title: Atrial tachyarrhythmias late after Fontan operation are related to increase in mortality and hospitalization.
abstract: BACKGROUND
  Atrial tachyarrhythmias are a known complication late after Fontan operation. Limited information is available on their prognostic value.
  
  
  METHODS
  All patients with previous Fontan operation followed at our institution since 1999 were identified from the electronic database and included in this study. Demographic and clinical characteristics including history of atrial tachyarrhythmias were recorded at the earliest full clinical assessment and patients were followed thereafter for all-cause mortality and hospitalization.
  
  
  RESULTS
  A total of 98 patients, mean age 31.5 ± 8.9 years, 43.8% male, 31.6% with a total cavopulmonary connection (TCPC) were identified. A history of atrial tachyarrhythmia was present at baseline in 60.2% of patients who were older (33.0 ± 8.3 vs 29.1 ± 9.4 years, p=0.002), less likely to have a TCPC (13.5% vs 58.9%, p<0.001), and more symptomatic in terms of NYHA class (51.9% vs 26.7%, p=0.007) compared to arrhythmia-free patients. During a median follow-up of 6.7 years 18 patients died and 64 patients were hospitalized. Even after adjustment for baseline clinical characteristics, atrial tachyarrhythmia was an independent predictor of death (propensity score adjusted HR 9.35, 95% CI: 1.10-79.18, p=0.04, c-statistic 0.88) and composite of death or hospitalization (propensity score adjusted HR 5.00, 95% CI: 2.47-10.09, p<0.0001).
  
  
  CONCLUSIONS
  In adult patients with a Fontan-type operation, the presence of atrial tachyarrhythmias is associated with higher morbidity and mortality at mid-term follow-up. Whether early arrhythmia targeting intervention may improve clinical outcome needs to be studied in a prospective manner.
authors.affiliation: Heart Rhythm and Adult Congenital Heart Centres, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannakoulas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.forename: Serkan
authors.initials: S
authors.lastname: Yuksel
authors.forename: Ryo
authors.initials: R
authors.lastname: Inuzuka
authors.forename: Antonia
authors.initials: A
authors.lastname: Pijuan-Domenech
authors.forename: Wajid
authors.initials: W
authors.lastname: Hussain
authors.forename: Edgar Lik
authors.initials: EL
authors.lastname: Tay
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects* / Q000401:mortality*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000209:etiology / Q000401:mortality*; D013997:Time Factors; D055815:Young Adult