Minimum and Average Heart Rates in Pediatric Fontan Patients with Favorable Postoperative Outcomes: A Holter...

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Fontan palliation increases risks of arrhythmias and sinus node dysfunction.
• Annual Holter monitoring is recommended, but normative data for Fontan patients is lacking.
• Existing data is limited, with only one study on healthy children.

Purpose of the Study:

• Establish normative Holter heart rate (HR) data for pediatric Fontan patients.
• Compare Holter data between Fontan patients and healthy children.
• Provide a reference dataset for ambulatory ECG screening in Fontan physiology.

Main Methods:

• Retrospective analysis of 642 Holter monitors from 133 Fontan patients (ages 5-21).
• Exclusion of patients with pacemakers, significant AV valve regurgitation, or poor ventricular function.
• Comparison of HR values with a cohort of 502 healthy controls.

Main Results:

• Fontan patients showed higher minimum HRs in adolescents and lower average HRs in younger children compared to controls.
• Fontan patients universally exhibited lower maximum HRs than healthy children.
• Male sex and digoxin use were linked to lower minimum HRs; heterotaxy correlated with higher minimum/average HRs.

Conclusions:

• This study provides the first normative Holter HR data for pediatric Fontan patients.
• Fontan patients do not necessarily have significantly lower minimum heart rates.
• Findings offer a clinical reference for evaluating Fontan patients and highlight the need for multicenter studies.