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Outcomes in adult Fontan patients with atrial tachyarrhythmias

Alexander C Egbe1, Heidi M Connolly1, Arooj R Khan1

  • 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.

American Heart Journal
|April 30, 2017
PubMed

Insights

For Fontan patients with atrial tachyarrhythmia, catheter ablation and Fontan conversion significantly reduce recurrence compared to antiarrhythmic drugs, leading to fewer adverse events. Early intervention at specialty centers is recommended.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Congenital Heart Disease

Background:

  • Optimal management for atrial tachyarrhythmia in Fontan patients remains unclear.
  • Fontan-associated arrhythmias pose significant clinical challenges.

Purpose of the Study:

  • To compare the efficacy of antiarrhythmic drugs (AAD), catheter ablation (CA), and Fontan conversion (FC) in managing atrial tachyarrhythmia (AR) in adult Fontan patients.
  • To evaluate freedom from AR recurrence and the occurrence of adverse events across different treatment strategies.

Main Methods:

  • Retrospective review of 264 adult Fontan patients diagnosed with atrial tachyarrhythmia.
  • Analysis of patients treated with AAD, CA, or FC, comparing freedom from AR and composite adverse events (stroke, heart failure hospitalization, death, heart transplant).

Main Results:

  • Catheter ablation achieved 41% freedom from AR at 60 months; Fontan conversion achieved 51% freedom from AR at 60 months.
  • Both CA and FC demonstrated significantly lower AR recurrence rates compared to AAD (7% freedom at 60 months).
  • Adverse events were more frequent in patients with recurrent AR and those treated solely with AAD.

Conclusions:

  • Catheter ablation and Fontan conversion are superior to antiarrhythmic drugs for managing atrial tachyarrhythmia in Fontan survivors.
  • Longer duration of atrial tachyarrhythmia correlates with higher recurrence rates and increased adverse events.
  • Prompt referral to specialized centers for CA or FC is advised for improved outcomes.
Abstract

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