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 incidence of late intra-atrial reentrant tachyarrhythmia (IART) in adult patients after Fontan surgery and the mid-term outcome of Fontan conversion with pacemaker placement and with or without antiarrhythmia 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 Childrens 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 ± 6.2 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) had significantly longer follow-up duration and higher incidence of IART than patients with a lateral tunnel or extracardiac conduit. 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 helped to control it.