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Background: Early interstage mortality following single ventricle reconstruction (SVR) remains significant and recent studies suggests an association between digoxin and decreased interstage mortality in arrhythmia-free patients, suggesting potential treatment of occult arrhythmia. Arrhythmias have been shown to be common in this population with single center experiences suggesting no impact on survival. The objective of this study is to determine the impact of tachyarrhyhmias and antiarrhythmic therapy on the survival of patients undergoing SVR.
Methods: Publically available data from the Pediatric Heart Network Single Ventricle Reconstruction trial was used. Patients with known tachyarrhythmia during their Stage I hospitalization were compared to those without arrhythmias. Patients treated for tachyarrhythmia were compared to those without treatment. Primary outcomes were mortality by the end of Stage I hospitalization, interstage mortality, and post-Glenn mortality.
Results: 128 patients with tachyarrhythmia were identified, 16 had arrhythmia prior to Stage I and 118 had arrhythmia post-operatively. The arrhythmia and arrhythmia-free groups did not differ in gender, prematurity, anatomic diagnosis, use of anticoagulation or heart failure medications, ECMO during Stage I hospitalization, or degree of TR on Stage I echo. Mortality did not differ between the tachyarrhythmia group and arrhythmia-free group at any stage during SVR [Stage I hospitalization (19.53% vs 15.48%, p=0.503), interstage mortality (7.81% vs 9.52% p=0.800), post-Glenn (31.25% vs 24.29% p=0.243)]. 74 patients treated with antiarrhythmics at time of Stage I discharge were identified. There was no difference in mortality between the treated and untreated subjects during the interstage period or post-Glenn.
Conclusions: Tachyarrhythmia is not associated with mortality during the Stage I hospitalization or follow-up through the Glenn operation. This finding challenges the use of digoxin to reduce interstage arrhythmic mortality. Since identified tachyarrhythmia does not appear to play a role in mortality, it is unlikely for occult arrhythmia to be responsible for significant interstage mortality.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Basic 5
Abstract Category: 4. Arrhythmias and Clinical EP: Basic
Presentation Number: 1281-113
- 2017 American College of Cardiology Foundation