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Atrial arrhythmias and thromboembolic complications in adults post Fontan surgery
Darryl Wan1, Jasmine Grewal1, Amanda Barlow1
1Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Adults with Fontan circulation frequently develop atrial arrhythmias and thromboembolic events. These complications are linked to age and surgical history, not traditional risk factors.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Cardiac Surgery
Background:
- Patients who undergo Fontan surgery are at risk for late complications in adulthood.
- Understanding factors associated with atrial arrhythmias and thromboembolic complications is crucial for managing this population.
Purpose of the Study:
- To investigate the factors associated with the development and persistence of atrial arrhythmias and thromboembolic complications in adults with univentricular physiology after Fontan surgery.
Main Methods:
- A single-center retrospective cohort study included patients aged 18 years and older with Fontan circulation.
- Data were analyzed using univariate and multivariate regression models to identify significant risk factors.
Main Results:
- Of 93 patients, 39.8% experienced atrial arrhythmias, associated with prior surgeries, increasing age, and atriopulmonary Fontan connection.
- Thromboembolic events occurred in 33% of patients, with stroke being the most common, associated with age and cirrhosis.
Conclusions:
- Atrial arrhythmias are common in adults with Fontan circulation, influenced by surgical history and age.
- Traditional risk factors may not predict these complications in the Fontan population.
Objective:
Patients with Fontan surgery experience late complications in adulthood. We studied the factors associated with the development and maintenance of atrial arrhythmias and thromboembolic complications in an adult population with univentricuar physiology post Fontan surgery.
Methods:
Single centre retrospective cohort study of patients ≥18 years of age with Fontan circulation followed at our quaternary care centre for more than 1 year were included. Univariate and multivariate regression models were used where applicable to ascertain clinically significant associations between risk factors and complications.
Results:
93 patients were included (age 30.2±8.8 years, 58% men). 28 (30%) had atriopulmonary Fontan connection, 35 (37.6%) had lateral tunnel Fontan and 29 (31.1%) had extracardiac Fontan pathway. After a mean of 7.27±5.1 years, atrial arrhythmia was noted in 37 patients (39.8%), of which 13 developed had atrial fibrillation (14%). The presence of atrial arrhythmia was associated with the number of prior cardiac surgeries/procedures, increasing age and prior atriopulmonary Fontan operation. Thromboembolic events were present in 31 patients (33%); among them 14 had stroke (45%), 3 had transient ischaemic attack (9.7%), 7 had pulmonary embolism (22.6%) and 5 had atrial thrombus with imaging (16.1%). The presence of thromboembolic events was only associated with age and the presence of cirrhosis in multivariate analysis.
Conclusions:
Atrial arrhythmias are common in adults with Fontan circulation at an early age, and are associated with prior surgical history and increasing age. Traditional risk factors may not be associated with atrial arrhythmia or thromboembolism in this cohort.
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