Yasuhara Jun, Kuno Toshiki, Taki Moe, Toda Koichi, Kumamoto Takashi, Kojima Takuro, Shimizu Hiroyuki, Yoshiba Shigeki, Kobayashi Toshiki, Sumitomo Naokata
Department of Pediatric Cardiology, Saitama Medical University International Medical Center.
Center for Cardiovascular Research and Heart Center, Nationwide Children's Hospital.
Int Heart J. 2019 Nov 30;60(6):1358-1365. doi: 10.1536/ihj.19-099. Epub 2019 Nov 15.
Postoperative arrhythmias are a frequent and fatal complication after the Fontan operation. However, clinical evidence demonstrating early postoperative arrhythmias in children undergoing the Fontan operation is limited. This study aimed to evaluate the prevalence of arrhythmias and identify the predictors of early postoperative supraventricular tachyarrhythmias (SVTs) after the Fontan procedure.Data were analyzed from 80 pediatric patients who underwent Fontan procedures between April 2000 and December 2017 in a single-center retrospective study. Early postoperative SVTs were defined as arrhythmias within 30 days after the Fontan procedure. We divided the patients into two groups, with or without early postoperative arrhythmias, and the predictors of early postoperative arrhythmias were analyzed. A multivariate logistic regression analysis was performed to determine independent predictors of early postoperative SVTs after the Fontan procedure.Early postoperative SVTs were observed in 21 patients (26.3%). The most common arrhythmia was junctional ectopic tachycardia. After an adjustment, an atrioventricular valve regurgitation (AVVR) grade of ≥2 (odds ratio 10.54, 95% confidence interval 2.52 to 44.17, P = 0.001) and preoperative arrhythmias (odds ratio 26.49, 95% confidence interval 1.64 to 428.62, P = 0.021) were significant predictors of early postoperative SVTs after the Fontan operation.An AVVR grade ≥2 and preoperative arrhythmia were significant predictors associated with early postoperative SVTs. Intervention for AVVR may provide clinical benefit for preventing early postoperative arrhythmias after the Fontan operation.
术后心律失常是Fontan手术常见且致命的并发症。然而，关于接受Fontan手术的儿童术后早期心律失常的临床证据有限。本研究旨在评估心律失常的发生率，并确定Fontan手术后早期室上性快速心律失常（SVT）的预测因素。
在一项单中心回顾性研究中，分析了2000年4月至2017年12月期间接受Fontan手术的80例儿科患者的数据。术后早期SVT定义为Fontan手术后30天内出现的心律失常。我们将患者分为两组，即有或无术后早期心律失常，并分析术后早期心律失常的预测因素。进行多因素逻辑回归分析以确定Fontan手术后早期SVT的独立预测因素。
21例患者（26.3%）出现术后早期SVT。最常见的心律失常是交界性异位性心动过速。经过调整后，房室瓣反流（AVVR）≥2级（比值比10.54，95%置信区间2.52至44.17，P = 0.001）和术前心律失常（比值比26.49，95%置信区间1.64至428.62，P = 0.021）是Fontan手术后早期SVT的显著预测因素。
AVVR≥2级和术前心律失常是与术后早期SVT相关的显著预测因素。对AVVR进行干预可能为预防Fontan手术后早期心律失常提供临床益处。
