Congenital Heart DiseaseImpact of arrhythmia circuit cryoablation during Fontan conversion for refractory atrial tachycardia
Section snippets
Methods
Between January 1993 and April 1997, 16 patients underwent Fontan revision for management of recurrent refractory atrial arrhythmias. The initial 4 patients in this series underwent surgical revision of the Fontan procedure, without specific therapy directed at the tachycardia circuit. Due to the recurrence of symptomatic atrial tachycardia postoperatively in these patients, despite improved hemodynamics, the subsequent 12 patients underwent cryoablation of the tachycardia circuit with anatomic
Preoperative arrhythmia characteristics
The mean age at onset of atrial arrhythmias was 11.8 ± 4.5 years. The mean interval between the first Fontan procedure and the onset of symptomatic tachycardia was 5.2 years. Atrial reentry tachycardia was initiated and terminated with atrial pacing protocols in 11 of 12 patients undergoing ablation (Table I). The patient with atrial fibrillation did not undergo testing. More than 1 tachycardia circuit was identified in 4 patients. The mean tachycardia cycle length was 280 ms (range 150 to
Discussion
The results from the current study indicate for the first time that aggressive surgical management of life-threatening arrhythmias in the postoperative Fontan population, with electrophysiologically guided cryoablation of the tachycardia circuit as well as correcting hemodynamic abnormalities, is highly effective and superior to either radiofrequency catheter ablation or Fontan conversion alone. Conversion to total cavopulmonary anastomosis alone resulted in improved hemodynamics, as reported
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2015, International Journal of CardiologyCitation Excerpt :In adult Fontan patients (a growing population), IART reduces quality of life and may even cause death in hemodynamically compromised patients [5]. Several studies have recommended that these patients be treated with Fontan conversion to the lateral tunnel (LT) or extracardiac conduit (ECC) Fontan with concomitant antiarrhythmic surgery [6–8]; however, outcomes of such a procedure have not been well identified. The aim of this study was to evaluate clinical features of and risk factors for late IART over an extended period and to assess mid-term outcomes of Fontan conversion with antiarrhythmic surgery.