The Effects of Modification to Lateral Tunnel Fontan Procedure for Prophylactic Arrhythmia Surgery

Refractory atrial arrhythmias and hemodynamic abnormalities are responsible for significant morbidity and mortality after the Fontan operation. We evaluated the long-term feasibility, safety, and efficacy of prophylactic atrial arrhythmia surgery performed concomitantly with the lateral tunnel Fontan operation.

From 1997 August to 2003 December, 27 patients underwent a initial lateral tunnel Fontan with an interventional atrial incision and cryoablation from the atriotomy to the coronary sinus and right atrioventricular valve annulus. This novel surgical technique consists of (1) right atriotomy extending to the coronary sinus to block the slow rate conduction isthmus; (2) cryoablation between right atriotomy and right atrioventricular valve annulus; (3) baffling to avoid injury to the crista terminalis; and (4) use of a sandwich technique with closure of right atriotomy incorporating the Gore-Tex (W. L. Gore & Associates, Flagstaff, AZ) patch to reduce atrial suture line.

There has been no early death after operation and one late death, which was not arrhythmic in etiology. At late follow-up of 15.2 ± 2.9 years (range, 5.5 to 18.0) after Fontan, spontaneous intraatrial reentrant tachycardia occurred in 1 patient, and inducible intraatrial reentrant tachycardia in 1 patient who required beta-blocker medication without ablation attempts. There was no evidence of early or late complications related to the interventional atrial incision and cryoablation. Four patients required late pacemaker implantation for sinus node dysfunction after Fontan operation.

The prophylactic arrhythmia surgery with our novel modification of the lateral tunnel Fontan procedure to reduce the development of intraatrial reentrant tachycardia was feasible and safe. Long-term follow-up results also demonstrated that this novel modification is effective for the prophylaxis of intraatrial reentrant tachycardia.