Journal article
An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations
The Journal of thoracic and cardiovascular surgery, Vol.148(2), pp.576-581
08/2014
DOI: 10.1016/j.jtcvs.2013.08.070
PMID: 24172692
Abstract
The study objective was to determine whether the extracardiac conduit Fontan confers an arrhythmia advantage over the intracardiac lateral tunnel Fontan.
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).
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.
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.
Details
- Title: Subtitle
- An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations
- Creators
- Seshadri Balaji - Department of Pediatrics, Oregon Health & Science University, Portland, OreAnkana Daga - Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PaDavid J Bradley - Department of Cardiology, CS Mott Children's Hospital, Ann Arbor, MichSusan P Etheridge - Department of Cardiology, Primary Children's Medical Center and University of Utah, Salt Lake City, UtahIan H Law - Department of Pediatrics, University of Iowa, Iowa City, IowaAnjan S Batra - Department of Pediatrics, University of California, Irvine, CalifShubayan Sanatani - Department of Cardiology, Children's Hospital, Vancouver, British Columbia, CanadaAnoop K Singh - Department of Cardiology, Children's Hospital of Wisconsin, Milwaukee, WisKelly K Gajewski - Department of Pediatrics, Medical University of South Carolina, Charleston, SCSabrina Tsao - Department of Cardiology, Children's Memorial Hospital, Chicago, IllHarinder R Singh - Department of Cardiology, Children's Hospital of Michigan, Detroit, MichSvjetlana Tisma-Dupanovic - Department of Cardiology, Mercy Children's Hospital, Kansas City, MoShigeru Tateno - Department of Pediatric Cardiology, Children's Hospital & Cardiovascular Center, Chiba, JapanMotoki Takamuro - Department of Pediatric Cardiology, Children's Hospital & Cardiovascular Center, Chiba, JapanHiromichi Nakajima - Department of Pediatric Cardiology, Hokkaido Medical Center, Hokkaido, JapanJolien W Roos-Hesselink - Department of Cardiology, Erasmus University, Rotterdam, The NetherlandsMaully Shah - Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: shahm@email.chop.edu
- Resource Type
- Journal article
- Publication Details
- The Journal of thoracic and cardiovascular surgery, Vol.148(2), pp.576-581
- DOI
- 10.1016/j.jtcvs.2013.08.070
- PMID
- 24172692
- ISSN
- 0022-5223
- eISSN
- 1097-685X
- Grant note
- DOI: 10.13039/100006458, name: Children's Hospital of Philadelphia
- Language
- English
- Date published
- 08/2014
- Academic Unit
- Cardiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984093336102771
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