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

Seshadri Balaji; Ankana Daga; David J. Bradley; Susan P. Etheridge; Ian H. Law; Anjan S. Batra; Shubayan Sanatani; Anoop K. Singh; Kelly K. Gajewski; Sabrina Tsao; Harinder R. Singh; Svjetlana Tisma-Dupanovic; Shigeru Tateno; Motoki Takamuro; Hiromichi Nakajima; Jolien W. Roos-Hesselink; Maully Shah

doi:10.1016/j.jtcvs.2013.08.070

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

Seshadri Balaji, Ankana Daga, David J. Bradley, Susan P. Etheridge, Ian H. Law, Anjan S. Batra, Shubayan Sanatani, Anoop K. Singh, Kelly K. Gajewski, Sabrina Tsao, Harinder R. Singh, Svjetlana Tisma-Dupanovic, Shigeru Tateno, Motoki Takamuro, Hiromichi Nakajima, Jolien W. Roos-Hesselink, Maully Shah^*

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

72 Scopus 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.

Original language	English (US)
Pages (from-to)	576-581
Number of pages	6
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	148
Issue number	2
DOIs	https://doi.org/10.1016/j.jtcvs.2013.08.070
State	Published - Aug 2014

Funding

Our study found that the ECC does not confer any long-term arrhythmia advantage over the ILT. Early postoperative bradyarrhythmia was seen more often after the ECC than the ILT. Therefore, the decision on which type of Fontan to perform on a specific patient should be based on individual, patient-related hemodynamic factors and surgical center preferences, and not on a presumed reduction in arrhythmias. The authors thank the Department of Pediatrics, Children’s Hospital of Philadelphia, for providing funding for this study; Jan Weber, RN, for nurse coordination support; Xuemei Zhang, MS, for statistical support; and the Pediatric and Congenital Electrophysiology Society and its membership for their support.

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine

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10.1016/j.jtcvs.2013.08.070

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Balaji, S., Daga, A., Bradley, D. J., Etheridge, S. P., Law, I. H., Batra, A. S., Sanatani, S., Singh, A. K., Gajewski, K. K., Tsao, S., Singh, H. R., Tisma-Dupanovic, S., Tateno, S., Takamuro, M., Nakajima, H., Roos-Hesselink, J. W., & Shah, M. (2014). An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations. Journal of Thoracic and Cardiovascular Surgery, 148(2), 576-581. https://doi.org/10.1016/j.jtcvs.2013.08.070

@article{d93341b212844564b658c466c12ebb62,

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

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 = "Seshadri Balaji and Ankana Daga and Bradley, {David J.} and Etheridge, {Susan P.} and Law, {Ian H.} and Batra, {Anjan S.} and Shubayan Sanatani and Singh, {Anoop K.} and Gajewski, {Kelly K.} and Sabrina Tsao and Singh, {Harinder R.} and Svjetlana Tisma-Dupanovic and Shigeru Tateno and Motoki Takamuro and Hiromichi Nakajima and Roos-Hesselink, {Jolien W.} and Maully Shah",

note = "Funding Information: Our study found that the ECC does not confer any long-term arrhythmia advantage over the ILT. Early postoperative bradyarrhythmia was seen more often after the ECC than the ILT. Therefore, the decision on which type of Fontan to perform on a specific patient should be based on individual, patient-related hemodynamic factors and surgical center preferences, and not on a presumed reduction in arrhythmias. The authors thank the Department of Pediatrics, Children{\textquoteright}s Hospital of Philadelphia, for providing funding for this study; Jan Weber, RN, for nurse coordination support; Xuemei Zhang, MS, for statistical support; and the Pediatric and Congenital Electrophysiology Society and its membership for their support. ",

year = "2014",

month = aug,

doi = "10.1016/j.jtcvs.2013.08.070",

language = "English (US)",

volume = "148",

pages = "576--581",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Mosby Inc.",

number = "2",

}

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 2014, 'An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations', Journal of Thoracic and Cardiovascular Surgery, vol. 148, no. 2, pp. 576-581. https://doi.org/10.1016/j.jtcvs.2013.08.070

An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations. / Balaji, Seshadri; Daga, Ankana; Bradley, David J. et al.
In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 2, 08.2014, p. 576-581.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations

AU - Balaji, Seshadri

AU - Daga, Ankana

AU - Bradley, David J.

AU - Etheridge, Susan P.

AU - Law, Ian H.

AU - Batra, Anjan S.

AU - Sanatani, Shubayan

AU - Singh, Anoop K.

AU - Gajewski, Kelly K.

AU - Tsao, Sabrina

AU - Singh, Harinder R.

AU - Tisma-Dupanovic, Svjetlana

AU - Tateno, Shigeru

AU - Takamuro, Motoki

AU - Nakajima, Hiromichi

AU - Roos-Hesselink, Jolien W.

AU - Shah, Maully

N1 - Funding Information: Our study found that the ECC does not confer any long-term arrhythmia advantage over the ILT. Early postoperative bradyarrhythmia was seen more often after the ECC than the ILT. Therefore, the decision on which type of Fontan to perform on a specific patient should be based on individual, patient-related hemodynamic factors and surgical center preferences, and not on a presumed reduction in arrhythmias. The authors thank the Department of Pediatrics, Children’s Hospital of Philadelphia, for providing funding for this study; Jan Weber, RN, for nurse coordination support; Xuemei Zhang, MS, for statistical support; and the Pediatric and Congenital Electrophysiology Society and its membership for their support.

PY - 2014/8

Y1 - 2014/8

N2 - 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.

AB - 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.

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

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