Clinical Analysis Of 64 Cases With Ebstein's Anomaly In Adults

Objective:To observe the evolution of arrhythmias after surgical treatment in adult patients with Ebstein's anomaly.Methods:Sixty-four patients of Ebstein's anomaly with or without arrhythmias were reviewed from April 2005 to January 2011 in Second Xiangya Hospital.28 Male and 36 Female, mean age was 34.2±10.9 years. Twenty-two patients(34%) had arrhythmias,12(54.5%) had ventricular preexcitation (Wolff-Parkinson-White syndrome)(include one W-P-W syndrome combining with atrial fibrillation),8(36.4%) had atrial fibrillation, and 2(9.1%) had paroxysmal supraventricular tachycardia. All the patients have accepted relevant surgical intervention such as tricuspid valve plasty (TVP), tricuspid valve replacement(TVR), atrialized ventricle plication, interrruption or surgical ablation of accessory pathways.The univariate analysis and logistic regression were undertaken to explore the early and late death risk factors.Results:There were two hospital deaths (3.1%). During a mean follow-up of 3.8±1.5 years,55 survivors(94.8%) were in NYHA functional classⅠorⅡ,2 survivors(3.5%) were inclassⅢ. There were one additional deaths (1.7%). Four patients were lost to follow-up. The univariate and regression analysis showed that history of cardiac operations and the failure symptoms of right ventricle such as ascites and hepatomegaly were the independent risk factors for the early and late death.22 patients with arrhythmias preoperative,1 patient died,2 patients were lost to follow-up,12(57.1%) were in permanent sinus rhythm,7 patients continued to have symptomatic arrhythmias, include 1(4.8%) W-P-W syndrome and 6(28.6%) atrial flutter/fibrillation. The incidence of arrhythmia with or without symptoms was reduced to 36.8%(7/19) of the surviving patients, P value<0.001.Conclusions:History of cardiac operations and the failure symptoms of right ventricle were the independent risk factors for the early and late death. Patients with Ebstein's anomaly and arrhythmia show substantial improvement after conservative surgical intervention, Patients with documented tachycardia or a history of palpitations should undergo preoperative electrophysiologic testing, and surgical treatment for arrhythmias should be positive.