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Relation of Norwood Shunt Type and Frequency of Arrhythmias at 6 Years (from the Single Ventricle Reconstruction Trial).

Publication ,  Journal Article
Cain, N; Saul, JP; Gongwer, R; Trachtenberg, F; Czosek, RJ; Kim, JJ; Kaltman, JR; LaPage, MJ; Janson, CM; Singh, AK; Hill, AC; Landstrom, AP ...
Published in: Am J Cardiol
April 15, 2022

The Norwood procedure with a right ventricular to pulmonary artery shunt (RVPAS) decreases early mortality, but requires a ventriculotomy, possibly increasing risk of ventricular arrhythmias (VAs) compared with the modified Blalock-Taussig shunt (MBTS). The effect of shunt and Fontan type on arrhythmias by 6 years of age in the SVRII (Single Ventricle Reconstruction Extension Study) was assessed. SVRII data collected on 324 patients pre-/post-Fontan and annually at 2 to 6 years included antiarrhythmic medications, electrocardiography (ECG) at Fontan, and Holter/ECG at 6 years. ECGs and Holters were reviewed for morphology, intervals, atrioventricular conduction, and arrhythmias. Isolated VA were seen on 6-year Holter in >50% of both cohorts (MBTS 54% vs RVPAS 60%), whereas nonsustained ventricular tachycardia was rare and observed in RVPAS only (2.7%). First-degree atrioventricular block was more common in RVPAS than MBTS (21% vs 8%, p = 0.01), whereas right bundle branch block, QRS duration, and QTc were similar. Antiarrhythmic medication usage was common in both groups, but most agents also supported ventricular function (e.g., digoxin, carvedilol). Of the 7 patients with death or transplant between 2 and 6 years, none had documented VAs, but compared with transplant-free survivors, they had somewhat longer QRS (106 vs 93 ms, p = 0.05). Atrial tachyarrhythmias varied little between MBTS and RVPAS but did vary by Fontan type (lateral tunnel 41% vs extracardiac conduit 29%). VAs did not vary by Fontan type. In conclusion, at 6-year follow-up, benign VAs were common in the SVRII population. However, despite the potential for increased VAs and sudden death in the RVPAS cohort, these data do not support significant differences or increased risk at 6 years. The findings highlight the need for ongoing surveillance for arrhythmias in the SVR population.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 15, 2022

Volume

169

Start / End Page

107 / 112

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Pulmonary Artery
  • Norwood Procedures
  • Hypoplastic Left Heart Syndrome
  • Humans
  • Heart Ventricles
  • Clinical Trials as Topic
  • Cardiovascular System & Hematology
  • Blalock-Taussig Procedure
  • Arrhythmias, Cardiac
 

Citation

APA
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ICMJE
MLA
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Cain, N., Saul, J. P., Gongwer, R., Trachtenberg, F., Czosek, R. J., Kim, J. J., … Newburger, J. W. (2022). Relation of Norwood Shunt Type and Frequency of Arrhythmias at 6 Years (from the Single Ventricle Reconstruction Trial). Am J Cardiol, 169, 107–112. https://doi.org/10.1016/j.amjcard.2021.12.056
Cain, Nicole, J Philip Saul, Russell Gongwer, Felicia Trachtenberg, Richard J. Czosek, Jeffrey J. Kim, Jonathon R. Kaltman, et al. “Relation of Norwood Shunt Type and Frequency of Arrhythmias at 6 Years (from the Single Ventricle Reconstruction Trial).Am J Cardiol 169 (April 15, 2022): 107–12. https://doi.org/10.1016/j.amjcard.2021.12.056.
Cain N, Saul JP, Gongwer R, Trachtenberg F, Czosek RJ, Kim JJ, et al. Relation of Norwood Shunt Type and Frequency of Arrhythmias at 6 Years (from the Single Ventricle Reconstruction Trial). Am J Cardiol. 2022 Apr 15;169:107–12.
Cain, Nicole, et al. “Relation of Norwood Shunt Type and Frequency of Arrhythmias at 6 Years (from the Single Ventricle Reconstruction Trial).Am J Cardiol, vol. 169, Apr. 2022, pp. 107–12. Pubmed, doi:10.1016/j.amjcard.2021.12.056.
Cain N, Saul JP, Gongwer R, Trachtenberg F, Czosek RJ, Kim JJ, Kaltman JR, LaPage MJ, Janson CM, Singh AK, Hill AC, Landstrom AP, Thacker D, Niu MC, DeWitt ES, Bulic A, Silver ES, Whitehill RD, Decker J, Newburger JW. Relation of Norwood Shunt Type and Frequency of Arrhythmias at 6 Years (from the Single Ventricle Reconstruction Trial). Am J Cardiol. 2022 Apr 15;169:107–112.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 15, 2022

Volume

169

Start / End Page

107 / 112

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Pulmonary Artery
  • Norwood Procedures
  • Hypoplastic Left Heart Syndrome
  • Humans
  • Heart Ventricles
  • Clinical Trials as Topic
  • Cardiovascular System & Hematology
  • Blalock-Taussig Procedure
  • Arrhythmias, Cardiac