Preliminary analysis of arrhythmias after the Fontan operation with extracardiac conduit compared with intra-atrial lateral tunnel.
BACKGROUND
It is to be expected that avoidance of the atrial suture line during extracardiac Fontan operation (ECFO) decreases the risk of postoperative arrhythmias.


METHODS
Two groups of consecutive patients (23 with lateral tunnel (LTFO) and 24 with extracardiac conduit) who underwent successful Fontan operations between 5/93 and 10/98 were comparatively analyzed. All patients had postoperatively standard ECG and 24-hour monitoring. During follow-up, all patients had 2 - 8 (mean 3) standard ECG recordings per year and 76 % of the patients a 24-hour Holter ECG once a year.


RESULTS
Median follow-up after ECFO and LTFO was 2.4 years and 4.5 years, respectively. The incidence of supraventricular tachyarrhythmias and bradyarrhythmias after ECFO versus LTFO was lower early after operation and during follow-up (p < 0.05). In follow-up, 20 ECFO patients (91 %) versus 11 patients after LTFO (52 %) remained in sinus rhythm (p < 0.01). Pacemaker insertion was required in 7 (33 %) LTFO patients but none of the ECFO patients (p < 0.01).


CONCLUSIONS
The extracardiac Fontan operation decreases the incidence of early and medium-term postoperative arrhythmias. Comparative long-term results are not yet available.
Ovroutski
S
S
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Augusterburger Platz 1, 13533 Berlin, Germany. ovroutski@dhzb.de
Dähnert
I
I
Alexi-Meskishvili
V
V
Nürnberg
J H
JH
Hetzer
R
R
Lange
P E
PE
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects*; D005858:Germany; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care