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

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 153; no. 3; pp. 638 - 645.e2
• Main Authors: Oster, Matthew E., Chen, Shan, Dagincourt, Nicholas, Bar-Cohen, Yaniv, Brothers, Matthew, Cain, Nicole, Colan, Steven D., Czosek, Richard J., Decker, Jamie A., Gamboa, David G., Idriss, Salim F., Kirsh, Joel A., LaPage, Martin J., Ohye, Richard G., Radojewski, Elizabeth, Shah, Maully, Silver, Eric S., Singh, Anoop K., Temple, Joel D., Triedman, John, Kaltman, Jonathan R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: arrhythmia; Arrhythmias, Cardiac - epidemiology; Arrhythmias, Cardiac - etiology; atrioventricular block; Cardiothoracic Surgery; Female; Follow-Up Studies; Heart Defects, Congenital - surgery; Humans; Incidence; Infant; Infant, Newborn; Male; mortality; Norwood; Norwood Procedures - adverse effects; outcomes; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Registries; Retrospective Studies; Risk Assessment - methods; Risk Factors; single ventricle; Survival Rate - trends; tachyarrhythmia; Treatment Outcome; United States - epidemiology; United States; Norwood; MBTS; outcomes; single ventricle; RVPAS; arrhythmia; atrioventricular block; CI; mortality; tachyarrhythmia; SVR; right ventricle-to-pulmonary artery shunt; modified Blalock–Taussig shunt; confidence interval; Single Ventricle Reconstruction
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2016.10.078

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. 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. 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. Tachyarrhythmias are common after the Norwood procedure, but atrioventricular block may portend a greater risk for interstage mortality.