Occurrence and management of atrial arrhythmia after long-term Fontan circulation

J Thorac Cardiovasc Surg. 2004 Feb;127(2):457-64. doi: 10.1016/j.jtcvs.2003.08.054.


Objectives: In patients after the Fontan operation, we determined risk factors for late failure and for intra-atrial re-entrant tachycardia at 15 to 20 years' follow-up. Midterm results after electrophysiologic ablation therapy for these tachycardias were also evaluated.

Methods: Current follow-up was available in 162 patients (2005 patient-years) with a wide range of underlying diagnoses operated on between February 1978 and May 1995. Risk factor analysis included patient-related and procedure-related variables, with late failure and the incidence of re-entrant tachycardia as outcome parameters.

Results: Forty late failures were observed (2.0 per 100 patient-years). At 15 years, Kaplan-Meier estimated survival was significantly (P =.007) better for patients with tricuspid atresia (93%) compared with that for patients with complex congenital malformation (71%). The sole multivariable risk factor for Fontan failure was the type of underlying diagnosis. At 20 years' follow-up, overall freedom from tachycardia was estimated to be 46% +/- 12%. Acute success of electrophysiologic ablation was seen in 25 (83%) of 30 patients, and Kaplan-Meier estimated freedom from recurrent tachycardia was 81% +/- 10% at 3 years. Multivariate analysis identified duration of Fontan circulation as the sole risk factor for re-entrant tachycardias.

Conclusion: After the modified Fontan operation, long-term survival in patients with tricuspid atresia was significantly better compared with that in patients with complex congenital malformations. As first-choice therapy for atrial re-entrant tachycardias, we recommend electrophysiologic ablation therapy.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Anastomosis, Surgical
  • Cardiopulmonary Bypass
  • Catheter Ablation*
  • Child
  • Child Welfare
  • Electrophysiologic Techniques, Cardiac
  • Female
  • Follow-Up Studies
  • Fontan Procedure*
  • Germany
  • Heart Atria / abnormalities
  • Heart Atria / surgery
  • Heart Defects, Congenital / surgery
  • Heart Ventricles / abnormalities
  • Heart Ventricles / surgery
  • Humans
  • Male
  • Multivariate Analysis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Postoperative Complications / surgery*
  • Pulmonary Artery / abnormalities
  • Pulmonary Artery / surgery
  • Pulmonary Circulation / physiology
  • Pulmonary Wedge Pressure / physiology
  • Risk Factors
  • Survival Analysis
  • Tachycardia, Atrioventricular Nodal Reentry / epidemiology
  • Tachycardia, Atrioventricular Nodal Reentry / etiology*
  • Tachycardia, Atrioventricular Nodal Reentry / surgery*
  • Time
  • Treatment Outcome
  • Vascular Resistance / physiology
  • Ventricular Pressure / physiology