title: Arrhythmia recurrence in adult patients with single ventricle physiology following surgical Fontan conversion.
abstract: OBJECTIVE
  To evaluate the incidence of atrial tachy-arrhythmia (AT) recurrence following conversion from right atrial-pulmonary artery (RA-PA) Fontan to total cavopulmonary connection (TCPC) in adults.
  
  
  BACKGROUND
  AT is a recognized sequel of Fontan palliation, especially in RA-PA Fontans, and is associated with significant morbidity. While catheter ablation achieves fairly reliable short-term success with low morbidity, conversion to TCPC with arrhythmia surgery is a highly effective treatment option for the classical Fontan patients with incessant AT.
  
  
  METHODS
  Single center retrospective review.
  
  
  RESULTS
  Twenty-seven adults underwent Fontan conversion from RA-PA to TCPC, mostly for AT indications (n = 24). Nine (33%) underwent conversion to a lateral tunnel (LT) and 18 (67%) to an extracardiac (EC) Fontan. Two patients died <30 days post-operatively. Both had liver failure and had been turned down for cardiac/liver transplantation. In-hospital complications occurred in 15/27 patients (55%), including recurrence of AT requiring cardioversion in six patients (22%) and persistent pleural effusions in 4 (15%). Mean follow-up was 4.2 years (range 3 months-14 years). Functional capacity improved from mean New York Heart Association (NYHA) class 1.8 pre-conversion to 1.2 post-conversion (P= 0.008). Twenty-one patients had concomitant arrhythmia surgery (MAZE in 12 patients with IART and Cox-MAZE in nine patients with A-Fib +/- IART). Of these, 3/21 (14%) had AT recurrence >3 months following conversion.
  
  
  CONCLUSIONS
  Conversion from RA-PA Fontan to TCPC, with arrhythmia surgery, decreases AT recurrence and improves functional capacity. The risk of peri-operative mortality is highest in patients with cirrhosis. AT recurred in 14% of patients.
authors.affiliation: Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Medical Center, BH-307 CHS, 650 Charles Young Drive South, Los Angeles, CA, USA. jaboulhosn@mednet.ucla.edu
authors.forename: Jamil
authors.initials: J
authors.lastname: Aboulhosn
authors.forename: Ryan
authors.initials: R
authors.lastname: Williams
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.forename: Rakhi
authors.initials: R
authors.lastname: Barkowski
authors.forename: Mark
authors.initials: M
authors.lastname: Plunkett
authors.forename: Pamela
authors.initials: P
authors.lastname: Miner
authors.forename: Linda
authors.initials: L
authors.lastname: Houser
authors.forename: Hillel
authors.initials: H
authors.lastname: Laks
authors.forename: Brian
authors.initials: B
authors.lastname: Reemtsen
authors.forename: Kevin
authors.initials: K
authors.lastname: Shannon
authors.forename: John
authors.initials: J
authors.lastname: Child
mesh_terms: D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult