title: An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations.
abstract: OBJECTIVE
  The study objective was to determine whether the extracardiac conduit Fontan confers an arrhythmia advantage over the intracardiac lateral tunnel Fontan.
  
  
  METHODS
  This multicenter study of 1271 patients compared bradyarrhythmia (defined as need for pacing) and tachyarrhythmia (defined as needing antiarrhythmic therapy) between 602 patients undergoing the intracardiac Fontan and 669 patients undergoing the extracardiac Fontan. The median age at the time of the Fontan procedure was 2.1 years (interquartile range, 1.6-3.2 years) for the intracardiac group and 3.0 years (interquartile range, 2.4-3.9) for the extracardiac group (P < .0001). The median follow-up was 9.2 years (interquartile range, 5-12.8) for the intracardiac group and 4.7 years (interquartile range, 2.8-7.7) for the extracardiac group (P < .0001).
  
  
  RESULTS
  Early postoperative (<30 days) bradyarrhythmia occurred in 24 patients (4%) in the intracardiac group and 73 patients (11%) in the extracardiac group (P < .0001). Early postoperative (<30 days) tachyarrhythmia occurred in 32 patients (5%) in the intracardiac group and 53 patients (8%) in the extracardiac group (P = not significant). Late (>30 days) bradyarrhythmia occurred in 105 patients (18%) in the intracardiac group and 63 patients (9%) in the extracardiac group (P < .0001). Late (>30 days) tachyarrhythmia occurred in 58 patients (10%) in the intracardiac group and 23 patients (3%) in the extracardiac group (P < .0001). By multivariate analysis factoring time since surgery, more patients in the extracardiac group had early bradycardia (odds ratio, 2.9; 95% confidence interval, 1.8-4.6), with no difference in early tachycardia, late bradycardia, or late tachycardia.
  
  
  CONCLUSIONS
  Overall arrhythmia burden is similar between the 2 groups, but the extracardiac Fontan group had a higher incidence of early bradyarrhythmias. There was no difference in the incidence of late tachyarrhythmias over time between the 2 operations. Therefore, the type of Fontan performed should be based on factors other than an anticipated reduction in arrhythmia burden from the extracardiac conduit.
authors.affiliation: Department of Pediatrics, Oregon Health & Science University, Portland, Ore.
authors.forename: Seshadri
authors.initials: S
authors.lastname: Balaji
authors.affiliation: Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Ankana
authors.initials: A
authors.lastname: Daga
authors.affiliation: Department of Cardiology, CS Mott Children's Hospital, Ann Arbor, Mich.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.affiliation: Department of Cardiology, Primary Children's Medical Center and University of Utah, Salt Lake City, Utah.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Etheridge
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City, Iowa.
authors.forename: Ian H
authors.initials: IH
authors.lastname: Law
authors.affiliation: Department of Pediatrics, University of California, Irvine, Calif.
authors.forename: Anjan S
authors.initials: AS
authors.lastname: Batra
authors.affiliation: Department of Cardiology, Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Shubayan
authors.initials: S
authors.lastname: Sanatani
authors.affiliation: Department of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Anoop K
authors.initials: AK
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Gajewski
authors.affiliation: Department of Cardiology, Children's Memorial Hospital, Chicago, Ill.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Tsao
authors.affiliation: Department of Cardiology, Children's Hospital of Michigan, Detroit, Mich.
authors.forename: Harinder R
authors.initials: HR
authors.lastname: Singh
authors.affiliation: Department of Cardiology, Mercy Children's Hospital, Kansas City, Mo.
authors.forename: Svjetlana
authors.initials: S
authors.lastname: Tisma-Dupanovic
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital & Cardiovascular Center, Chiba, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tateno
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital & Cardiovascular Center, Chiba, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Takamuro
authors.affiliation: Department of Pediatric Cardiology, Hokkaido Medical Center, Hokkaido, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Cardiology, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: shahm@email.chop.edu.
authors.forename: Maully
authors.initials: M
authors.lastname: Shah
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001919:Bradycardia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013610:Tachycardia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents