Author + information
- Jerry Michael,
- Barbara Burkhardt,
- William Scott,
- Ilana Zeltser,
- Franz Gerald Greil,
- Animesh Tandon and
- Mohammad Tarique Hussain
Sinus node dysfunction (SND) occurs in up to 40% of patients after Fontan palliation and can impair cardiac output secondary to atrioventricular dyssynchrony or chronotropic incompetence and may be an early indicator of future Fontan failure. The relationship between SND and atrial function has not been established.
In this single center, prospective study, patients >7 years old with a history of a Fontan palliation underwent a non-sedated cardiac MRI and 48-hour Holter monitoring. A chart review was performed to assess for clinical symptoms of SND. Exclusion criteria included current anti-arrhythmic therapy, implanted pacemakers, and moderate to severe ventricular dysfunction. Atrial volumes were measured by both the area-length biplane method as well as by short axis stack to calculate atrial active, passive, and total ejection fractions. Holter monitors were reviewed for evidence of SND as defined by a minimum heart rate less than 2 standard deviations below the age adjusted average heart rate, sinus pauses longer than 3 seconds, or more than 50% junctional rhythm.
31 patients (25 male, mean age 16 years with a range of 11-25 years) participated. SND was present in 22 patients. Patients with SND had decreased atrial active ejection fractions (median 10.6% IQR (6.5 to 16.4%)) compared to those without SND (median 22.2% IQR (20.9 to 25.1%)) (p=0.007). Older age at the time of MRI was associated with increased incidence of SND (p=0.009). There was no significant difference for atrial volumes or total and passive atrial ejection fraction between groups. There was poor correlation between atrial volume measurements by biplane method as compared to short axis stack measurements (ICC 0.69-0.76).
SND in Fontan patients is associated with a reduced atrial active ejection fraction and older age. 3D atrial volumetric assessment is advised over 2D biplane estimation in Fontan patients. Further studies are needed to determine whether reduced atrial ejection fraction is a consequence of SND or if it is a contributing factor in the development of SND. Early detection of atrial function changes may help predict SND and, thereby, guide medical management of Fontan patients.
Poster Hall, Hall A/B
Sunday, March 11, 2018, 3:45 p.m.-4:30 p.m.
Session Title: Outcomes: Tetralogy of Fallot, Ebstein, Fontan and PDA
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1255-370
- 2018 American College of Cardiology Foundation