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Loss of sinus rhythm after total cavopulmonary connection
R E Kavey1, W E Gaum, C J Byrum
1Division of Pediatric Cardiology, SUNY-Health Science Center, Syracuse 13210, USA.
Insights
Total cavopulmonary connection (TCPC) surgery often leads to a loss of sinus rhythm (SR) in patients with functional single ventricle. The Fontan procedure, however, preserves SR more consistently postoperatively, indicating potential sinus node compromise during TCPC.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Electrophysiology
Background:
- Total cavopulmonary connection (TCPC) is a surgical repair for functional single ventricle, differing from the Fontan procedure by its involvement of the sinus node area.
- Understanding the impact of TCPC on sinus rhythm is crucial for long-term patient outcomes.
Purpose of the Study:
- To compare electrocardiogram (ECG) findings after TCPC and Fontan procedures.
- To evaluate the effect of cavopulmonary connection on postoperative sinus rhythm.
Main Methods:
- Retrospective analysis of ECG findings in patients who underwent TCPC versus Fontan procedure.
- Comparison of sinus rhythm (SR) prevalence and maintenance between the two surgical groups at different postoperative time points.
Main Results:
- TCPC patients showed a significant decrease in SR postoperatively (63% initially, 40% by 2 years) compared to Fontan patients (88% initially, 76% by 2 years).
- Loss of SR in TCPC patients was often associated with junctional rhythm (JR) or nonsinus atrial rhythm (NSAR).
- No significant differences were found in age at repair, preoperative diagnosis, or surgeon for TCPC patients experiencing SR loss.
Conclusions:
- The high incidence of SR loss following TCPC suggests operative compromise of the sinus node area.
- The Fontan procedure appears to maintain sinus rhythm more effectively than TCPC.
Background:
Total cavopulmonary connection (TCPC) to repair functional single ventricle involves the sinus node area, in contrast to the Fontan procedure. We compared ECG findings after TCPC and Fontan to evaluate the impact of the cavopulmonary connection on sinus rhythm postoperatively.
Methods And Results:
The Fontan group consisted of 17 patients repaired at 7.8 +/- 3.1 years of age (mean +/- SD): 11 for tricuspid or pulmonary atresia (TA/PA) and 6 for single ventricle. The TCPC group consisted of 19 patients repaired at 5.1 +/- 3.2 years of age (mean +/- SD) (P < .001): 9 for TA/PA, 4 for single ventricle, and 6 for hypoplastic left heart syndrome. Mean follow-up after Fontan was 7.7 +/- 2.7 years versus 2.8 +/- 1.6 years for TCPC (P < .001). Preoperative ECGs on all TCPC patients showed sinus rhythm (SR), whereas 16 of 17 Fontan patients had SR and one had nonsinus atrial rhythm (NSAR) since birth. On the first postdischarge ECG, 12 of 19 TCPC patients (63%) were in SR, 4 were in junctional rhythm (JR), and 3 were in NSAR. In comparison, 15 of 17 Fontan patients (88%) were in SR with 1 of 17 in NSAR and 1 in supraventricular tachycardia (P < .05 with chi 2 test). By 2 years postoperatively, only 6 of 15 TCPC patients available for follow-up (40%) were in SR, with 7 of 15 in JR and 2 of 15 in NSAR. By contrast, 13 of 17 Fontan patients (76%) remained in SR, with 1 in NSAR and 3 in JR (P < .05 with chi 2 test). TCPC patients with loss of SR did not differ from other patients in the group in age at repair, preoperative diagnosis, or surgeon performing the procedure.
Conclusions:
This significant incidence of loss of SR temporally related to surgery suggests that operative compromise of the sinus node area is common with TCPC.