Predictors of early- and late-onset supraventricular tachyarrhythmias after Fontan operation

被引:123
作者
Durongpisitkul, K
Porter, CJ
Cetta, F
Offord, KP
Slezak, JM
Puga, FJ
Schaff, HV
Danielson, GK
Driscoll, DJ
机构
[1] Mayo Clin & Mayo Fdn, Pediat Cardiol Sect, Rochester, MN 55905 USA
[2] Mayo Clin & Mayo Fdn, Biostat Sect, Rochester, MN 55905 USA
[3] Mayo Clin & Mayo Fdn, Div Thorac & Cardiovasc Surg, Rochester, MN 55905 USA
关键词
arrhythmia; Fontan procedure; pediatrics; tachyarrhythmias;
D O I
10.1161/01.CIR.98.11.1099
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The objectives of our study were to determine the frequency of supraventricular tachyarrhythmias (SVTAs) among modifications of the Fontan operation and identify risk factors for developing SVTA. Methods and Results-The population consisted of all patients who had any modification of the Fontan operation at the Mayo Clinic between 1985 and 1993. Clinically significant SVTAs were those requiring initiation or change of antiarrhythmic treatment, and they were divided into early SVTAs (<30 days after the operation) and late SVTAs (greater than or equal to 30 days after the operation). Clinical histories were reviewed, and health status questionnaires were sent. Four hundred ninety-nine patients had various modifications of the Fontan operation. Frequency of early SVTA was 15%, Risk factors identified by multivariate analysis for early SVTA were AV valve regurgitation, abnormal AV valve, and preoperative SVTA. Frequency of late SVTA was 6% by 1 year, 12% by 3 years, and 17% by 5 years. Risk factors for late SVTA were age at operation (<3 or greater than or equal to 10 years) and systemic AV valve replacement. By univariate and multivariate analysis, the type of Fontan operation was not a significant risk factor for late SVTA when all 6 modifications were considered. However, when we analyzed the frequency of late SVTA for the 2 recently used modifications, we found a lower frequency of late SVTA in patients with atriopulmonary connection with lateral tunnel compared with those with total cavopulmonary connection. Conclusions-Postoperative SVTA continues to be a significant problem. Risk factors for SVTA are AV valve regurgitation, abnormal AV valve, preoperative SVTA, and age at operation. Frequency of SVTA does not appear to be related to type of Fontan procedure except for slightly lower frequency in patients with atriopulmonary connection with lateral tunnel compared with those with total cavopulmonary connection.
引用
收藏
页码:1099 / 1107
页数:9
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