title: Intra-atrial reentrant tachycardia in adult patients after Fontan operation.
abstract: BACKGROUND
  Atrial tachyarrhythmia is a major late complication in adult Fontan patients. This study examined the clinical features and risk factors of late intra-atrial reentrant tachyarrhythmia (IART) in adult patients after Fontan surgery and the mid-term outcome of Fontan conversion with or without antiarrhythmic surgery in these patients.
  
  
  METHODS
  We conducted a retrospective study on adult patients who were born before 1994 and survived at least 3 months after a Fontan operation at Seoul National University Children's Hospital.
  
  
  RESULTS
  We followed 160 patients over 20.9 ± 4.1 years. Sustained atrial tachycardia was identified in 51 patients, and IART was found in 41, appearing a mean 13.6 years after surgery. By the 25 year follow-up, 40% had developed IART. The incidence of IART significantly increased over time. Patients with an atriopulmonary connection (APC) (n=65) had significantly longer follow-up duration and higher incidence of IART than patients with a lateral tunnel (n=86) or extracardiac conduit Fontan (n=9). On multivariate analysis, APC, sinus node dysfunction, and nonsustained atrial tachycardia were found to be significantly associated with IART. Twenty-four patients with IART underwent Fontan conversion. Over the follow-up period, IART severity scores in the 22 patients who survived after Fontan conversion decreased significantly, and New York Heart Association functional class significantly improved. On multivariate analysis, protein losing enteropathy and ventricular dysfunction were found to be significant risk factors for mortality.
  
  
  CONCLUSIONS
  IART was common in adult Fontan patients, and Fontan conversion with or without antiarrhythmic surgery and pacemaker placement helped to control it.
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
authors.forename: Mi Kyoung
authors.initials: MK
authors.lastname: Song
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea. Electronic address: eunjbaek@snu.ac.kr.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Bae
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
authors.forename: Bo Sang
authors.initials: BS
authors.lastname: Kwon
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
authors.forename: Gi Beom
authors.initials: GB
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
authors.forename: Chung Il
authors.initials: CI
authors.lastname: Noh
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
authors.forename: Jung Yun
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
authors.forename: Woong Han
authors.initials: WH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
authors.forename: Jeong Ryul
authors.initials: JR
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects*; D005544:Forecasting; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013615:Tachycardia, Sinoatrial Nodal Reentry / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
keywords: Congenital heart disease; Fontan procedure; Supraventricular tachycardia; Tachyarrhythmia