Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network

• Type of Material: Article
• Authors: Matthew Oster, Emory University; Shan Chen, New England Research Institutes; Nicholas Dagincourt, New England Research Institutes; Yaniv Bar-Cohen, Childrens Hospital of Los Angeles; Matthew Brothers, Emory University; Nicole Cain, Medical University of South Carolina; Steven D. Colan, Boston Children’s Hospital; Richard J. Czosek, Cincinnati Children's Hospital Medical Center; Jamie A. Decker, Johns Hopkins All Children's Heart Institute; David G. Gamboa, University of Utah; Salim F. Idriss, Duke University; Joel A. Kirsh, Hospital for Sick Children and University of Toronto; Martin j. LaPage, University of Michigan; Richard G. Ohye, University of Michigan Medical School; Elizabeth Radojewski, Hospital for Sick Children and University of Toronto; Maully Shah, Childrens Hospital of Philadelphia; Eric S. Silver, Columbia University; Anoop K. Singh, Children's Hospital of Wisconsin; Joel D. Temple, Nemours/Alfred I. duPont Hospital for Children; John Triedman, Boston Children's Hospital; Jonathan R. Kaltman, National Institutes of Health
• Language: English
• Date: 2017-03-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2016 The American Association for Thoracic Surgery
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jtcvs.2016.10.078
• Title of Journal or Parent Work: Journal of Thoracic and Cardiovascular Surgery
• ISSN: 0022-5223
• Volume: 153
• Issue: 3
• Start Page: 638
• End Page: +
• Grant/Funding Information: This work was supported by HL068269, HL068270, HL068279, HL068281, HL068285, HL068292, HL068290, HL068288, HL085057, HL109781, and HL109737 from the National Heart, Lung, and Blood Institute.
• Keywords: Cardiac & Cardiovascular Systems; outcomes; tachyarrhythmia; MORTALITY; Respiratory System; SURGERY; arrhythmia; INFANTS; Science & Technology; atrioventricular block; single ventricle; CONDUIT; VENTRICLE RECONSTRUCTION TRIAL; Surgery; BLALOCK-TAUSSIG; Life Sciences & Biomedicine; Cardiovascular System & Cardiology; RHYTHM ABNORMALITIES; TACHYARRHYTHMIAS; mortality; Norwood; RISK-FACTORS; DEATH
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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.