Incidence of Bradycardia in Children after Fontan Surgery—An Observational Cohort Study

Background: Children with univentricular hearts after Fontan surgery are at risk for developing postoperative bradycardia and bradycardia is an important risk factor for exercise limitation and reduced quality of life in Fontan children. The aim of the study was to determine the incidence of arrhythmia and especially bradycardia requiring pacemaker implantation postoperatively in those children.

Methods: Retrospective observational cohort study at a tertiary care pediatric cardiology center including children with univentricular hearts undergoing Fontan surgery between 2008 and 2021.

Results: Forty-five children were included in the study. The median age at surgery was 4.7 years (3; 11), median body weight was 16 kg (12; 32). Of these children, 15 patients (33%) already had the diagnosis of bradycardia before Fontan surgery. After Fontan surgery, another 10 children (22%) developed bradyarrhythmia during the postoperative course. The most common form of bradycardia was junctional escape rhythm, followed by atrial escape rhythm and sinus bradycardia. Five children (11%) required pacemaker implantation after Fontan surgery (median age at pacemaker implantation 6.4 years). Gender, type of congenital heart disease, and oxygen saturation were not associated with bradycardia after Fontan surgery.

Conclusion: In our cohort study, there was a relevant increase in the incidence of bradycardia in children after Fontan surgery, and 11% finally required permanent pacemaker implantation. We could not identify risk factors to predict postoperative bradycardia. Further studies are needed to allow for preoperative risk stratification to identify children who might profit from combining Fontan surgery with permanent pacemaker implantation.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025