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Background  Interstage mortality ( IM ) remains significant after stage 1 palliation (S1P) for single‐ventricle heart disease ( SVD ), with many deaths sudden and unexpected. We sought to determine whether digoxin use post‐S1P is associated with reduced  IM , utilizing the multicenter database of the National Pediatric Cardiology Quality Improvement Collaborative ( NPCQIC ).    Methods and Results  From June 2008 to July 2013, 816 infants discharged after S1P from 50 surgical sites completed the interstage to stage  II  palliation, transplant, or  IM . Arrhythmia during S1P hospitalization or discharge on antiarrhythmic medications were exclusions (n=270); 2 patients were lost to follow‐up. Two analyses were performed: (1) propensity‐score adjusted logistic regression with  IM  as outcome and (2) retrospective cohort analysis for patients discharged on digoxin versus not, matched for surgical site and other established  IM  risk factors. Of 544 study patients, 119 (21.9%) were discharged on digoxin. Logistic regression analysis with propensity score, site‐size group, and digoxin use as predictor variables showed an increased risk of  IM  in those not discharged on digoxin (odds ratio, 8.6; lower confidence limit, 1.9; upper confidence limit, 38.3;  P <0.01). The retrospective cohort analysis for 60 patients on digoxin (matched for site of care, type of S1P, post‐S1P  ECMO  use, genetic syndrome, discharge feeding route, ventricular function, tricuspid regurgitation, and aortic arch gradient) showed 0%  IM  in the digoxin at discharge group and an estimated  IM  difference between the 2 groups of 9% ( P =0.04).    Conclusions  Among  SVD  infants in the  NPCQIC  database discharged post‐S1P with no history of arrhythmia, use of digoxin at discharge was associated with reduced  IM .

journal of the american heart association

Digoxin Use Is Associated With Reduced Interstage Mortality in Patients With No History of Arrhythmia After Stage I Palliation for Single Ventricle Heart Disease