Late development of intra-atrial reentrant tachycardia in lateral tunnel Fontan patients and the preventive role of prophylactic cryoablation

Young Hye Ryu; Mi Kyoung Song; Sang-Yun Lee; Gi Beom Kim; Yong Jin Kim; Eun-Jung Bae

doi:10.1016/j.jtcvs.2023.11.028

Late development of intra-atrial reentrant tachycardia in lateral tunnel Fontan patients and the preventive role of prophylactic cryoablation

J Thorac Cardiovasc Surg. 2023 Nov 21:S0022-5223(23)01104-2. doi: 10.1016/j.jtcvs.2023.11.028. Online ahead of print.

Authors

Young Hye Ryu¹, Mi Kyoung Song¹, Sang-Yun Lee¹, Gi Beom Kim¹, Yong Jin Kim², Eun-Jung Bae³

Affiliations

¹ Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
² Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, South Korea.
³ Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: eunjbaek@snu.ac.kr.

PMID: 37992960
DOI: 10.1016/j.jtcvs.2023.11.028

Abstract

Objective: Intra-atrial reentrant tachycardia is an important late-onset complication in patients undergoing the Fontan procedure. However, the protective effects of prophylactic cryoablation against late-onset intra-atrial reentrant tachycardia are unclear. This study investigated the late development of intra-atrial reentrant tachycardia in patients undergoing the lateral tunnel Fontan procedure and the role of prophylactic cryoablation.

Methods: This was a single-center retrospective cohort study of patients who underwent the lateral tunnel Fontan procedure between 1988 and 2003. Univariate and multivariable competing risks regression models were used to determine the associations of prophylactic cryoablation and covariates with the outcomes of interest: late-onset intra-atrial reentrant tachycardia, all-cause mortality, and cardiovascular mortality.

Results: In total, 130 patients who underwent the lateral tunnel Fontan procedure, 30 of whom had undergone prophylactic cryoablation, were included in this study and followed up for a median of 23.6 years (interquartile range, 17.7-26.5). Intra-atrial reentrant tachycardia was identified in 14 patients (10.8%), none of whom underwent prophylactic cryoablation. The median Fontan-to-intra-atrial reentrant tachycardia time was 17.2 years (interquartile range, 11.1-23.1). Prophylactic cryoablation was protective against late-onset intra-atrial reentrant tachycardia (P < .0001) and cardiovascular mortality (P < .0001) in the type 3 test.

Conclusions: None of the patients who underwent prophylactic cryoablation developed late-onset intra-atrial reentrant tachycardia during a median follow-up time of 22.9 years. Our study demonstrated that prophylactic cryoablation was effective in preventing late-onset intra-atrial reentrant tachycardia and cardiovascular mortality in patients undergoing the lateral tunnel Fontan.

Keywords: atrial flutter; cardiovascular mortality; intra-atrial reentrant tachycardia; lateral tunnel Fontan operation; mortality; prophylactic cryoablation.