Congenital and surgically acquired Wolff-Parkinson-White syndrome in patients with tricuspid atresia.
OBJECTIVE
There are reports associating an increased incidence of Wolff-Parkinson-White syndrome with tricuspid atresia. Here we report on electrophysiologic studies in patients with tricuspid atresia and Wolff-Parkinson-White syndrome after the Fontan operation. In these patients the atrial arrhythmia often seen in patients undergoing the Fontan operation triggered atrioventricular re-entrant tachycardia or caused life-threatening arrhythmias.


METHODS
Five patients with tricuspid atresia after palliation with a modified Fontan operation (atrioinfundibular connections) and Wolff-Parkinson-White syndrome are presented.


RESULTS
Four of these patients had symptomatic paroxysmal orthodromic atrioventricular re-entrant tachycardia and a history of syncope; one of them additionally had atrial flutter with 2:1 conduction to the ventricle. A fifth patient presented with a life-threatening broad-complex tachycardia. In electrophysiologic studies an accessory pathway was localized in the right septal area in 3 patients. In 2 patients the accessory atrioventricular pathways were created by means of surgical intervention, connecting the right atrial appendage to the right ventricular outflow tract. All patients could be managed successfully by means of catheter ablation.


CONCLUSIONS
In patients with tricuspid atresia, there are congenital and surgically acquired accessory pathways responsible for the increased rate of Wolff-Parkinson-White syndrome. Both types of accessory pathways can and should be treated by means of catheter ablation because atrial arrhythmia often seen in patients undergoing the Fontan operation can trigger atrioventricular re-entrant tachycardia or cause life-threatening tachycardia. Congenital accessory pathways should be excluded carefully before surgical intervention for total cavopulmonary anastomosis in patients with tricuspid atresia.
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart-Center Munich, Technical University of Munich, Lazarettstrasse 36, D-80636 Munich, Germany. hager@dhm.mhn.de
Alfred
A
Hager
Bernhard
B
Zrenner
Silke
S
Brodherr-Heberlein
Ilse
I
Steinbauer-Rosenthal
Juergen
J
Schreieck
John
J
Hess
D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D018729:Fontan Procedure; D006329:Heart Conduction System / Q000002:abnormalities*; D006801:Humans; D008297:Male; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000209:etiology; D018785:Tricuspid Atresia / Q000150:complications*; D014927:Wolff-Parkinson-White Syndrome / Q000209:etiology* / Q000503:physiopathology