Sinus node dysfunction after intraatrial lateral tunnel and extracardiac conduit fontan procedures

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Electrophysiology

Background:

• The Fontan procedure is a palliative surgery for complex single-ventricle congenital heart defects.
• Sinus node dysfunction is a potential complication following Fontan procedures.
• Comparing intraatrial lateral tunnel (IALT) and extracardiac conduit (ECC) techniques is crucial for optimizing outcomes.

Purpose of the Study:

• To compare the incidence of sinus node dysfunction between IALT and ECC Fontan procedures.
• To evaluate the occurrence of atrial tachycardia in patients undergoing IALT versus ECC.
• To assess the need for permanent pacemaker implantation in relation to the surgical technique.

Main Methods:

• Retrospective analysis of 36 patients who underwent total cavopulmonary connection Fontan procedure between 1992 and 1998.
• Evaluation of 24-hour Holter recordings for sinus node dysfunction and atrial tachycardia.
• Review of clinical follow-up data and surface electrocardiograms.

Main Results:

• Sinus node dysfunction occurred in 21% of the IALT group (4/19) versus 59% of the ECC group (10/17) (p=0.04).
• No atrial tachycardia episodes were identified in either group.
• Three patients in the ECC group required permanent pacemaker implantation for sinus node dysfunction; none in the IALT group did.

Conclusions:

• Both IALT and ECC Fontan procedures are associated with a significant incidence of sinus node dysfunction.
• The ECC technique demonstrated a higher rate of sinus node dysfunction and pacemaker requirement compared to IALT.
• While IALT appears favorable, current data are insufficient to definitively recommend one technique over the other for the Fontan procedure.