Relation of Norwood Shunt Type and Frequency of Arrhythmias at 6 Years (from the Single Ventricle Reconstruction Trial).
Relation of Norwood Shunt Type and Frequency of Arrhythmias at 6 Years (from the Single Ventricle Reconstruction Trial).
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诺伍德分流类型与 6 年心律失常频率的关系（来自单心室重建试验）。
DOI：
10.1016/j.amjcard.2021.12.056
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发表时间：
2022
期刊：
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通讯作者：
De
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作者：
Cain,Nicole;Saul,JPhilip;Gongwer,Russell;Trachtenberg,Felicia;Czosek,RichardJ;Kim,JeffreyJ;Kaltman,JonathonR;LaPage,MartinJ;Janson,ChristopherM;Singh,AnoopK;Hill,AllisonC;Landstrom,AndrewP;Thacker,Deepika;Niu,MaryC;De
与改良的Blalock-Taussig分流术（MBTS）相比，Norwood手术右心室至肺动脉分流术（RVPAS）降低了早期死亡率，但需要脑室切除术，可能增加室性心律失常（VAs）的风险。在SVRII（单心室重建扩展研究）中评估分流和Fontan类型对6岁前心律失常的影响。收集的SVRII数据包括324名患者在Fontan治疗前/后以及每年2至6年的抗心律失常药物、Fontan治疗时的心电图（ECG）和6年时的动态心电图(Holter) /ECG。回顾心电图和动态心电图的形态学、间期、房室传导和心律失常。在两组患者中，有50%的人（MBTS组为54%，RVPAS组为60%）在6年动态心电图中发现孤立性室性心动过速，而非持续性室性心动过速很少见，仅在RVPAS组中观察到（2.7%）。一级房室传导阻滞在RVPAS中比MBTS更常见（21% vs 8%, p = 0.01），而右束分支传导阻滞、QRS持续时间和QTc相似。抗心律失常药物的使用在两组中都很常见，但大多数药物也支持心室功能（如地高辛、卡维地洛）。在7例2 - 6年间死亡或移植的患者中，没有记录VAs，但与无移植幸存者相比，他们的QRS稍长（106 ms vs 93 ms, p = 0.05）。心房性心动过速在MBTS和RVPAS之间变化不大，但在Fontan类型之间存在差异（外侧隧道41% vs心外导管29%）。不同丰坦类型的VAs无差异。总之，在6年的随访中，良性VAs在SVRII人群中很常见。然而，尽管在RVPAS队列中有可能增加VAs和猝死，但这些数据不支持6年的显著差异或风险增加。研究结果强调了对SVR人群心律失常进行持续监测的必要性。
The Norwood procedure with a right ventricular to pulmonary artery shunt (RVPAS) decreases early mortality, but requires a ventriculotomy, possibly increasing risk of ventricular arrhythmias (VAs) compared with the modified Blalock-Taussig shunt (MBTS). The effect of shunt and Fontan type on arrhythmias by 6 years of age in the SVRII (Single Ventricle Reconstruction Extension Study) was assessed. SVRII data collected on 324 patients pre-/post-Fontan and annually at 2 to 6 years included antiarrhythmic medications, electrocardiography (ECG) at Fontan, and Holter/ECG at 6 years. ECGs and Holters were reviewed for morphology, intervals, atrioventricular conduction, and arrhythmias. Isolated VA were seen on 6-year Holter in >50% of both cohorts (MBTS 54% vs RVPAS 60%), whereas nonsustained ventricular tachycardia was rare and observed in RVPAS only (2.7%). First-degree atrioventricular block was more common in RVPAS than MBTS (21% vs 8%, p = 0.01), whereas right bundle branch block, QRS duration, and QTc were similar. Antiarrhythmic medication usage was common in both groups, but most agents also supported ventricular function (e.g., digoxin, carvedilol). Of the 7 patients with death or transplant between 2 and 6 years, none had documented VAs, but compared with transplant-free survivors, they had somewhat longer QRS (106 vs 93 ms, p = 0.05). Atrial tachyarrhythmias varied little between MBTS and RVPAS but did vary by Fontan type (lateral tunnel 41% vs extracardiac conduit 29%). VAs did not vary by Fontan type. In conclusion, at 6-year follow-up, benign VAs were common in the SVRII population. However, despite the potential for increased VAs and sudden death in the RVPAS cohort, these data do not support significant differences or increased risk at 6 years. The findings highlight the need for ongoing surveillance for arrhythmias in the SVR population.