Faculty Collaboration Database

An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations. J Thorac Cardiovasc Surg 2014 Aug;148(2):576-81

Date

11/01/2013

Pubmed ID

24172692

DOI

10.1016/j.jtcvs.2013.08.070

Scopus ID

2-s2.0-84904672681 (requires institutional sign-in at Scopus site)   71 Citations

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.

Author List

Balaji S, Daga A, Bradley DJ, Etheridge SP, Law IH, Batra AS, Sanatani S, Singh AK, Gajewski KK, Tsao S, Singh HR, Tisma-Dupanovic S, Tateno S, Takamuro M, Nakajima H, Roos-Hesselink JW, Shah M

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

Anti-Arrhythmia Agents
Bradycardia
Cardiac Pacing, Artificial
Chi-Square Distribution
Child, Preschool
Female
Fontan Procedure
Heart Defects, Congenital
Humans
Incidence
Infant
Kaplan-Meier Estimate
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Patient Selection
Prevalence
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Tachycardia
Time Factors
Treatment Outcome