title: Impact of Fontan conversion with arrhythmia surgery and pacemaker therapy.
abstract: OBJECTIVE
  In the long-term period after Fontan operation, atrial arrhythmia was one of the important factors to decide the postoperative quality of life. We reviewed the impact of Fontan conversion with arrhythmia surgery and pacemaker therapy.
  
  
  METHODS
  Thirty-eight patients underwent Fontan conversion using extracardiac conduit from 1992, and 22 patients with atrial arrhythmia underwent maze procedure simultaneously using cryoablation or radiofrequency ablation and epicardial DDD pacemaker implantation and 16 patients had regular 'sinus' rhythm before Fontan conversion. Mean follow-up period was 52 months. Pre- and postoperative clinical course were analyzed. Average weight, age at Fontan conversion, and years after first Fontan operation were 49.0 kg, 25.8 years old, 14.7 years, respectively. Nineteen percent of patients were in New York Heart Association class I (NYHA I), and 74% of patients were in NYHA II, and 7% were in NYHA III, respectively.
  
  
  RESULTS
  Except three early deaths, actual survival rate at 1 year and 5 years were 80% and 64%, respectively. In survivors, 80% of the patients obtained regular heart rhythm including artificial pacemaker rhythm, although only 43% of the patients had regular 'sinus' rhythm before the Fontan conversion. Postoperative average cardiothoracic ratio and oxygen saturation (SpO(2)) were 50% and 94%, and 74% of patients were in NYHA I and 26% were in NYHA II, respectively, after Fontan conversion.
  
  
  CONCLUSIONS
  Mid-term results of Fontan conversion with arrhythmia surgery and pacemaker therapy were acceptable. Restoration of regular rhythm might improve the postoperative NYHA status and the activity of the daily life.
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan. shiramat@hij.twmu.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hiramatsu
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Iwata
authors.forename: Goki
authors.initials: G
authors.lastname: Matsumura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Konuma
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamazaki
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D003452:Cryosurgery / Q000379:methods; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010138:Pacemaker, Artificial; D011788:Quality of Life; D012086:Reoperation / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult