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Atrial flutter (AFL) frequently develops in patients with congenital heart defects (CHD) after palliative or corrective cardiac surgery.1 Post-operative AFL is an important clinical problem as the presence of AFL is associated with both increased morbidity and mortality.2 Strategies to prevent the occurrence of post-operative AFL are therefore necessary. However, in order to prevent post-operative AFL, knowledge of the underlying mechanism resulting in the development of these tachyarrhythmias is mandatory.In line with the observation that chronotropic incompetence predisposes to recurrent episodes of atrial fibrillation (AF), Anand et al . tested the hypothesis that sinoatrial node dysfunction and associated chronic bradycardia may also predispose to AFL after cardiac surgery for CHD. If a relationship could be established between chronotropic incompetence and post-operative AFL, pacing manoeuvres aimed at restoring chronotropic competence may serve a valuable prevention strategy.Sinus node dysfunction in CHD patients is caused by direct damage to the sinus node or the sinus node blood supply during cardiac surgery. Furthermore, sinus node dysfunction may be the result of the underlying congenital disorder. Damage to the sinus node and its artery can be the result of cannulation of the superior caval vein, the atriotomy, or the … *Corresponding author. Tel: +31 (0) 71 526 2020; fax: +31 (0) 71 522 6567. E-mail address : n.m.s.de_groot{at}lumc.nl

european heart journal

The relationship between sinus node dysfunction, bradycardia-mediated atrial remodelling, and post-operative atrial flutter in patients with congenital heart defects