{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:09:14Z","timestamp":1792782554156,"version":"4.5.0"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["UM1TR004403"],"award-info":[{"award-number":["UM1TR004403"]}],"id":[{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fontan palliation is associated with an increased risk for arrhythmias and sinus node dysfunction. Although annual Holter monitoring is recommended for routine surveillance, there is no normative Holter data for this population, with only one study describing such data in healthy children. To describe Holter data for patients with Fontan physiology, compare this data to healthy children, and establish a normative data set for those undergoing routine ambulatory ECG screening. This retrospective, single-center study analyzed 642 Holter monitors from 133 Fontan patients aged 5\u201321 years, collected between 1970 and 2023. Patients with pacemakers, significant atrioventricular valve regurgitation, or severely depressed ventricular function were excluded. Demographic and clinical data were collected, and HR values were compared to a healthy control cohort. The Fontan cohort was predominantly male (69%), with right ventricular dominance (59%) and extracardiac Fontan palliation (80%). Compared to 502 healthy controls, Fontan patients had significantly higher minimum HRs in adolescents (14\u201316 years), lower average HRs in younger age groups (4\u201312 years), and universally lower maximum HRs. Within the Fontan group, males and those on digoxin had lower minimum HRs, while heterotaxy was associated with higher minimum and average HRs. This is the first study to establish normative Holter HR data in pediatric Fontan patients and compare it to healthy counterparts. These findings suggest Fontan patients do not have significantly lower minimum heart rates and provide a valuable reference for clinical evaluation, supporting the need for larger, multicenter studies.<\/jats:p>","DOI":"10.1007\/s00246-025-04106-x","type":"journal-article","created":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T10:47:23Z","timestamp":1765018043000},"page":"3154-3161","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Minimum and Average Heart Rates in Pediatric Fontan Patients with Favorable Postoperative Outcomes: A Holter Monitoring Study"],"prefix":"10.1007","volume":"47","author":[{"given":"Peter","family":"Barrale","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex R","family":"Sigman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Pajazetovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Riley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linder H","family":"Wendt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Salameh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Janou\u0161ek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin W","family":"Hale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian H","family":"Law","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"issue":"6","key":"4106_CR1","doi-asserted-by":"publisher","first-page":"e234","DOI":"10.1161\/CIR.0000000000000696","volume":"140","author":"J Rychik","year":"2019","unstructured":"Rychik J, Atz AM, Celermajer DS, Deal BJ, Gatzoulis MA, Gewillig MH, Hsia TY, Hsu DT, Kovacs AH, McCrindle BW, Newburger JW, Pike NA, Rodefeld M, Rosenthal DN, Schumacher KR, Marino BS, Stout K, Veldtman G, Younoszai AK, d\u2019Udekem Y (2019) American Heart Association Council on cardiovascular disease in the young and council on cardiovascular and stroke nursing. Evaluation and management of the child and adult with Fontan circulation: a scientific statement from the American heart association. Circulation 140(6):e234\u2013e284. https:\/\/doi.org\/10.1161\/CIR.0000000000000696Epub 2019 Jul 1. PMID: 31256636","journal-title":"Circulation"},{"issue":"17","key":"4106_CR2","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1161\/CIRCULATIONAHA.116.022816","volume":"134","author":"RG Ohye","year":"2016","unstructured":"Ohye RG, Schranz D, D\u2019Udekem Y (2016) Current therapy for hypoplastic left heart syndrome and related single ventricle lesions. Circulation 134(17):1265\u20131279. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.116.022816PMID: 27777296; PMCID: PMC5119545","journal-title":"Circulation"},{"issue":"3","key":"4106_CR3","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1136\/thx.26.3.240","volume":"26","author":"F Fontan","year":"1971","unstructured":"Fontan F, Baudet E (1971) Surgical repair of tricuspid Atresia. Thorax 26(3):240\u2013248. https:\/\/doi.org\/10.1136\/thx.26.3.240PMID: 5089489; PMCID: PMC1019078","journal-title":"Thorax"},{"issue":"1","key":"4106_CR4","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/apa.16023","volume":"111","author":"E Hedlund","year":"2022","unstructured":"Hedlund E, Lundell B (2022) Fontan circulation has improved life expectancy for infants born with complex heart disease over the last 50 years but has also resulted in significant morbidity. Acta Paediatr 111(1):11\u201316. https:\/\/doi.org\/10.1111\/apa.16023Epub 2021 Jul 23. PMID: 34235784","journal-title":"Acta Paediatr"},{"key":"4106_CR5","unstructured":"Shaddy RE, Penn DJ, Cetta F, Feltes TF, Mital S (2022) Moss and adams\u2019 heart disease in Infants, Children, and adolescents: including the fetus and young Adult. 2, vol 2. Tenth. 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