Hakacova Nina, Lakomy Miroslav, Kovacikova Lubica
Cardiac Intensive Care Unit, Children's Cardiac Center, Slovakia.
J Electrocardiol. 2008 Mar-Apr;41(2):173-7. doi: 10.1016/j.jelectrocard.2007.10.007.
Arrhythmias are frequent causes of morbidity and mortality in patients with single ventricle physiology after Fontan operation. The aim of this study was to evaluate which type of Fontan procedure--lateral tunnel (LT) or extracardiac conduit (EC)--provides superior outcomes related to the problem of early postoperative and 1-year follow-up arrhythmias.
We retrospectively analyzed the incidence, types, and duration of rhythm disorders in 101 consecutive patients who received either LT (n = 60) or EC (n = 41) between April 1997 and March 2006 in Slovak Children's Cardiac Center, Bratislava (Slovakia). Weight, age, sex, and the type of heart morphology did not differ significantly between the 2 groups. The rhythm was monitored and documented perioperatively and postoperatively with standard electrocardiogram (ECG) recording and continual ECG monitoring. Duration of extracorporeal circulation, duration of aortic crossclamp and hemodynamic variables were analyzed with respect to the development of early arrhythmias in both groups. Twenty-four-hour ECG Holter monitoring (DMS 300-7, Holterreader, Producer DMS, Nevada, USA) was used to detect arrhythmias at the 1-year follow-up.
Early postoperative rhythm abnormalities were identified in 31 patients (52%) who underwent LT and in 22 patients (54%) who underwent EC. The most frequent type of rhythm disturbance was junctional rhythm in both groups. The bivariate analysis revealed that there was no significant difference in the incidence, type, or duration of early onset arrhythmias between the 2 groups. Although, there was no significant difference in the duration of arrhythmia since the admission form the operating room. The need of aortic crossclamp was significantly lower in EC group (P < .001). However, this did not correlate with lower incidence of early onset arrhythmias with EC modification. At the 1-year follow-up, the prevalence of arrhythmias was similar in both groups.
Extracardiac conduit as compared with LT does not provide superior outcomes related to the problem of early and 1-year onset arrhythmias. Other factors than the risk of early postoperative and early follow-up arrhythmias should be considered in surgical preference of modification strategy.
在Fontan手术治疗单心室生理的患者中，心律失常是发病和死亡的常见原因。本研究的目的是评估哪种类型的Fontan手术——侧隧道（LT）或心外管道（EC）——在术后早期和1年随访心律失常问题上能提供更好的结果。
我们回顾性分析了1997年4月至2006年3月期间在斯洛伐克布拉迪斯拉发的斯洛伐克儿童心脏中心连续接受LT（n = 60）或EC（n = 41）手术的101例患者心律失常的发生率、类型和持续时间。两组患者的体重、年龄、性别和心脏形态类型无显著差异。围手术期和术后通过标准心电图（ECG）记录和连续ECG监测对心律进行监测和记录。分析了两组体外循环时间、主动脉阻断时间和血流动力学变量与早期心律失常发生的关系。在1年随访时，使用24小时动态心电图监测（DMS 300 - 7，Holterreader，生产商DMS，美国内华达州）检测心律失常。
接受LT手术的31例患者（52%）和接受EC手术的22例患者（54%）在术后早期发现心律异常。两组中最常见的心律失常类型是交界性心律。双变量分析显示两组早期心律失常的发生率、类型或持续时间无显著差异。尽管从手术室入院后心律失常的持续时间无显著差异。EC组主动脉阻断的需求显著更低（P <.001）。然而，这与EC改良术早期心律失常发生率较低无关。在1年随访时，两组心律失常的患病率相似。
与LT相比，心外管道在早期和1年发作性心律失常问题上并未提供更好的结果。在手术方式选择策略时，应考虑除术后早期和早期随访心律失常风险之外的其他因素。
