Incidence of arrhytmogenic events after extra-cardiac conduit type Fontan

  • Dr Aya Miyazaki, Department of Pediatric Cardiology, National Cardiovascular Center, Japan
  • Dr Hideo Ohuchi, Department of Pediatric Cardiology, National Cardiovascular Center, Japan
  • Dr Heima Sakaguchi, Department of Pediatric Cardiology, National Cardiovascular Center
  • Dr Masaki Yamamoto, Department of Pediatric Cardiology, National Cardiovascular Center
  • Dr Ken-ichi Kurosaki, Department of Pediatric Cardiology, National Cardiovascular Center
  • Dr Toshikatsu Yagihara, National Cardiovascular Center, Japan
  • Dr Osamu Yamada, Department of Pediatric Cardiology, National Cardiovascular Center, Japan

    • Background: The extra-cardiac conduit type Fontan procedure (ECC) has a lower incidence of arrhythmogenic events compared with lateral tunnel and atriopulmonary connection. However some intrinsic arrhythmogenic patients, such as isomerism heart have shown a high incidence of arrhythmias.
    Methods: Two hundred twelve patients (age at ECC: 4.2 ± 5.7 yrs) underwent ECC since 1995. We retrospectively reviewed the incidence and the clinical course of arrhythmias after ECC (follow-up period after ECC: 5.6 ± 3.1 yrs).
    Results: Atrial situs was solitus (SS) in 144 patients, inversus (SI) in 8, right isomerism (RI) in 38 and left isomerism (LI) in 15. The Supraventricular tachycardias (SVT) occurred in 26 patients (12%) after perioperative period, and 18 patients (8%) was required antiarrhythmic medication during follow-up. Two patients (RI: 1, SI: 1) died related with SVT in early postoperative period, and 2 (RI: 2) died later. The freedom from SVT after perioperative period of ECG in SS/SI, RI ,LI was 93%, 70% ,70% at 5 years, and 93%, 65%, 70% at 10 years (p < 0.0001). Pacemaker implantation (PMI) was performed after ECC in 17 patients (8%), caused by sinus node dysfunction in 12, atrioventricular block in 4 and atrioventricular block creation as the treatment of SVT in 1. The freedom from PMI in SS/SI, RI ,LI was 95%, 90% ,57% at 5 years (p = 0.0003).
    Conclusion: Because postoperative arrhythmogenic events are not uncommon in ECC patients, preoperative comprehensive therapeutic strategy, including EPS, should be considered in some ECC patients, especially in isomerism heart.