title: The mid-term surgical results of Fontan conversion with antiarrhythmia surgery.
abstract: OBJECTIVE
  We investigated the mid-term surgical results of Fontan conversion with antiarrhythmias surgery and permanent pacemaker implantation, which were complications of a previous Fontan operation.
  
  
  METHODS
  From January 1996 to November 2011, we performed Fontan conversion in 31 of 260 Fontan cases (M:F = 17:14, mean age = 19.0 years). The Fontan conversion from atriopulmonary connection (APC) to extracardiac conduit (ECC) was performed in 20 patients, APC to lateral tunnel in 5 and lateral tunnel to ECC in 6. The clinical outcomes and improvements of arrhythmias were analysed. The types of arrhythmias included atrial flutter in 21 patients, atrial fibrillation with flutter in 4 patients and junctional tachycardia in 3 patients.
  
  
  RESULTS
  Twenty-six patients (83.9%) required antiarrhythmia surgery (isthmus cryoablation = 9, right-sided maze = 13, bilateral maze = 4). In addition, 23 patients (74.2%) received a permanent pacemaker. The New York Heart Association functional class (NYHA Fc) was statistically improved after the surgery during the 6.5-year median follow-up duration (preoperative NYHA Fc = 1.77, postoperative NYHA Fc = 1.13, n = 15, P = 0.001). There were 4 late mortalities. Actuarial 5-year survival was 90.0 ± 5.5%. And freedom from arrhythmia was 91.8 ± 5.5%, at 5 years. Normal sinus rhythm was maintained in 12 patients (38.7%), pacing-dependent rhythm in 10 patients (32.3%) and intermittent pacing-dependent rhythm in 4 patients (12.9%).
  
  
  CONCLUSIONS
  Fontan conversion with antiarrhythmia surgery and permanent pacemaker implantation is safe and improves the clinical outcome and arrhythmias.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Woo Sung
authors.initials: WS
authors.lastname: Jang
authors.forename: Woong-Han
authors.initials: WH
authors.lastname: Kim
authors.forename: Kwangho
authors.initials: K
authors.lastname: Choi
authors.forename: JinHae
authors.initials: J
authors.lastname: Nam
authors.forename: Eun Seok
authors.initials: ES
authors.lastname: Choi
authors.forename: Jeong Ryul
authors.initials: JR
authors.lastname: Lee
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Bo Sang
authors.initials: BS
authors.lastname: Kwon
authors.forename: Gi Beom
authors.initials: GB
authors.lastname: Kim
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Bae
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000379:methods*; D016019:Survival Analysis
keywords: Antiarrhythmia surgery; Fontan conversion; Pacemaker implantation