Seshadri Balaji1, Ankana Daga2, David J Bradley3, Susan P Etheridge4, Ian H Law5, Anjan S Batra6, Shubayan Sanatani7, Anoop K Singh8, Kelly K Gajewski9, Sabrina Tsao10, Harinder R Singh11, Svjetlana Tisma-Dupanovic12, Shigeru Tateno13, Motoki Takamuro13, Hiromichi Nakajima14, Jolien W Roos-Hesselink15, Maully Shah16. 1. Department of Pediatrics, Oregon Health & Science University, Portland, Ore. 2. Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa. 3. Department of Cardiology, CS Mott Children's Hospital, Ann Arbor, Mich. 4. Department of Cardiology, Primary Children's Medical Center and University of Utah, Salt Lake City, Utah. 5. Department of Pediatrics, University of Iowa, Iowa City, Iowa. 6. Department of Pediatrics, University of California, Irvine, Calif. 7. Department of Cardiology, Children's Hospital, Vancouver, British Columbia, Canada. 8. Department of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wis. 9. Department of Pediatrics, Medical University of South Carolina, Charleston, SC. 10. Department of Cardiology, Children's Memorial Hospital, Chicago, Ill. 11. Department of Cardiology, Children's Hospital of Michigan, Detroit, Mich. 12. Department of Cardiology, Mercy Children's Hospital, Kansas City, Mo. 13. Department of Pediatric Cardiology, Children's Hospital & Cardiovascular Center, Chiba, Japan. 14. Department of Pediatric Cardiology, Hokkaido Medical Center, Hokkaido, Japan. 15. Department of Cardiology, Erasmus University, Rotterdam, The Netherlands. 16. Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: shahm@email.chop.edu.
Abstract
OBJECTIVE: The study objective was to determine whether the extracardiac conduit Fontan confers an arrhythmia advantage over the intracardiac lateral tunnel Fontan. METHODS: This multicenter study of 1271 patients compared bradyarrhythmia (defined as need for pacing) and tachyarrhythmia (defined as needing antiarrhythmic therapy) between 602 patients undergoing the intracardiac Fontan and 669 patients undergoing the extracardiac Fontan. The median age at the time of the Fontan procedure was 2.1 years (interquartile range, 1.6-3.2 years) for the intracardiac group and 3.0 years (interquartile range, 2.4-3.9) for the extracardiac group (P < .0001). The median follow-up was 9.2 years (interquartile range, 5-12.8) for the intracardiac group and 4.7 years (interquartile range, 2.8-7.7) for the extracardiac group (P < .0001). RESULTS: Early postoperative (<30 days) bradyarrhythmia occurred in 24 patients (4%) in the intracardiac group and 73 patients (11%) in the extracardiac group (P < .0001). Early postoperative (<30 days) tachyarrhythmia occurred in 32 patients (5%) in the intracardiac group and 53 patients (8%) in the extracardiac group (P = not significant). Late (>30 days) bradyarrhythmia occurred in 105 patients (18%) in the intracardiac group and 63 patients (9%) in the extracardiac group (P < .0001). Late (>30 days) tachyarrhythmia occurred in 58 patients (10%) in the intracardiac group and 23 patients (3%) in the extracardiac group (P < .0001). By multivariate analysis factoring time since surgery, more patients in the extracardiac group had early bradycardia (odds ratio, 2.9; 95% confidence interval, 1.8-4.6), with no difference in early tachycardia, late bradycardia, or late tachycardia. CONCLUSIONS: Overall arrhythmia burden is similar between the 2 groups, but the extracardiac Fontan group had a higher incidence of early bradyarrhythmias. There was no difference in the incidence of late tachyarrhythmias over time between the 2 operations. Therefore, the type of Fontan performed should be based on factors other than an anticipated reduction in arrhythmia burden from the extracardiac conduit.
OBJECTIVE: The study objective was to determine whether the extracardiac conduit Fontan confers an arrhythmia advantage over the intracardiac lateral tunnel Fontan. METHODS: This multicenter study of 1271 patients compared bradyarrhythmia (defined as need for pacing) and tachyarrhythmia (defined as needing antiarrhythmic therapy) between 602 patients undergoing the intracardiac Fontan and 669 patients undergoing the extracardiac Fontan. The median age at the time of the Fontan procedure was 2.1 years (interquartile range, 1.6-3.2 years) for the intracardiac group and 3.0 years (interquartile range, 2.4-3.9) for the extracardiac group (P < .0001). The median follow-up was 9.2 years (interquartile range, 5-12.8) for the intracardiac group and 4.7 years (interquartile range, 2.8-7.7) for the extracardiac group (P < .0001). RESULTS: Early postoperative (<30 days) bradyarrhythmia occurred in 24 patients (4%) in the intracardiac group and 73 patients (11%) in the extracardiac group (P < .0001). Early postoperative (<30 days) tachyarrhythmia occurred in 32 patients (5%) in the intracardiac group and 53 patients (8%) in the extracardiac group (P = not significant). Late (>30 days) bradyarrhythmia occurred in 105 patients (18%) in the intracardiac group and 63 patients (9%) in the extracardiac group (P < .0001). Late (>30 days) tachyarrhythmia occurred in 58 patients (10%) in the intracardiac group and 23 patients (3%) in the extracardiac group (P < .0001). By multivariate analysis factoring time since surgery, more patients in the extracardiac group had early bradycardia (odds ratio, 2.9; 95% confidence interval, 1.8-4.6), with no difference in early tachycardia, late bradycardia, or late tachycardia. CONCLUSIONS: Overall arrhythmia burden is similar between the 2 groups, but the extracardiac Fontan group had a higher incidence of early bradyarrhythmias. There was no difference in the incidence of late tachyarrhythmias over time between the 2 operations. Therefore, the type of Fontan performed should be based on factors other than an anticipated reduction in arrhythmia burden from the extracardiac conduit.
Authors: Katarzyna Januszewska; Anna Schuh; Anja Lehner; Robert Dalla-Pozza; Edward Malec Journal: Pediatr Cardiol Date: 2017-02-10 Impact factor: 1.655
Authors: Ian H Law; Osman Alam; Edward L Bove; Richard G Ohye; David J Bradley; Sunkyung Yu; Macdonald Dick Journal: Circ Arrhythm Electrophysiol Date: 2016-12
Authors: Matthew E Oster; Shan Chen; Nicholas Dagincourt; Yaniv Bar-Cohen; Matthew Brothers; Nicole Cain; Steven D Colan; Richard J Czosek; Jamie A Decker; David G Gamboa; Salim F Idriss; Joel A Kirsh; Martin J LaPage; Richard G Ohye; Elizabeth Radojewski; Maully Shah; Eric S Silver; Anoop K Singh; Joel D Temple; John Triedman; Jonathan R Kaltman Journal: J Thorac Cardiovasc Surg Date: 2016-11-16 Impact factor: 5.209