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

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 148; no. 2; pp. 576 - 581
• Main Authors: Balaji, Seshadri, MBBS, MRCP (UK), PhD, Daga, Ankana, MD, Bradley, David J., MD, Etheridge, Susan P., MD, Law, Ian H., MD, Batra, Anjan S., MD, Sanatani, Shubayan, MD, Singh, Anoop K., MD, Gajewski, Kelly K., MD, Tsao, Sabrina, MD, Singh, Harinder R., MD, Tisma-Dupanovic, Svjetlana, MD, Tateno, Shigeru, MD, Takamuro, Motoki, MD, Nakajima, Hiromichi, MD, Roos-Hesselink, Jolien W., MD, PhD, Shah, Maully, MBBS
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.08.2014
• Subjects: Anti-Arrhythmia Agents - therapeutic use; Bradycardia - diagnosis; Bradycardia - epidemiology; Bradycardia - therapy; Cardiac Pacing, Artificial; Cardiothoracic Surgery; Chi-Square Distribution; Child, Preschool; Female; Fontan Procedure - adverse effects; Fontan Procedure - methods; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - epidemiology; Heart Defects, Congenital - surgery; 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 - diagnosis; Tachycardia - drug therapy; Tachycardia - epidemiology; Time Factors; Treatment Outcome; 24; extracardiac conduit; OR; ECC; atrial flutter; AFL; ECG; SND; atriopulmonary connection; supraventricular tachycardia; IQR; interquartile range; odds ratio; sinus node dysfunction; electrocardiography; ILT; SVT; intracardiac lateral tunnel; SD; APC; incisional atrial reentrant tachycardia; IART; 20; standard deviation
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2013.08.070

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.