title: Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Tachyarrhythmias are common after the Norwood procedure, but atrioventricular block may portend a greater risk for interstage mortality.
authors.affiliation: Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga. Electronic address: osterm@kidsheart.com.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.affiliation: New England Research Institutes, Watertown, Mass.
authors.forename: Shan
authors.initials: S
authors.lastname: Chen
authors.affiliation: New England Research Institutes, Watertown, Mass.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Dagincourt
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, Calif.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Bar-Cohen
authors.affiliation: Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Matthew
authors.initials: M
authors.lastname: Brothers
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: Nicole
authors.initials: N
authors.lastname: Cain
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, The Heart Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Czosek
authors.affiliation: Department of Pediatrics, Johns Hopkins All Children's Heart Institute, St Petersburg, Fla.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Decker
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: David G
authors.initials: DG
authors.lastname: Gamboa
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC.
authors.forename: Salim F
authors.initials: SF
authors.lastname: Idriss
authors.affiliation: Department of Paediatrics & Labatt Family Heart Centre, Hospital for Sick Children & University of Toronto, Toronto, Ontario.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Kirsh
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Mich.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: LaPage
authors.affiliation: Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.affiliation: Department of Paediatrics & Labatt Family Heart Centre, Hospital for Sick Children & University of Toronto, Toronto, Ontario.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Radojewski
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Maully
authors.initials: M
authors.lastname: Shah
authors.affiliation: Division of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Silver
authors.affiliation: Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Anoop K
authors.initials: AK
authors.lastname: Singh
authors.affiliation: Division of Cardiology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Del.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Temple
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass.
authors.forename: John
authors.initials: J
authors.lastname: Triedman
authors.affiliation: Division of Cardiovascular Sciences, The National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kaltman
mesh_terms: D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Norwood; arrhythmia; atrioventricular block; mortality; outcomes; single ventricle; tachyarrhythmia