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Combined Atrial Volume is Associated with Significant Atrial Arrhythmias in Total Cavopulmonary Connection Fontan

Anna N Kamp1,2, Carmen Kiper3, Jennifer Russell4

  • 1Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Tower Building, Suite T3234, Columbus, OH, 43205, USA. anna.kamp@nationwidechildrens.org.

Pediatric Cardiology
|August 24, 2023
PubMed

Insights

Combined atrial volume (CAV) is associated with significant atrial arrhythmias (SAA) in Fontan palliation patients. An indexed CAV of 80 mL/kg or higher may indicate increased SAA risk.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Cardiac Imaging

Background:

  • Atrial arrhythmias are a frequent complication after Fontan palliation, leading to increased morbidity and mortality.
  • Atrial volume assessment, particularly by cardiac magnetic resonance imaging, is established in acquired heart disease for predicting atrial arrhythmias.
  • Limited data exists on atrial volume's role in Fontan palliation patients, despite its known significance in other cardiac conditions.

Purpose of the Study:

  • To investigate the association between combined atrial volume (CAV) and the risk of significant atrial arrhythmias (SAA) in patients with total cavopulmonary connection (TCPC) Fontan palliation.
  • To determine if CAV is a predictive marker for SAA in this specific patient population.

Main Methods:

  • A single-center retrospective case-control study involving 17 TCPC Fontan patients with SAA and 17 age- and sex-matched controls.
  • Combined atrial volume (CAV) was analyzed using 3D imaging data, encompassing both atria but excluding the Fontan baffle.
  • Statistical analysis compared CAV between case and control groups, controlling for potential confounding factors.

Main Results:

  • No significant differences were found in age, gender, Fontan type, atrioventricular valve regurgitation, or ventricular function between the groups.
  • Combined atrial volume (CAV) was significantly higher in patients experiencing SAA compared to the control group.
  • All control patients exhibited an indexed CAV of ≤80 mL/kg, suggesting a potential threshold for risk.

Conclusions:

  • This study provides the first evidence linking increased combined atrial volume (CAV) to a higher risk of significant atrial arrhythmias (SAA) in Fontan palliation patients.
  • Indexed CAV ≥80 mL/kg may serve as a valuable imaging biomarker for identifying TCPC Fontan patients at elevated risk for SAA.
  • Further research is warranted to validate these findings and explore therapeutic implications.

Keywords:
Adult congenital heart diseaseAtrial arrhythmiaFontan palliation

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