Surgical therapy of arrhythmias in single-ventricle patients undergoing Fontan or Fontan conversion

Abstract

Background: Arrhythmia is detrimental to Fontan hemodynamics. Clinical outcomes among Fontan patients who underwent antiarrhythmic treatment were retrospectively reviewed.

Methods: From January 1996 to January 2007, 182 patients underwent a Fontan procedure, including Fontan conversion. Thirty-nine of the 182 patients showed various arrhythmias pre- or post-Fontan operations, and were treated surgically including Fontan conversion (18 patients) or medically. The authors analyzed the outcomes of arrhythmia treatments retrospectively.

Results: Thirty-nine patients (21.4%) showed various arrhythmias, such as atrial flutter, atrial fibrillation, junctional rhythm, sinus node dysfunction, or brady tachyarrhythmia pre- or post-Fontan procedure. Follow-up duration was 13.1 +/- 8.7 years (11 months to 325 months).Atrial flutter and fibrillation only developed in 17 patients who received atriopulmonary connection Fontan, and who were treated by Fontan conversion with concomitant procedures such as Cox-maze procedure (two patients), right-side maze and pacemaker implantation (five patients), right atrial isthmus ablation (four patients), right atrial isthmus cryoablation and pacemaker implantation (five patients), and only pacemaker implantation (one patient). The 21 patients who showed arrhythmia at the time of the Fontan procedure underwent the following procedures concomitantly: right atrial isthmus cryoablation with pacemaker implantation (one patient), right atrial isthmus cryoablation (one patient), or pacemaker implantation (nine patients). The remaining 10 patients, who showed junctional rhythm, sinus bradycardia, or intermittent ectopic beats, were managed medically. There were two late mortalities due to protein-losing enteropathy. As a result, 33 patients (89.2%) maintained atrioventricular synchrony, 19 in sinus rhythm and 14 supported by a DDD-type pacemaker. The remaining four patients (10.8%) showed persistent junctional rhythm with a stable hemodynamic status.

Conclusions: The various arrhythmias in Fontan patients were well controlled by aggressive surgical management.