Abstract 9230: Arrhythmias After the Fontan Operation; Which is Superior: Intracardiac Lateral Tunnel or Extracardiac Conduit? An International Multicenter Study of 1271 Patients
Bibliographic record
Abstract
Background: Arrhythmias, both brady and tachyarrhythmias, are common after the Fontan operation for single ventricle. By avoiding surgery near the sinus node, reducing pressure overload of the right atrium (RA), and decreasing RA scarring, the extracardiac conduit (ECC) is thought to be less arrhythmogenic than the intracardiac lateral tunnel (ILT). Evidence of such superiority is, however, lacking or inconclusive. Methods: An international multi-center retrospective study of 1271 patients was performed comparing early and late bradyarrhythmia (defined as need for pacing) and tachyarrhythmia (defined as needing any acute or chronic anti-arrhythmic therapy) between 669 ECC and 602 ILT patients. Age at Fontan was ILT 2.8 +/- 2.2 vs ECC 3.5 +/- 2.2 (p<0.0001). Results: In the early post-operative period, bradyarrhythmias requiring pacing were noted in 83 (11%) ECC patients vs 24 (4%) ILT patients (p < 0.0001) and tachyarrhythmias were noted in 53 (8%) ECC patients vs 32 (5%) ILT (p=ns). At follow-up (FU) (ECC 4.8+/- 4 years Vs ILT 8.9 +/- 5.4, mean +/- SD p<0.0001)), bradyarrhythmias were seen in 39 (6%) ECC vs 62 (10%) ILT (P <0.003) and tachyarrhythmias in 23 (3%) ECC vs 58 (10%) ILT (p< 0.0001). However, when length of FU was factored in, the incidence of brady and tachyarrhythmias did not differ between the 2 groups (p=ns). Conclusions: ECC has a higher incidence of early bradyarrhythmias. When length of FU is accounted for, late arrhythmia burden is similar between the two groups. Overall, the ECC does not appear to be less arrhythmogenic than the ILT. Therefore, the decision of which type of Fontan to perform may best be based upon individual patient anatomy, hemodynamic factors and surgeon preference rather than on a desired decrease in arrhythmia burden from the ECC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".