title: Follow-Up of a Prospective Surgical Strategy to Prevent Intra-Atrial Reentrant Tachycardia After the Fontan Operation.
abstract: BACKGROUND
  Intra-atrial reentrant tachycardia (IART) after the Fontan operation had an early reported incidence of 10% to 35% during early and intermediate follow-up and posed substantial management challenges.
  
  
  RESULTS
  To reduce the incidence of IART after the Fontan procedure, we performed a randomized, double-blind study to evaluate the impact of an incision in the right atrium joining the lateral tunnel suture line and the tricuspid valve annulus. Between March 1998 and September 2003, 134 subjects (median age: 1.8 years; range: 1.3-5.2 years; 91 men) were randomly assigned to receive the incision. All 134 patients had a form of single ventricle pathological anatomy. The clinical course, electrocardiograms, and Holter monitoring were available for review in 114 subjects at a median of 8.2-year follow-up (range: 0.9-11.9 years). There were 2 late deaths, neither subject had IART. The combined incidence of sustained IART was 3.5% (4/114). There was no difference in the occurrence of sustained IART between those subjects receiving the incision and those who did not (2 in each group) during follow-up. No patients of either group experienced short-term complications.
  
  
  CONCLUSIONS
  Despite the fact that the primary outcome of this trial was not reached, the most significant finding was that with current management, the incidence of IART is considerably lower than the early retrospective, observational studies suggested.
authors.affiliation: From the Division of Pediatric Cardiology, Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City (I.H.L.); and Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases (O.A., D.J.B., S.Y., M.D.) and Department of Cardiac Surgery (E.L.B., R.G.O.), University of Michigan Medical School, Ann Arbor.
authors.forename: Ian H
authors.initials: IH
authors.lastname: Law
authors.affiliation: From the Division of Pediatric Cardiology, Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City (I.H.L.); and Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases (O.A., D.J.B., S.Y., M.D.) and Department of Cardiac Surgery (E.L.B., R.G.O.), University of Michigan Medical School, Ann Arbor.
authors.forename: Osman
authors.initials: O
authors.lastname: Alam
authors.affiliation: From the Division of Pediatric Cardiology, Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City (I.H.L.); and Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases (O.A., D.J.B., S.Y., M.D.) and Department of Cardiac Surgery (E.L.B., R.G.O.), University of Michigan Medical School, Ann Arbor.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Bove
authors.affiliation: From the Division of Pediatric Cardiology, Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City (I.H.L.); and Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases (O.A., D.J.B., S.Y., M.D.) and Department of Cardiac Surgery (E.L.B., R.G.O.), University of Michigan Medical School, Ann Arbor.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.affiliation: From the Division of Pediatric Cardiology, Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City (I.H.L.); and Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases (O.A., D.J.B., S.Y., M.D.) and Department of Cardiac Surgery (E.L.B., R.G.O.), University of Michigan Medical School, Ann Arbor.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.affiliation: From the Division of Pediatric Cardiology, Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City (I.H.L.); and Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases (O.A., D.J.B., S.Y., M.D.) and Department of Cardiac Surgery (E.L.B., R.G.O.), University of Michigan Medical School, Ann Arbor.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: From the Division of Pediatric Cardiology, Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City (I.H.L.); and Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases (O.A., D.J.B., S.Y., M.D.) and Department of Cardiac Surgery (E.L.B., R.G.O.), University of Michigan Medical School, Ann Arbor. mdick@umich.edu.
authors.forename: Macdonald
authors.initials: M
authors.lastname: Dick
mesh_terms: D004311:Double-Blind Method; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006329:Heart Conduction System / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies; D013615:Tachycardia, Sinoatrial Nodal Reentry / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*
keywords: Fontan procedure; cardiovascular surgery; congenital heart disease; suture; tachycardia