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Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network
Authors:Matthew E. Oster  Shan Chen  Nicholas Dagincourt  Yaniv Bar-Cohen  Matthew Brothers  Nicole Cain  Steven D. Colan  Richard J. Czosek  Jamie A. Decker  David G. Gamboa  Salim F. Idriss  Joel A. Kirsh  Martin J. LaPage  Richard G. Ohye  Elizabeth Radojewski  Maully Shah  Eric S. Silver  Anoop K. Singh  Jonathan R. Kaltman
Affiliation:1. Department of Pediatrics, Children''s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga;2. New England Research Institutes, Watertown, Mass;3. Division of Pediatric Cardiology, Department of Pediatrics, Children''s Hospital Los Angeles, Los Angeles, Calif;4. Department of Pediatrics, Medical University of South Carolina, Charleston, SC;5. Department of Cardiology, Boston Children''s Hospital, Boston, Mass;6. Division of Pediatric Cardiology, Department of Pediatrics, The Heart Center, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;7. Department of Pediatrics, Johns Hopkins All Children''s Heart Institute, St Petersburg, Fla;8. Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah;9. Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC;10. Department of Paediatrics & Labatt Family Heart Centre, Hospital for Sick Children & University of Toronto, Toronto, Ontario;11. Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Mich;12. Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Mich;13. Department of Pediatrics, Children''s Hospital of Philadelphia, Philadelphia, Pa;14. Division of Pediatrics, Columbia University Medical Center, New York, NY;15. Department of Pediatrics, Children''s Hospital of Wisconsin, Milwaukee, Wis;p. Division of Cardiology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Del;q. Division of Cardiovascular Sciences, The National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
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:arrhythmia  atrioventricular block  mortality  Norwood  outcomes  single ventricle  tachyarrhythmia  CI  confidence interval  MBTS  modified Blalock–Taussig shunt  RVPAS  right ventricle-to-pulmonary artery shunt  SVR  Single Ventricle Reconstruction
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