[Late atrial tachycardia after Fontan-type procedure. Cooperative study of 52 cases].
The Fontan procedure has allowed to improve the outcome of complex congenital cardiopathy involving single ventricle.  A better understanding of the systemic venous circulation has favored bicavo-bipulmonary derivation instead of atrio-pulmonary derivation.  However, in spite of the improvement in surgical procedures, post-operative arrhythmias still occur with an increasing rate during follow-up reaching 40 to 50% of the patients in some series.  We report a series of 52 patients of which 92% presented a severe atrial arrhythmia (atrial fibrillation or atrial flutter) during a 6-year follow-up.  The outcome was worse in case of classic or modified Fontan (n=15) or direct dicavo-bipulmonary procedures (n=7).  The non-modified Fontan group was characterized by a lower functional class (63% NYHA class I or II), more refractory atrial arryhthmias (37%), more deaths or transplanted patients (26%).  Amiodarone was very effective in this context as opposed to the failure of class 1 anti-arrhythmic drugs.  However, low dosage amiodarone in combination with a beta-blocker is recommended taking into account the important rate of amiodarone-induced side effects (53%).  Atrial arrhythmia ablation was unsuccessful (8/10 failures).  Anti-arrhythmic surgery (N=3) has been incompletely evaluated.  In summary, transformation of failing Fontan procedures into bicavo-bipulmonary derivations seems to offer the best outcome at the price of a high surgical risk.
Lucet
V
V
Unité de rythmologie pédiatrique, Château des Côtes, 78350 Les Loges-en-Josas.
D000293:Adolescent; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology*; D001282:Atrial Flutter / Q000209:etiology*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D005260:Female; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications
D000889:Anti-Arrhythmia Agents