Value of provocative electrophysiology testing in the management of pediatric patients after congenital heart surgery

Dionne A, Kheir JN, Gauvreau K, Triedman JK, Abrams DJ, Alexander ME, DeWitt ES, Mah DY, Walsh EP, Bezzerides VJ.
Pacing Clin Electrophysiol. 2020 Apr 24. doi: 10.1111/pace.13925. [Epub ahead of print] PMID: 32329521
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Objective: To determine the impact of provocative electrophysiology testing in post-operative congenital heart disease (CHD) patients on the management of supraventricular tachycardia (SVT) and clinical outcomes.

Methods: This is a retrospective study including patients < 18 years of age with surgery for CHD who had post-operative SVT between 2006-2017. Post-operative outcomes were compared between patients with and without post-operative electrophysiology testing using the Wilcoxon rank sum test, Fisher’s exact test, Kaplan-Meier method with the log-rank test and Cox proportional hazard model.

Results: From 341 patients who had SVT after surgery for CHD, 65 (19%) had post-operative electrophysiology testing. There was no significant difference in baseline patient characteristics or surgical complexity between patients with and without electrophysiology testing. Patients with inducible SVT on electrophysiology testing were more likely to have recurrence of SVT prior to hospital discharge with an odds ratio 4.0 [95% confidence interval 1.3, 12.0]. Patients who underwent post-operative electrophysiology testing had shorter intensive care unit (12 [6, 20] vs. 16 [9, 32] days, HR 2.1 [95% CI 1.6, 2.8], p<0.001) and hospital (25 [13, 38] vs 31 [18, 54] days, HR 1.8 [95% CI 1.4, 2.4], p<0.001) length of stay.

Conclusion: Post-operative electrophysiology testing was associated with improved post-operative outcomes, likely related to the ability to predict recurrence of arrhythmia and tailored antiarrhythmic management. This article is protected by copyright. All rights reserved.