Tachyarrhythmia Following Norwood Operation

Gist, Katja M.; Schuchardt, Eleanor L.; Moroze, Meghan K.; Kaufman, Jonathan; Cruz, Eduardo M. da; Campbell, David N.; Mitchell, Max B.; Jaggers, James; Collins, Kathryn K.; McCanta, Anthony C.

doi:10.1177/2150135113516982

Cited by 9 publications

(18 citation statements)

References 11 publications

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“…With regard to shunt type, there are mixed findings. Whereas in this study, MBTS was potentially associated with the development of tachyarrhythmia, Gist and colleagues 19 did not find shunt type to be a significant factor, and McFerson and colleagues 18 found MBTS to have a protective effect. Because our cohort is larger than those of these prior studies, we believe that our study provides the most accurate estimate of risk.…”

Section: Discussioncontrasting

confidence: 68%

“…18 However, the increased morbidity does not translate to an increase in mortality. Our study and the 2 smaller studies previously mentioned 18,19 found no tachyarrhythmia-associated increase in mortality from the time of the Norwood procedure to the time of the stage II procedure. One small, single-center study of 50 patients previously found an association of arrhythmia with mortality before the stage II procedure, but this study included both tachyarrhythmias and bradyarrhythmias, and was limited only to those who survived the initial hospitalization after the Norwood procedure.…”

Section: Discussionsupporting

confidence: 63%

“…First, the rate of postoperative tachyarrhythmias in approximately 20% of subjects is lower than that of recently published single-center studies, which found rates of 50% (among 66 subjects) 18 and 35% (among 98 subjects). 19 These varying rates may be due to differences in study definition (only cases in which treatment was administered met inclusion in our study) or methods of case ascertainment. Second, there are differences with regard to risk factors for the development of tachyarrhythmias.…”

Section: Discussionmentioning

confidence: 94%

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

Oster

Chen

Dagincourt

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 94%

See 1 more Smart Citation

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

Oster

Chen

Dagincourt

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…Only 1 study has shown increased postoperative arrhythmias with the RV-PA shunt compared with the modified Blalock-Taussig shunt, 8 but ventricular arrhythmias were rare in that study and there was no difference in rates of VT between the 2 shunt techniques. Similarly, documented instances of VT or ventricular fibrillation are low in the few studies that have reported arrhythmias in this patient population, making comparisons of these 2 shunt types and the association of VT/ventricular fibrillation difficult 9, 10. Although the rate of interstage sudden cardiac death at home for HLHS has been shown to be as high as 42%, the effect of the RV-PA shunt was not studied in that series 11 …”

Section: Discussionmentioning

confidence: 96%

Implantation of the subcutaneous implantable cardioverter-defibrillator with retroperitoneal generator placement in a child with hypoplastic left heart syndrome

Reeves

Kim

Mitchell

et al. 2015

HeartRhythm Case Reports

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“…[1][2][3][4] In patients with single ventricle physiology undergoing stage 1 procedures, the incidence of arrhythmia is as high as 20-50%. [5][6][7][8] Arrhythmias have been shown to be associated with significant morbidity in patients after a stage 1 procedure, including longer time to extubation and total hospital length of stay (LOS). 5,7,8 While some studies report tachyarrhythmias as a risk factors for interstage mortality, [9][10][11] others did not find any association with mortality at time of hospital discharge or during the interstage period.…”

Section: Introductionmentioning

confidence: 99%

Value of provocative electrophysiology testing in the management of pediatric patients after congenital heart surgery

Dionne

Kheir

Triedman

et al. 2020

Pacing Clinical Electrophis

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Objective To determine the impact of provocative electrophysiology testing in postoperative congenital heart disease (CHD) patients on the management of supraventricular tachycardia (SVT) and clinical outcomes. Methods This is a retrospective study including patients <18 years of age with surgery for CHD who had postoperative SVT between 2006 and 2017. Postoperative outcomes were compared between patients with and without postoperative electrophysiology testing using the Wilcoxon rank sum test, Fisher's exact test, Kaplan‐Meier method with the log‐rank test, and Cox proportional hazard model. Results From 341 patients who had SVT after surgery for CHD, 65 (19%) had postoperative electrophysiology testing. There was no significant difference in baseline patient characteristics or surgical complexity between patients with and without electrophysiology testing. Patients with inducible SVT on electrophysiology testing were more likely to have recurrence of SVT prior to hospital discharge with an odds ratio 4.0 (95% confidence interval 1.3, 12.0). Patients who underwent postoperative electrophysiology testing had shorter intensive care unit (12 [6, 20] vs 16 [9, 32] days, HR 2.1 [95% CI 1.6, 2.8], P < .001) and hospital (25 [13, 38] vs 31 [18, 54] days, HR 1.8 [95% CI 1.4, 2.4], P < .001) length of stay. Conclusion Postoperative electrophysiology testing was associated with improved postoperative outcomes, likely related to the ability to predict recurrence of arrhythmia and tailored antiarrhythmic management.

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Tachyarrhythmia Following Norwood Operation

Cited by 9 publications

References 11 publications

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

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

Implantation of the subcutaneous implantable cardioverter-defibrillator with retroperitoneal generator placement in a child with hypoplastic left heart syndrome

Value of provocative electrophysiology testing in the management of pediatric patients after congenital heart surgery

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