Premium
Risks and outcomes of direct current cardioversion in children and young adults with congenital heart disease
Author(s) -
Morello Melissa L.,
Khoury Philip R.,
Knilans Timothy K.,
Veldtman Gruschen,
Spar David S.,
Anderson Jeffery B.,
Czosek Richard J.
Publication year - 2018
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13315
Subject(s) - medicine , heart disease , retrospective cohort study , logistic regression , pediatrics , cardioversion , univariate analysis , adverse effect , atrial fibrillation , multivariate analysis
Objectives Evaluate the efficacy, outcomes, and complications associated with direct current cardioversion (DCCV) in the treatment of arrhythmias in pediatric and adult congenital heart disease (CHD) populations and identify patient and procedural characteristics associated with adverse events. Background Pediatric and adult patients with CHD are at risk of atrial arrhythmias. DCCV is effective but is associated with potential complications. Methods In this single‐center retrospective series, patients who underwent DCCV between January 2010 and May 2015 were identified and categorized as pediatric (<18 years) or adult (> 18 years). Records were reviewed for demographic, arrhythmic, and CHD‐specific characteristics; acute efficacy; and 3‐month arrhythmia recurrence. Complications were categorized as life‐threatening (LT) or non‐life‐threatening (NLT). Univariate followed by multiple variable and logistic regression (LR) analyses were used to identify characteristics associated with complications. Results We identified 104 patients with 152 discrete DCCV events with median age 17.4 years (0.15–62.2). DCCV efficacy was 89% with 3‐month recurrence of 46%. There were 52 complications among 24 patients, median age 17.7 years (0.15–49). Risks associated with NLT complications are as follows: moderate–severe systolic dysfunction (8/152 encounters, P = < 0.01) and more than one shock per DCCV encounter (P = < 0.01). Six of eight encounters with moderate–severe systolic dysfunction were <18 years (P = 0.1). Risks for LT complications included age >18 years and associated NLT complication. Adults had more frequent arrhythmia recurrence within 3 months than children (P = < 0.01). Conclusions DCCV is effective for arrhythmias but is associated with frequent recurrence, particularly in adult patients. Complications associated with DCCV may be greater than previously reported. Additional support and precautions should be in place for those at greatest risk.