Modification to the Fontan procedure for the prophylaxis of intra-atrial reentrant tachycardia: short-term results of a prospective randomized blinded trial.
OBJECTIVE
We evaluated the feasibility, safety, and short-term efficacy of an interventional atrial incision placed at the time of the Fontan operation to reduce the development of intra-atrial reentrant tachycardia.


METHODS
This prospective randomized blinded trial was conducted in patients with congenital heart disease undergoing an initial lateral tunnel Fontan. Intervention patients underwent a lateral tunnel Fontan with an interventional atrial incision/cryoablation from the atriotomy to the right atrioventricular annulus. Controls underwent a standard lateral tunnel Fontan. Safety of the intervention was monitored. Short-term efficacy was determined by comparisons of conduction block across the incision area and spontaneous or inducible atrial arrhythmias.


RESULTS
There were no significant differences between intervention (n = 21, median 2.4 years, range 0.8-3.9) and controls (n = 21, median 2.7 years, range 1.5-13.9) in age, type of heart disease, surgical parameters, or postoperative outcomes. Safety parameters showed no difference between groups in number or severity of adverse events. Short-term efficacy included evidence of conduction block with a longer conduction time across the incision area in intervention patients (median 97 ms, range 35-160) compared with controls (median 40 ms, range 8-77, P =.0001). No intervention patients had spontaneous or inducible intra-atrial reentrant tachycardia versus 2 controls (0/21 versus 2/21, P = NS).


CONCLUSIONS
An interventional atrial incision to reduce intra-atrial reentrant tachycardia in the Fontan operation was feasible and safe. The intervention changed the atrial substrate as shown by an increase in conduction time. Short-term results showed a low incidence of intra-atrial reentrant tachycardia in all patients. Longer follow-up is necessary to assess clinical efficacy.
Collins
Kathryn K
KK
University of California-San Francisco, San Francisco, CA, USA.
Rhee
Edward K
EK
Delucca
Janet M
JM
Alexander
Mark E
ME
Bevilacqua
Laura M
LM
Berul
Charles I
CI
Walsh
Edward P
EP
Mayer
John E
JE
Jonas
Richard A
RA
del Nido
Pedro J
PJ
Triedman
John K
JK
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods*; D006325:Heart Atria / Q000601:surgery; D006329:Heart Conduction System / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D009431:Neural Conduction; D011446:Prospective Studies; D013617:Tachycardia, Supraventricular / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*