학술논문
Abstract 11516: Is Norwood Shunt Type Predictive of Ventricular Arrhythmias
Document Type
Article
Author
Cain, Nicole; Saul, J Philip P; Gongwer, Russell; Bulic, Anica; Czosek, Richard J; DeWitt, Elizabeth S; Hill, Allison; Janson, Christopher; Kaltman, Jonathan; Kim, Jeffrey; Landstrom, Andrew P; LaPage, Martin J; Niu, Mary; Silver, Eric S; Singh, Anoop K; Thacker, Deepika; Trachtenberg, Felicia; Whitehill, Robert; Newburger, Jane W
Source
Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA11516-A11516, 1p
Subject
Language
ISSN
00097322; 15244539
Abstract
Introduction:The Norwood procedure with right-ventricular-to-pulmonary-artery shunt (RVPAS) decreases early mortality leading this approach to be adopted by many centers. However, it requires a right ventriculotomy, with potentially greater risk of ventricular arrhythmias than with the modified Blalock-Taussig Shunt (MBTS). We compared the effect of shunt type on the incidence of ventricular arrhythmias by 6 yrs of age in the Pediatric Heart Network (PHN) Single Ventricle Reconstruction Follow-up (SVR2) trial.Methods:PHN SVR2 collected the following data pre/post Fontan and annually at ages 2-6 years: EP procedures, pacemakers, anti-arrhythmic meds (AARx), study-related Holter/ECG at 6 yrs, and all clinical ECGs. ECG and Holter were reviewed for wave intervals, AV conduction and arrhythmias, focused on ventricular arrhythmias.Results:SVR2 enrolled 324 pts with analysis available for 292 pre-Fontan ECGs, 226 6-yr ECGs and 205 6-yr Holters. Pre-Fontan and 6-yr ECGs showed rare ventricular ectopy (VE) in both groups: Pre-Fontan: MBTS 0% vs RVPAS 1.9%; 6-yr: MBTS 1.9% vs RVPAS 0.6%. Six-yr holter showed a high prevalence of isolated VE in both groups ? MBTS 54% vs RVPAS 60% and rare non-sustained ventricular tachycardia (VT) with a maximum of 8 beats ? MBTS 0% vs RVPAS 2.7%. First and 2nddegree type 1 AV block were more common in RVPAS than MBTS (21% and 5.5% in RVPAS vs 8.3% and 2.1% in MBTS); RBBB, QRS duration, and QTc were similar. AARx medications were rare in both groups. Of 7 pts with death or transplant between 2-6 years, none had ventricular arrhythmias, but compared with transplant-free survivors, they had longer QRS (106.7 vs 93.5 ms, p=0.05), and trended toward longer QTc (475 vs 438 ms, p=0.08) and PR intervals (140.7 vs 131.9 ms, p=0.54).Conclusion:Pre-Fontan and 6-yr rhythm data by ECG and Holter in SVR2 show statistically similar incidence of VE and ECG parameters between MBTS and RVPAS patients, with the exception of 1st/2nddegree type 1 AV block. Isolated VE was common in both groups (over 50%), but VT was rare, non-sustained, and only present in RVPAS. Patients who had death/transplant demonstrated a longer QRS and trended toward longer QTc. RVPAS does not appear to promote significant ventricular arrhythmias in single ventricle pts up to age 6.