Faculty Collaboration Database

Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network. J Thorac Cardiovasc Surg 2017 Mar;153(3):638-645.e2

Date

12/13/2016

Pubmed ID

27939495

Pubmed Central ID

PMC5328584

DOI

10.1016/j.jtcvs.2016.10.078

Scopus ID

2-s2.0-85007586964 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

OBJECTIVES: The study objective was to determine the predictors of new-onset arrhythmia among infants with single-ventricle anomalies during the post-Norwood hospitalization and the association of those arrhythmias with postoperative outcomes (ventilator time and length of stay) and interstage mortality.

METHODS: After excluding patients with preoperative arrhythmias, we used data from the Pediatric Heart Network Single Ventricle Reconstruction Trial to identify risk factors for tachyarrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, junctional ectopic tachycardia, and ventricular tachycardia) and atrioventricular block (second or third degree) among 544 eligible patients. We then determined the association of arrhythmia with outcomes during the post-Norwood hospitalization and interstage period, adjusting for identified risk factors and previously published factors.

RESULTS: Tachyarrhythmias were noted in 20% of subjects, and atrioventricular block was noted in 4% of subjects. Potentially significant risk factors for tachyarrhythmia included the presence of modified Blalock-Taussig shunt (P = .08) and age at Norwood (P = .07, with risk decreasing each day at age 8-20 days); the only significant risk factor for atrioventricular block was undergoing a concomitant procedure at the time of the Norwood (P = .001), with the greatest risk being in those undergoing a tricuspid valve procedure. Both tachyarrhythmias and atrioventricular block were associated with longer ventilation time and length of stay (P < .001 for all analyses). Tachyarrhythmias were not associated with interstage mortality; atrioventricular block was associated with mortality among those without a pacemaker in the unadjusted analysis (hazard ratio, 2.3; P = .02), but not after adding covariates.

CONCLUSIONS: Tachyarrhythmias are common after the Norwood procedure, but atrioventricular block may portend a greater risk for interstage mortality.

Author List

Oster ME, Chen S, Dagincourt N, Bar-Cohen Y, Brothers M, Cain N, Colan SD, Czosek RJ, Decker JA, Gamboa DG, Idriss SF, Kirsh JA, LaPage MJ, Ohye RG, Radojewski E, Shah M, Silver ES, Singh AK, Temple JD, Triedman J, Kaltman JR, Pediatric Heart Network Investigators

Author

Anoop K. Singh MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Arrhythmias, Cardiac
Female
Follow-Up Studies
Heart Defects, Congenital
Humans
Incidence
Infant
Infant, Newborn
Male
Norwood Procedures
Postoperative Complications
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Survival Rate
Treatment Outcome
United States