperative electrophysiological evaluation and concomitant arrhythmia ablation reduce sudden death in patients with Ebstein's anomaly undergoing surgical repair?
Observational (n=30)
No
Does preoperative electrophysiological evaluation and concomitant arrhythmia ablation reduce sudden death in patients with Ebstein's anomaly undergoing surgical repair?
Absolute Event Rate: 0% vs 30%
Preoperative electrophysiological evaluation and concomitant arrhythmia ablation during surgical repair of Ebstein's anomaly is associated with a reduction in sudden death.
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Supports preoperative EP evaluation with ablation in Ebstein's repair; leaves open randomized confirmation of sudden death reduction.
BACKGROUND: Repairing Ebstein's anomaly without correction of associated arrhythmia may result in sudden death. Catheter or surgical ablation is indicated for various symptomatic tachyarrhythmias in Ebstein's anomaly. METHODS: Between October 1973 and October 1997, 30 patients with Ebstein's anomaly underwent surgical repair in our hospital. Tricuspid valve replacement was performed in 13 patients, tricuspid annuloplasty and valvuloplasty in the remaining 17 patients. Preoperative electrophysiological studies were performed in 11 patients after 1980. Concomitant arrhythmia ablation was done in 10 patients: 4 for Wolff-Parkinson-White syndrome, 2 for atrioventricular (AV) nodal reentrant tachycardia, one for ventricular tachycardia and 3 for paroxysmal atrial flutter and fibrillation. RESULTS: No mortality or major morbidity occurred in those patients undergoing arrhythmia intervention. There were 7 deaths in total; 6 died suddenly, and the other died of purulent mediastinitis. None of the 6 sudden deaths underwent preoperative electrophysiological evaluation. The functional recovery was good in all survivals. CONCLUSIONS: We conclude that detailed preoperative electrophysiological evaluation in patients with Ebstein's anomaly is mandatory. Aggressive surgical intervention of the associated arrhythmias in addition to anatomic correction can reduce the sudden death in Ebstein's anomaly.
Huang et al. (2000) conducted an observational in Ebstein's anomaly (n=30). Preoperative electrophysiological studies and concomitant arrhythmia ablation vs. No preoperative electrophysiological evaluation and ablation was evaluated on Sudden death. Concomitant arrhythmia ablation during surgical repair of Ebstein's anomaly eliminated sudden death (0% vs 30% in those without preoperative electrophysiological evaluation).