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Arrhythmia management in the Fontan patient
B J Deal1, C Mavroudis, C L Backer
1Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA. bdeal@childrensmemorial.org
Pediatric Cardiology
|September 11, 2007
Summary
Fontan patients frequently develop atrial tachycardia, impacting hemodynamics. Surgical intervention offers low mortality and recurrence, improving function, and warrants earlier consideration than transplantation.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Atrial tachycardia is common in Fontan patients, often linked to hemodynamic issues.
- Management of arrhythmias in Fontan physiology presents unique challenges.
Purpose of the Study:
- To review arrhythmia management in Fontan patients.
- To examine surgical outcomes for Fontan conversion with arrhythmia surgery.
Main Methods:
- Review of arrhythmia incidence, types (macro-reentrant, atrial fibrillation), and risk factors.
- Analysis of surgical results for 117 patients undergoing Fontan conversion and arrhythmia surgery (ablation, maze procedures).
Main Results:
- Low operative mortality (0.8%) and arrhythmia recurrence (12.8%) after a mean 56-month follow-up.
- Significant functional status improvement in most patients post-surgery.
- High early mortality associated with cardiac transplantation in this population.
Conclusions:
- Fontan conversion with arrhythmia surgery is safe and effective, with low recurrence and improved function.
- Addressing the electromechanical nature of tachycardia is crucial.
- Earlier surgical intervention is recommended over delayed transplantation due to high transplant-related mortality.
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