An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations

被引：57

作者：

Balaji, Seshadri ^{[1
]}

Daga, Ankana ^{[2
]}

Bradley, David J. ^{[3
]}

Etheridge, Susan P. ^{[4
,5
]}

Law, Ian H. ^{[6
]}

Batra, Anjan S. ^{[7
]}

Sanatani, Shubayan ^{[8
]}

Singh, Anoop K. ^{[9
]}

Gajewski, Kelly K. ^{[10
]}

Tsao, Sabrina ^{[11
]}

Singh, Harinder R. ^{[12
]}

Tisma-Dupanovic, Svjetlana ^{[13
]}

Tateno, Shigeru ^{[14
,15
]}

Takamuro, Motoki ^{[14
,15
]}

Nakajima, Hiromichi ^{[16
]}

Roos-Hesselink, Jolien W. ^{[17
]}

Shah, Maully ^{[2
]}

机构：

[1] Oregon Hlth & Sci Univ, Dept Pediat, Portland, OR 97201 USA

[2] Childrens Hosp Philadelphia, Dept Cardiol, Philadelphia, PA 19104 USA

[3] Univ Michigan, CS Mott Childrens Hosp, Dept Cardiol, Ann Arbor, MI 48109 USA

[4] Primary Childrens Med Ctr, Dept Cardiol, Salt Lake City, UT 84103 USA

[5] Univ Utah, Salt Lake City, UT USA

[6] Univ Iowa, Dept Pediat, Iowa City, IA 52242 USA

[7] Univ Calif Irvine, Dept Pediat, Irvine, CA 92717 USA

[8] British Columbia Childrens Hosp, Dept Cardiol, Vancouver, BC V6H 3V4, Canada

[9] Childrens Hosp Wisconsin, Dept Cardiol, Milwaukee, WI 53201 USA

[10] Med Univ S Carolina, Dept Pediat, Charleston, SC 29425 USA

[11] Childrens Mem Hosp, Dept Cardiol, Chicago, IL 60614 USA

[12] Childrens Hosp Michigan, Dept Cardiol, Detroit, MI 48201 USA

[13] Childrens Mercy Hosp, Dept Cardiol, Kansas City, MO 64108 USA

[14] Childrens Hosp, Dept Pediat Cardiol, Chiba, Japan

[15] Ctr Cardiovasc, Chiba, Japan

[16] Hokkaido Med Ctr, Dept Pediat Cardiol, Sapporo, Hokkaido, Japan

[17] Erasmus Univ, Dept Cardiol, Rotterdam, Netherlands

来源：

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY | 2014年 / 148卷 / 02期

关键词：

SINUS NODE DYSFUNCTION; TOTAL CAVOPULMONARY CONNECTION; RIGHT HEART BYPASS; ATRIOPULMONARY CONNECTION; AGE;

D O I：

10.1016/j.jtcvs.2013.08.070

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：576 / 581

页数：6

共 18 条

[1] Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: Impact on outcomes [J].