Prospective study of the incidence and determinants of arrhythmia after total cavopulmonary connection

Atrial distension after Fontan operation may predispose to arrhythmia. Modifications aimed at decreasing the extent of right atrial distension (total cavopulmonary connection, TCPC) have been associated with a lower incidence of early arrhythmia, but serial evaluation has not been performed.

All 119 patients undergoing TCPC between March 1987 and December 1993 were enrolled in a prospective study to evaluate the incidence and determinants of arrhythmia by use of ambulatory ECG (AECG) monitoring. Median age at surgery was 5.9 years (range, 0.5 to 19.7 years), and median follow-up was 4.9 years (2.0 to 8.7 years). AECGs were performed before and after surgery and serially during follow-up. There were 17 early deaths, including 8 among 20 patients who had new arrhythmia documented in the operating in the operating room or intensive care unit. For the 102 patients who survived > 30 days after surgery, the proportion free of new AECG arrhythmia or first arrhythmic symptoms was 93% (CI, 89% to 99%) at 2 years and 78% (CI, 66% to 90%) at 5 years. Actuarial analysis treats occurrence of arrhythmia as permanent; however, most of the arrhythmia during follow-up was transient, so that the proportion of patients without arrhythmia was similar before and during follow-up. To date, there has been only 1 late arrhythmic death.

The low prevalence of clinically important arrhythmia during medium-term follow-up supports the TCPC as the preferred option for Fontan surgery.