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Randomized Controlled Trial
. 2017 Mar;153(3):638-645.e2.
doi: 10.1016/j.jtcvs.2016.10.078. Epub 2016 Nov 16.

Development and Impact of Arrhythmias After the Norwood Procedure: A Report From the Pediatric Heart Network

Affiliations
Free PMC article
Randomized Controlled Trial

Development and Impact of Arrhythmias After the Norwood Procedure: A Report From the Pediatric Heart Network

Matthew E Oster et al. J Thorac Cardiovasc Surg. .
Free PMC article

Abstract

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.

Keywords: Norwood; arrhythmia; atrioventricular block; mortality; outcomes; single ventricle; tachyarrhythmia.

Conflict of interest statement

Conflict of Interest Statement

Authors have nothing to disclose with regard to commercial support.

Figures

FIGURE 1
FIGURE 1
Selection of subjects from the SVR Trial.
FIGURE 2
FIGURE 2
Occurrence of postoperative arrhythmias. Among the 544 subjects who received a Norwood procedure in the SVR Trial, 134 had at least 1 postoperative arrhythmia. Eleven subjects had more than 1 type of arrhythmia. Atrioventricular block includes second- and third-degree blocks.
FIGURE 3
FIGURE 3
Transplant-free survival for subjects with tachyarrhythmia (A) and atrioventricular block (B) versus those without arrhythmia. Patients were censored at the time of stage II procedure. Dashed lines indicate 95% CIs.
VIDEO 1
VIDEO 1
Dr Matthew Oster explains the key findings and implications from this study. Video available at: http://www.jtcvs.org.

Comment in

  • Thinking, fast and slow.
    Alsoufi B. Alsoufi B. J Thorac Cardiovasc Surg. 2017 Mar;153(3):646-647. doi: 10.1016/j.jtcvs.2016.11.024. Epub 2016 Nov 19. J Thorac Cardiovasc Surg. 2017. PMID: 27964979 No abstract available.

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