Arrhythmia Recurrence in Adult Patients with Single Ventricle Physiology Following Surgical Fontan Conversion |
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Authors: | Jamil Aboulhosn MD Ryan Williams BS Kalyanam Shivkumar MD PhD Rakhi Barkowski MD Mark Plunkett MD Pamela Miner MN Linda Houser MN Hillel Laks MD Brian Reemtsen MD Kevin Shannon MD John Child MD |
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Affiliation: | 1. Ahmanson/UCLA Adult Congenital Heart Disease Center;2. Cardiac Arrhythmia Center;3. Cardiothoracic Surgery, University of Kentucky, Lexington, Ky, USA;4. Cardiothoracic Surgery;5. Pediatric Cardiology, UCLA Medical Center, Los Angeles, Calif |
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Abstract: | Objectives. To evaluate the incidence of atrial tachy-arrhythmia (AT) recurrence following conversion from right atrial-pulmonary artery (RA-PA) Fontan to total cavopulmonary connection (TCPC) in adults. Background. AT is a recognized sequel of Fontan palliation, especially in RA-PA Fontans, and is associated with significant morbidity. While catheter ablation achieves fairly reliable short-term success with low morbidity, conversion to TCPC with arrhythmia surgery is a highly effective treatment option for the classical Fontan patients with incessant AT. Methods. Single center retrospective review. Results. Twenty-seven adults underwent Fontan conversion from RA-PA to TCPC, mostly for AT indications (n = 24). Nine (33%) underwent conversion to a lateral tunnel (LT) and 18 (67%) to an extracardiac (EC) Fontan. Two patients died <30 days post-operatively. Both had liver failure and had been turned down for cardiac/liver transplantation. In-hospital complications occurred in 15/27 patients (55%), including recurrence of AT requiring cardioversion in six patients (22%) and persistent pleural effusions in 4 (15%). Mean follow-up was 4.2 years (range 3 months–14 years). Functional capacity improved from mean New York Heart Association (NYHA) class 1.8 pre-conversion to 1.2 post-conversion (P= 0.008). Twenty-one patients had concomitant arrhythmia surgery (MAZE in 12 patients with IART and Cox-MAZE in nine patients with A-Fib +/− IART). Of these, 3/21 (14%) had AT recurrence >3 months following conversion. Conclusions. Conversion from RA-PA Fontan to TCPC, with arrhythmia surgery, decreases AT recurrence and improves functional capacity. The risk of peri-operative mortality is highest in patients with cirrhosis. AT recurred in 14% of patients. |
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Keywords: | Congenital Heart Disease Fontan Arrhythmia |
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