@Article{chd.12833,
AUTHOR = {Benjamin Zielonka, Yuli Y. Kim, Gregory E. Supple, Sara L. Partington, Emily S. Ruckdeschel, Francis E. Marchlinski, David S. Frankel},
TITLE = {Improvement in ventricular function with rhythm control of atrial arrhythmias may delay the need for atrioventricular valve surgery in adults with congenital heart disease},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {6},
PAGES = {931--938},
URL = {http://www.techscience.com/schd/v14n6/38902},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Atrial arrhythmias and atrioventricular valve regurgitation (AVVR) are
common causes of morbidity among adults with congenital heart disease (ACHD).
The impact of rhythm control on AVVR in this population is unknown. We sought
to determine whether a rhythm control strategy is associated with greater freedom
from AV valve surgery than a rate control strategy.<br/>
<b>Design:</b> Patients evaluated by both ACHD and electrophysiology specialists at a single
academic center were screened for atrial arrhythmias and at least moderate‐severe
AVVR. Clinical and electrographic data were abstracted. All echocardiograms were in‐
terpreted by a single echocardiographer blinded to treatment strategy. Patients were
followed until AV valve surgery, heart transplantation, death, or last clinical follow‐up.<br/>
<b>Results:</b> Rhythm control was attempted in 9 of 24 identified patients. Among these
nine patients, arrhythmias were eliminated in three and reduced from persistent to
paroxysmal in another three. In the rhythm control group, mean left ventricular ejec‐
tion fraction improved from 54.4 ± 12.4% to 60.0 ± 11.5% (P = .02) and mean right
ventricular systolic function increased nearly one grade (P = .02). AVVR did not de‐
crease significantly. No significant change in left or right ventricular systolic function,
or AVVR was observed among the 15 patients treated with rate control. Four‐year
survival free of AV valve operation and heart transplant was 88% in the rhythm con‐
trol group and 31% in the rate control group (P = .04).<br/>
<b>Conclusions:</b> In ACHD patients with atrial arrhythmias and at least moderate‐severe
AVVR, a rhythm control strategy was associated with improved biventricular systolic
function. This improvement in ventricular function and symptoms may allow valve
surgery to be deferred.},
DOI = {10.1111/chd.12833}
}