Risk factors for atrial tachyarrhythmias after the Fontan operation

J Am Coll Cardiol. 1994 Dec;24(7):1735-41. doi: 10.1016/0735-1097(94)90181-3.


Objectives: The purpose of this study was to define the incidence and risk factors for atrial tachyarrhythmias after the Fontan operation.

Background: Atrial tachyarrhythmias cause morbidity after the Fontan operation. Causative factors may be affected by the type of systemic to pulmonary connection.

Methods: The Fontan operation was performed in 270 consecutive patients between 1982 and 1992. The mean age at operation was 7.0 +/- 4.3 years. Direct atriopulmonary connection was used in 138 patients (51%), total cavopulmonary connection in 94 (35%) and right atrial to right ventricular connection in 38 (14%).

Results: Atrial tachyarrhythmias were seen early postoperatively in 55 patients (20%), preoperative atrial tachyarrhythmia being the only risk factor. Follow-up was achieved for 228 early survivors (97%) at a mean interval of 4.4 years. There were 20 late deaths. Late atrial tachyarrhythmias were noted in 29% of patients who received an atriopulmonary connection, 14% of those who received a total cavopulmonary connection and 18% of those who received a right ventricular connection (p < 0.02). Significant risk factors as determined by univariate and multiple logistic regression analysis were atriopulmonary connection type (odds ratio 0.40 for total cavopulmonary relative to atriopulmonary connection [p < 0.05] and 0.37 for right ventricular relative to atriopulmonary connection [p = 0.08]), longer follow-up interval (odds ratio 1.32 for each consecutive year [p < 0.002]) and atrial tachyarrhythmia in the operative period (odds ratio 6.31 [p < 0.0001]).

Conclusions: Early postoperative atrial tachyarrhythmias, length of follow-up and atriopulmonary connection are significant independent risk factors for the presence of late atrial tachyarrhythmias.

MeSH terms

  • Analysis of Variance
  • Atrial Fibrillation / etiology*
  • Child
  • Child, Preschool
  • Death, Sudden, Cardiac
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Fontan Procedure / adverse effects*
  • Fontan Procedure / methods
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / surgery*
  • Humans
  • Male
  • Pulmonary Artery / surgery
  • Risk Factors
  • Tachycardia, Atrioventricular Nodal Reentry / etiology
  • Tachycardia, Ectopic Atrial / etiology
  • Tachycardia, Supraventricular / etiology*
  • Tricuspid Atresia / mortality
  • Tricuspid Atresia / surgery
  • Venae Cavae / surgery