A Common Angiotensin-Converting Enzyme (ACE) Polymorphism and Preoperative ACE Inhibition Modify Risk of Tachyarrhythmias After Congenital Heart Surgery

BACKGROUND:

The angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism is described in association with numerous phenotypes including arrhythmias, and may provide predictive value among pediatric patients undergoing congenital heart surgery.

OBJECTIVE:

To examine the role of a common polymorphism on postoperative tachyarrhythmias in a large cohort of pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB).

METHODS:

Subjects undergoing congenital heart surgery with CPB at our institution were consecutively enrolled from September 2007 through December 2012. In addition to DNA, perioperative clinical data were obtained from subjects.

RESULTS:

Postoperative tachyarrhythmias were documented in 45% of 886 enrollees, and 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). I/D or D/D genotypes were independently associated with a 60% increase in odds of new tachyarrhythmia (OR 1.6, 95%CI 1.1-2.3, p=0.02). 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), driven by a five-fold reduction in tachyarrhythmias among I/I genotype patients (OR 0.19, 95% CI 0.04-0.88, p=0.02).

CONCLUSIONS:

The risk of tachyarrhythmias after congenital heart surgery is independently affected by the ACE I/D polymorphism. Preoperative ACE inhibition is associated with a lower risk of postoperative tachyarrhythmias, an antiarrhythmic effect that appears genotype dependent. An understanding of genotype variation may play an important role in the perioperative management of congenital heart surgery.