Key result
Pediatric congenital heart disease patients with late postoperative atrial flutter achieved a significantly lower percentage of predicted maximum heart rate compared to controls (67% vs 80%, P<0.001).
Why the study?
Is late postoperative atrial flutter associated with chronotropic incompetence in young congenital heart disease patients?
Case-Control (n=84)
Is late postoperative atrial flutter associated with chronotropic incompetence in young congenital heart disease patients?
Absolute Event Rate: 67% vs 80%
p-value: p=<0.001
Late postoperative atrial flutter in pediatric congenital heart disease patients is strongly associated with chronotropic incompetence, suggesting a potential role for rate-adaptive pacing to reduce flutter risk.
Late postoperative atrial flutter was associated with chronotropic incompetence in pediatric CHD; leaves open whether rate-adaptive pacing reduces risk.
AIMS: Atrial flutter causes late postoperative morbidity in congenital heart disease (CHD). Sinoatrial node dysfunction is associated with late postoperative atrial flutter, but pacing interventions driven by minimum heart rates (HR) have yielded mixed results. METHODS AND RESULTS: A retrospective case-control study was used to test the hypothesis that late postoperative atrial flutter is associated with chronotropic incompetence in active young CHD patients. Control CHD patients aged < or =18 years without documented supraventricular ectopy (n = 42) were matched with 42 patients (cases) having atrial flutter onset > or =6 months postoperatively. Minimum, average, and maximum non-flutter HRs were obtained from outpatient ambulatory 24 h ECG (Holter) recordings and graded exercise tests. Chronotropic competence was assessed using percentage of age-specific predicted maximum HR achieved, and calculated chronotropic index. Effects of rate-adaptive programming and maximum atrial pacing rates were analysed in 19 permanently paced cases. Least square estimates of minimum HRs were similar in cases and controls (54+/-2 vs. 52+/-2 bpm). Average HRs were lower in cases (75+/-2 vs. 81+/-2 bpm, P=0.02). Cases and controls differed most significantly with respect to percentage of predicted maximum HR achieved (67+/-2 vs. 80+/-2%, P < 0.001). This difference remained highly significant when the data were adjusted for age, sex, permanent pacing, and negatively chronotropic medication usage at the time of testing. Among paced patients, atrial flutter was significantly less likely to be observed in the setting of rate-adaptive pacing [odds ratio (OR) = 0.36; P < 0.05], and the likelihood of detecting atrial flutter decreased relative to the maximum programmed atrial pacing rate (OR 0.87 for every 5% increment in maximum pacing rate relative to maximum predicted HR for age; P < 0.05). CONCLUSION: Late postoperative atrial flutter is associated with chronotropic incompetence in paediatric CHD patients.
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N. Anand (2006) conducted a case-control in Late postoperative atrial flutter in congenital heart disease (n=84). Late postoperative atrial flutter vs. No supraventricular ectopy was evaluated on Percentage of age-specific predicted maximum heart rate achieved (p=<0.001). Pediatric congenital heart disease patients with late postoperative atrial flutter achieved a significantly lower percentage of predicted maximum heart rate compared to controls (67% vs 80%, P<0.001).