Occurrence and management of atrial arrhythmia after long-term Fontan circulation.
OBJECTIVE
In patients after the Fontan operation, we determined risk factors for late failure and for intra-atrial re-entrant tachycardia at 15 to 20 years' follow-up. Midterm results after electrophysiologic ablation therapy for these tachycardias were also evaluated.


METHODS
Current follow-up was available in 162 patients (2005 patient-years) with a wide range of underlying diagnoses operated on between February 1978 and May 1995. Risk factor analysis included patient-related and procedure-related variables, with late failure and the incidence of re-entrant tachycardia as outcome parameters.


RESULTS
Forty late failures were observed (2.0 per 100 patient-years). At 15 years, Kaplan-Meier estimated survival was significantly (P =.007) better for patients with tricuspid atresia (93%) compared with that for patients with complex congenital malformation (71%). The sole multivariable risk factor for Fontan failure was the type of underlying diagnosis. At 20 years' follow-up, overall freedom from tachycardia was estimated to be 46% +/- 12%. Acute success of electrophysiologic ablation was seen in 25 (83%) of 30 patients, and Kaplan-Meier estimated freedom from recurrent tachycardia was 81% +/- 10% at 3 years. Multivariate analysis identified duration of Fontan circulation as the sole risk factor for re-entrant tachycardias.


CONCLUSIONS
After the modified Fontan operation, long-term survival in patients with tricuspid atresia was significantly better compared with that in patients with complex congenital malformations. As first-choice therapy for atrial re-entrant tachycardias, we recommend electrophysiologic ablation therapy.
Weipert
Joachim
J
Department of Cardiac Surgery, German Heart Center Munich. Weipert@dhm.mhn.de
Noebauer
Christian
C
Schreiber
Christian
C
Kostolny
Martin
M
Zrenner
Bernhard
B
Wacker
Annett
A
Hess
John
J
Lange
Ruediger
R
D000293:Adolescent; D000714:Anastomosis, Surgical; D002315:Cardiopulmonary Bypass; D017115:Catheter Ablation; D002648:Child; D002669:Child Welfare; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D005858:Germany; D006325:Heart Atria / Q000002:abnormalities / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery; D011652:Pulmonary Circulation / Q000502:physiology; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012307:Risk Factors; D016019:Survival Analysis; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology