Predictors of Early Postoperative Supraventricular Tachyarrhythmias in Children After the Fontan Procedure (original) (raw)
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Predictors of Early and Late-Onset Supraventricular Tachyarrhythmias After Fontan Operation
Background-The objectives of our study were to determine the frequency of supraventricular tachyarrhythmias (SVTAs) among modifications of the Fontan operation and identify risk factors for developing SVTA. Methods and Results-The population consisted of all patients who had any modification of the Fontan operation at the Mayo Clinic between 1985 and 1993. Clinically significant SVTAs were those requiring initiation or change of antiarrhythmic treatment, and they were divided into early SVTAs (Ͻ30 days after the operation) and late SVTAs (Ն30 days after the operation). Clinical histories were reviewed, and health status questionnaires were sent. Four hundred ninety-nine patients had various modifications of the Fontan operation. Frequency of early SVTA was 15%. Risk factors identified by multivariate analysis for early SVTA were AV valve regurgitation, abnormal AV valve, and preoperative SVTA. Frequency of late SVTA was 6% by 1 year, 12% by 3 years, and 17% by 5 years. Risk factors for late SVTA were age at operation (Ͻ3 or Ն10 years) and systemic AV valve replacement. By univariate and multivariate analysis, the type of Fontan operation was not a significant risk factor for late SVTA when all 6 modifications were considered. However, when we analyzed the frequency of late SVTA for the 2 recently used modifications, we found a lower frequency of late SVTA in patients with atriopulmonary connection with lateral tunnel compared with those with total cavopulmonary connection. Conclusions-Postoperative SVTA continues to be a significant problem. Risk factors for SVTA are AV valve regurgitation, abnormal AV valve, preoperative SVTA, and age at operation. Frequency of SVTA does not appear to be related to type of Fontan procedure except for slightly lower frequency in patients with atriopulmonary connection with lateral tunnel compared with those with total cavopulmonary connection. (Circulation. 1998;98:1099-1107.)
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2012
Objective: Advanced age, dilated right atrium, increased preoperative pulmonary artery pressure, increased right atrial pressure, technique of operation, and poor ventricular function were reported to be risk factors for postoperative arrhythmia. Aim of this study is to determine the risk factor for postoperative arrhythmia after Fontan operation with regard to ventricle dominancy and hemodynamic parameters. Methods: In this retrospective study, the data of the patients including age, weight, dominant ventricle, type of cardiac anomaly, previous operations, duration of cardiopulmonary bypass (CPB), duration of aortic clamping, cardiac rhythm, pulmonary artery pressure, the Nakata Index, systemic atrioventricular (AV) valve insufficiency were obtained from the hospital records, the echocardiographic files, and cardiac catheterization records. Patients were assigned to dominant left ventricle or dominant right ventricle groups. Statistical analysis was performed using the Mann-Whitney U test. Results: Arrhythmia was observed in 21 (52.5%) patients in the postoperative period. No postoperative arrhythmia was observed in patients with a right atrial pressure of <5 mmHg, whereas postoperative arrhythmias were observed in patients with a right atrial pressure of ≥5 mmHg (p<0.05). When the effects of preoperative and postoperative pulmonary artery pressures on postoperative arrhythmia were evaluated, postoperative arrhythmia was determined in only 2 (12.5%) of 8 patients with a preoperative mean pulmonary artery pressure of ≤9 mmHg, whereas postoperative arrhythmia was observed in 19 (59.3%) of 32 patients with a preoperative pulmonary artery pressure of ≥10 mmHg. A preoperative mean pulmonary artery pressure of >10 mmHg increased the risk of postoperative arrhythmia (p<0.02). Postoperative arrhythmia was determined in 8 (53%) of 15 patients with a dominant right ventricle, and in 13 (52%) of 25 patients with a dominant left ventricle (p>0.05). Conclusion: While a preoperative mean pulmonary artery pressure of >10 mmHg and a preoperative right atrial pressure of >5 mmHg were the risk factors for postoperative arrhythmia in patients undergoing Fontan procedure, the right or left ventricular dominance was not a risk factor.
Effect of age and surgical technique on symptomatic arrhythmias after the Fontan procedure
The American Journal of Cardiology, 1995
The purpose of this study was to determine the effects of newer Fontan modifications (lateral tunnel with or without fenestmtion) and p" tient's the incidence and impact o age at surgery on symptomatic postoperative early and intermediate arrhythmias. Modifications to the Fontan procedure are used to decrease postoperative complications, and the Fontan procedure is now zig ter rformed. on yyn r changes m ventncu ar 9"r ti!nk to reduce agenchon. A retrospechve review was done of the medical records of 151 consecutive patienk, ranging in a e from 1 to 49 years, who underwent a Fontan pmc eil ure at Texas Children's Hospital between 1987 and 1993. Risk factors were identified for eorfy and intermediate arrhythmias. Age at time of the procedure was an independent pfedic-tor of earfy atrial arrhythmias (p = 0.03), ventricular arrh 2 mias (p = 0.003), and junctional ectopic tachyca ia (JET) (p = 0.05). We found that the older the patient at surgery, the higher the incidence of atrial and ventricular arrhythmias, whereas the younger the patient, the higher the incidence of Jm. Using Cox's proportional-hazards model, the risk of intermediate atrial arrhythmias after lateml tunnel modification was % that after atriopulmonary connection. Youn tients who underwent the Fontan procedure ha B er paa lower risk for early atrial and ventricular arrh P mia but an increased risk for JET. The lateral tunne modiiication can be performed in order to reduce the risk of intermediate atrial arrhythmias.
International Journal of Cardiology, 2012
Background: Atrial tachyarrhythmias are a known complication late after Fontan operation. Limited information is available on their prognostic value. Methods: All patients with previous Fontan operation followed at our institution since 1999 were identified from the electronic database and included in this study. Demographic and clinical characteristics including history of atrial tachyarrhythmias were recorded at the earliest full clinical assessment and patients were followed thereafter for all-cause mortality and hospitalization. Results: A total of 98 patients, mean age 31.5 ± 8.9 years, 43.8% male, 31.6% with a total cavopulmonary connection (TCPC) were identified. A history of atrial tachyarrhythmia was present at baseline in 60.2% of patients who were older (33.0 ± 8.3 vs 29.1 ± 9.4 years, p = 0.002), less likely to have a TCPC (13.5% vs 58.9%, p b 0.001), and more symptomatic in terms of NYHA class (51.9% vs 26.7%, p = 0.007) compared to arrhythmia-free patients. During a median follow-up of 6.7 years 18 patients died and 64 patients were hospitalized. Even after adjustment for baseline clinical characteristics, atrial tachyarrhythmia was an independent predictor of death (propensity score adjusted HR 9.35, 95% CI: 1.10-79.18, p = 0.04, c-statistic 0.88) and composite of death or hospitalization (propensity score adjusted HR 5.00, 95% CI: 2.47-10.09, p b 0.0001). Conclusions: In adult patients with a Fontan-type operation, the presence of atrial tachyarrhythmias is associated with higher morbidity and mortality at mid-term follow-up. Whether early arrhythmia targeting intervention may improve clinical outcome needs to be studied in a prospective manner.
Interactive Cardiovascular and Thoracic Surgery, 2019
OBJECTIVES: This study aims to evaluate our 45-year experience with the Fontan procedure and to identify risk factors for late mortality and morbidity. METHODS: Demographic, preoperative, perioperative and postoperative characteristics were retrospectively collected for all patients who underwent a Fontan procedure in a single centre between 1972 and 2016. RESULTS: The study included 277 Fontan procedures (44 atriopulmonary connections, 28 Fontan-Björk, 42 lateral tunnels and 163 extracardiac conduits). Early failure occurred in 17 patients (6.1%). Median follow-up of the study cohort was 11.9 years (Q 1-Q 3 7.6-17.5).
Intra-atrial reentrant tachycardia in adult patients after Fontan operation
International journal of cardiology, 2015
Atrial tachyarrhythmia is a major late complication in adult Fontan patients. This study examined the clinical features and risk factors of late intra-atrial reentrant tachyarrhythmia (IART) in adult patients after Fontan surgery and the mid-term outcome of Fontan conversion with or without antiarrhythmic surgery in these patients. We conducted a retrospective study on adult patients who were born before 1994 and survived at least 3months after a Fontan operation at Seoul National University Children's Hospital. We followed 160 patients over 20.9±4.1years. Sustained atrial tachycardia was identified in 51 patients, and IART was found in 41, appearing a mean 13.6years after surgery. By the 25year follow-up, 40% had developed IART. The incidence of IART significantly increased over time. Patients with an atriopulmonary connection (APC) (n=65) had significantly longer follow-up duration and higher incidence of IART than patients with a lateral tunnel (n=86) or extracardiac conduit ...
Ventricular Performance in Long-Term Survivors After Fontan Operation
The Annals of Thoracic Surgery, 2011
Background. Ventricular function and arrhythmia in patients with Fontan circulation in long-term follow-up are still unknown. Methods. We retrospectively reviewed 48 patients who survived and were followed up for more than 15 years, among 110 patients who underwent Fontan operation in our institute from 1979 to 1992. Atriopulmonary connection was performed in 26 patients and total cavopulmonary connection in 22. The patients were categorized into right ventricle, left ventricle, and biventricle groups. Follow-up cardiac catheterization and exercise test were performed routinely every 5 years post surgery. Median age at Fontan operation was 5 years. Results. Mean follow-up was 18.5 years. Cardiac index in the total cavopulmonary connection group was higher than in the atriopulmonary connection group at 10 and 15 years post surgery (p < 0.05). Ejection fraction in the left-ventricle group was higher than in the right-ventricle group. End-diastolic volume at 5, 10, and 15 years was significantly lower than at 1 year (p < 0.05). End-diastolic pressure at 10 years was significantly higher than at 1 and 5 years (p < 0.05). Beyond 15 years, 6 patients developed ventricular tachycardia. The only significant risk factors for the onset of ventricular tachycardia in a multivariate analysis were age at Fontan operation and absolute age (p < 0.05). Conclusions. Long-term follow-up of patients demonstrated that postoperative ventricular systolic performance seemed to become steady. Ventricular tachycardia was detected 15 years post surgery, especially in older patients with older age at Fontan operation, possibly revealing a risk factor in the long-term postoperative period, thereby meriting further consideration.
Predictors of rhythm disturbances and subsequent morbidity after the Fontan operation
The American Journal of Cardiology, 1989
The electrocardiographic, hemodynamic and surgical data of 30 patients who underwent a Fontan operation between 1977 and 1986 were retrospectively reviewed to identify the incidence and predictors of immediate and late postoperative arrhythmias and associated morbidity in long-term survivors. Of 4 patients who died less than 1 year after operation (mortality 13%), 1 death was related to an arrhythmia. Three patients were not in sinus rhythm before operation and were excluded from the statistical analysis that examined predictors of arrhythmias. The remaining 23 long-term survivors have been followed 6.3 +/- 2.6 years (mean +/- standard deviation) since surgery and all remain in New York Heart Association functional class I or II. Ten patients (43%) developed immediate postoperative arrhythmias (less than or equal to 30 days) whereas 11 (48%) had late arrhythmias. With up to 10.7 years of follow-up, the proportion of patients free from late arrhythmias continues to decline. Arrhythmias included bradyarrhythmias, atrial tachyarrhythmias, the tachy-brady syndrome and supraventricular ectopic activity. Immediate postoperative arrhythmias predicted late arrhythmias (p = 0.022). The preoperative electrocardiogram was the only variable useful in predicting both immediate and late postoperative arrhythmias. A more negative P-wave deflection in lead V1 (-2.4 +/- 0.7 vs -1.4 +/- 1.2 mV, p = 0.02) predicted patients with immediate postoperative arrhythmias, whereas both greater P-wave duration and a more negative deflection in this lead predicted late arrhythmias (103 +/- 14 vs 83 +/- 20 ms, p = 0.01, and -2.5 +/- 0.8 vs -1.3 +/- 1.0 mV, p = 0.005, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)