Risk factors for postoperative arrhythmia in patients with physiologic univentricular hearts undergoing Fontan procedure

Abstract

Objective: Advanced age, dilated right atrium, increased preoperative pulmonary artery pressure, increased right atrial pressure, technique of operation, and poor ventricular function were reported to be risk factors for postoperative arrhythmia. Aim of this study is to determine the risk factor for postoperative arrhythmia after Fontan operation with regard to ventricle dominancy and hemodynamic parameters. Methods: In this retrospective study, the data of the patients including age, weight, dominant ventricle, type of cardiac anomaly, previous operations, duration of cardiopulmonary bypass (CPB), duration of aortic clamping, cardiac rhythm, pulmonary artery pressure, the Nakata Index, systemic atrioventricular (AV) valve insufficiency were obtained from the hospital records, the echocardiographic files, and cardiac catheterization records. Patients were assigned to dominant left ventricle or dominant right ventricle groups. Statistical analysis was performed using the Mann-Whitney U test. Results: Arrhythmia was observed in 21 (52.5%) patients in the postoperative period. No postoperative arrhythmia was observed in patients with a right atrial pressure of <5 mmHg, whereas postoperative arrhythmias were observed in patients with a right atrial pressure of ≥5 mmHg (p<0.05). When the effects of preoperative and postoperative pulmonary artery pressures on postoperative arrhythmia were evaluated, postoperative arrhythmia was determined in only 2 (12.5%) of 8 patients with a preoperative mean pulmonary artery pressure of ≤9 mmHg, whereas postoperative arrhythmia was observed in 19 (59.3%) of 32 patients with a preoperative pulmonary artery pressure of ≥10 mmHg. A preoperative mean pulmonary artery pressure of >10 mmHg increased the risk of postoperative arrhythmia (p<0.02). Postoperative arrhythmia was determined in 8 (53%) of 15 patients with a dominant right ventricle, and in 13 (52%) of 25 patients with a dominant left ventricle (p>0.05). Conclusion: While a preoperative mean pulmonary artery pressure of >10 mmHg and a preoperative right atrial pressure of >5 mmHg were the risk factors for postoperative arrhythmia in patients undergoing Fontan procedure, the right or left ventricular dominance was not a risk factor. (Anadolu Kardiyol Derg 2012; 12: 347-51) Key words: Univentricular heart, Fontan operation, arrhythmia, risk factors Original Investigation Özgün Araşt›rma 347ÖZET Amaç: Literatürde yapılan çalışmalarda ileri yaş, sağ atriyum boyutunun büyüklüğü, ortalama pulmoner arter basıncı, sağ atriyum basıncı, sistemik ventrikülün düşük ejeksiyon fraksiyonu, ameliyat tekniği postoperatif aritmi için risk faktörü olarak saptanmıştır. Bu çalışmada sistemik dolaşımı sağlayan 'dominant ventrikül' ün sağ ventrikül ya da sol ventrikül olmasının ve hemodinamik parametrelerin postoperatif aritmi açısından risk faktörü olup olmadığı araştırılmıştır.Yöntemler: Fontan ameliyatı yapılmış 1997 ve 2008 yılları arasındaki 40 hastanın verileri retrospektif olarak değerlendirildi. Hastaların ekokardiyografi notları, kard...

Ventricular Dyssynchrony Late after the Fontan Operation is Associated with Decreased Survival and the Presence of Arrhythmias

“…Lastly, our data supported prior studies that atrial and ventricular arrhythmias are highly prevalent in patients palliated to a Fontan, with similar distribution across ventricular dominant subtypes. 7,48 Arrhythmias were associated with ventricular dilation, dysfunction, prolonged QRS duration, Fontan type, and markers of mechanical dyssynchrony. There is lack of agreement regarding the optimal technique for the Fontan completion.…”

Long-term outcomes after first-onset arrhythmia in Fontan physiology

“…Also, many of the previous publications have quoted the incidence of arrhythmias without distinguishing the difference between tachyarrhythmias and bradyarrhythmias. [10][11][12] There is concern that the onset of an arrhythmia is the first sign of deterioration of the Fontan circulation. Ascertaining how true this hypothesis is will help guide therapy in these patients and in particular help to optimize the timing of interventions such as the Fontan conversion.…”

Right Ventricular Dominance Is Associated With Inferior Outcomes After the Extracardiac Fontan

“…They accounted for 30% to 59% of complications in similar studies 2,9 However, there are no data suggesting a relationship between ventricular dominance and these specific outcomes. 2,[9][10][11][12] Future studies may uncover an association with long-term events if arrhythmia and requirement of pacemaker/ICD placement are not included in the composite outcome.…”