Abstract 9463: Clinical and Genetic Evidence for Angiotensin Converting Enzyme Inhibition to Prevent Postoperative Tachyarrhythmias After Congenital Heart Surgery
Background: The common insertion/deletion polymorphism in the gene encoding angiotensin-converting enzyme (ACE I/D) has been described in association with tachyarrhythmias. We prospectively examined the role of this polymorphism in a large cohort of pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB).
Methods: Subjects undergoing congenital heart surgery at our institution were consecutively recruited and enrolled from September 2007 through December 2012. In addition to DNA, demographic and perioperative clinical data were obtained from all subjects.
Results: Over the study period, 886 subjects undergoing congenital heart surgery with CPB were enrolled. Postoperative tachyarrhythmias were documented in 45% of patients, most commonly ventricular tachycardia (16%), junctional ectopic tachycardia (11%), and atrial tachycardia (10%). Postoperative tachyarrhythmias were associated with prolonged mechanical ventilation (p<0.001) and ICU length of stay (p<0.001). ACE I/D was in Hardy-Weinberg equilibrium (19% I/I, 49% I/D, 32% D/D). Tachyarrhythmias were noted in 47% of index cases with I/D or D/D genotypes, relative to 36% of cases with an I/I genotype (p=0.01). Presence of the I/D or D/D genotype was associated with a 60% increase in odds of new tachyarrhythmia (OR 1.6, 95%CI 1.1-2.3, p=0.02), independent of significant univariate predictors. While preoperative ACE inhibitor administration was independently associated with a 47% reduction in odds of postoperative tachyarrhythmia in the entire cohort (OR 0.53, 95%CI 0.32-0.88, p=0.01), this reduction was driven primarily by a five-fold reduction in tachyarrhythmias among patients with the I/I genotype (OR 0.19, 95% CI 0.04-0.88, p=0.02).
Conclusions: The risk of tachyarrhythmias after congenital heart surgery is affected by the ACE I/D polymorphism, independent of other known risk factors. Preoperative ACE inhibition is associated with a lower risk of postoperative tachyarrhythmias, and this antiarrhythmic effect appears genotype dependent. Given the associated morbidity of postoperative arrhythmias, an understanding of genotype variation may play an important role in the perioperative management of congenital heart surgery.
- © 2013 by American Heart Association, Inc.