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Arrhythmias after Fontan operation: comparison of lateral tunnel and extracardiac conduit.
J Electrocardiol. 2008 Mar-Apr; 41(2):173-7.JE

Abstract

BACKGROUND

Arrhythmias are frequent causes of morbidity and mortality in patients with single ventricle physiology after Fontan operation. The aim of this study was to evaluate which type of Fontan procedure--lateral tunnel (LT) or extracardiac conduit (EC)--provides superior outcomes related to the problem of early postoperative and 1-year follow-up arrhythmias.

METHODS

We retrospectively analyzed the incidence, types, and duration of rhythm disorders in 101 consecutive patients who received either LT (n = 60) or EC (n = 41) between April 1997 and March 2006 in Slovak Children's Cardiac Center, Bratislava (Slovakia). Weight, age, sex, and the type of heart morphology did not differ significantly between the 2 groups. The rhythm was monitored and documented perioperatively and postoperatively with standard electrocardiogram (ECG) recording and continual ECG monitoring. Duration of extracorporeal circulation, duration of aortic crossclamp and hemodynamic variables were analyzed with respect to the development of early arrhythmias in both groups. Twenty-four-hour ECG Holter monitoring (DMS 300-7, Holterreader, Producer DMS, Nevada, USA) was used to detect arrhythmias at the 1-year follow-up.

RESULTS

Early postoperative rhythm abnormalities were identified in 31 patients (52%) who underwent LT and in 22 patients (54%) who underwent EC. The most frequent type of rhythm disturbance was junctional rhythm in both groups. The bivariate analysis revealed that there was no significant difference in the incidence, type, or duration of early onset arrhythmias between the 2 groups. Although, there was no significant difference in the duration of arrhythmia since the admission form the operating room. The need of aortic crossclamp was significantly lower in EC group (P < .001). However, this did not correlate with lower incidence of early onset arrhythmias with EC modification. At the 1-year follow-up, the prevalence of arrhythmias was similar in both groups.

CONCLUSIONS

Extracardiac conduit as compared with LT does not provide superior outcomes related to the problem of early and 1-year onset arrhythmias. Other factors than the risk of early postoperative and early follow-up arrhythmias should be considered in surgical preference of modification strategy.

Authors+Show Affiliations

Cardiac Intensive Care Unit, Children's Cardiac Center, Slovakia. nina.hakacova@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18328341

Citation

Hakacova, Nina, et al. "Arrhythmias After Fontan Operation: Comparison of Lateral Tunnel and Extracardiac Conduit." Journal of Electrocardiology, vol. 41, no. 2, 2008, pp. 173-7.
Hakacova N, Lakomy M, Kovacikova L. Arrhythmias after Fontan operation: comparison of lateral tunnel and extracardiac conduit. J Electrocardiol. 2008;41(2):173-7.
Hakacova, N., Lakomy, M., & Kovacikova, L. (2008). Arrhythmias after Fontan operation: comparison of lateral tunnel and extracardiac conduit. Journal of Electrocardiology, 41(2), 173-7. https://doi.org/10.1016/j.jelectrocard.2007.10.007
Hakacova N, Lakomy M, Kovacikova L. Arrhythmias After Fontan Operation: Comparison of Lateral Tunnel and Extracardiac Conduit. J Electrocardiol. 2008 Mar-Apr;41(2):173-7. PubMed PMID: 18328341.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arrhythmias after Fontan operation: comparison of lateral tunnel and extracardiac conduit. AU - Hakacova,Nina, AU - Lakomy,Miroslav, AU - Kovacikova,Lubica, PY - 2007/06/18/received PY - 2007/10/29/accepted PY - 2008/3/11/pubmed PY - 2008/4/17/medline PY - 2008/3/11/entrez SP - 173 EP - 7 JF - Journal of electrocardiology JO - J Electrocardiol VL - 41 IS - 2 N2 - BACKGROUND: Arrhythmias are frequent causes of morbidity and mortality in patients with single ventricle physiology after Fontan operation. The aim of this study was to evaluate which type of Fontan procedure--lateral tunnel (LT) or extracardiac conduit (EC)--provides superior outcomes related to the problem of early postoperative and 1-year follow-up arrhythmias. METHODS: We retrospectively analyzed the incidence, types, and duration of rhythm disorders in 101 consecutive patients who received either LT (n = 60) or EC (n = 41) between April 1997 and March 2006 in Slovak Children's Cardiac Center, Bratislava (Slovakia). Weight, age, sex, and the type of heart morphology did not differ significantly between the 2 groups. The rhythm was monitored and documented perioperatively and postoperatively with standard electrocardiogram (ECG) recording and continual ECG monitoring. Duration of extracorporeal circulation, duration of aortic crossclamp and hemodynamic variables were analyzed with respect to the development of early arrhythmias in both groups. Twenty-four-hour ECG Holter monitoring (DMS 300-7, Holterreader, Producer DMS, Nevada, USA) was used to detect arrhythmias at the 1-year follow-up. RESULTS: Early postoperative rhythm abnormalities were identified in 31 patients (52%) who underwent LT and in 22 patients (54%) who underwent EC. The most frequent type of rhythm disturbance was junctional rhythm in both groups. The bivariate analysis revealed that there was no significant difference in the incidence, type, or duration of early onset arrhythmias between the 2 groups. Although, there was no significant difference in the duration of arrhythmia since the admission form the operating room. The need of aortic crossclamp was significantly lower in EC group (P < .001). However, this did not correlate with lower incidence of early onset arrhythmias with EC modification. At the 1-year follow-up, the prevalence of arrhythmias was similar in both groups. CONCLUSIONS: Extracardiac conduit as compared with LT does not provide superior outcomes related to the problem of early and 1-year onset arrhythmias. Other factors than the risk of early postoperative and early follow-up arrhythmias should be considered in surgical preference of modification strategy. SN - 1532-8430 UR - https://www.unboundmedicine.com/medline/citation/18328341/Arrhythmias_after_Fontan_operation:_comparison_of_lateral_tunnel_and_extracardiac_conduit_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-0736(07)00891-6 DB - PRIME DP - Unbound Medicine ER -