Arrhythmia Recurrence in Adult Patients with Single Ventricle Physiology Following Surgical Fontan Conversion

Aboulhosn, Jamil; Williams, Ryan J.; Shivkumar, Kalyanam; Barkowski, Rakhi Shah; Plunkett, Mark; Miner, Pamela D.; Houser, Linda; Laks, Hillel; Reemtsen, Brian; Shannon, Kevin; Child, John S.

doi:10.1111/j.1747-0803.2010.00443.x

Cited by 48 publications

(11 citation statements)

References 10 publications

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“…The treatment options for atrial arrhythmias in Fontan physiology include AAD, catheter ablation and anti-arrhythmic surgery [5] , [9] , [14] . This is well demonstrated in a study by Aboulhosn et al [17] , where they authors reviewed outcomes in 27 adult Fontan patients undergoing Fontan conversion from atriopulmonary Fontan to TCPC. Aboulhosn et al observe that Fontan conversion operation was associated with reduced risk of recurrence of atrial tachyarrhythmias and improve functional status [17] .…”

Section: Discussionmentioning

confidence: 68%

Recurrent sustained atrial arrhythmias and thromboembolism in Fontan patients with total cavopulmonary connection

Egbe

Miranda

Devara

et al. 2021

IJC Heart & Vasculature

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Background Total cavopulmonary connection (TCPC) is associated with a lower risk of incident atrial arrhythmias as compared to atriopulmonary Fontan, but the risk of recurrent atrial arrhythmias is unknown in this population. The purpose of this study was to determine the incidence and risk factors for recurrent atrial arrhythmias and thromboembolic complications in patients with TCPC. Methods This is a retrospective multicenter study conducted by the Alliance for Adult Research in Congenital Cardiology (AARCC), 2000–2018. The inclusion criteria were TCPC patients (age > 15 years) with prior history of atrial arrhythmia. Results A total of 103 patients (age 26 ± 7 years; male 58 [56%]) met inclusion criteria. The mean age at initial arrhythmia diagnosis was 13 ± 5 years, and atrial arrhythmias were classified as atrial flutter/tachycardia in 85 (83%) and atrial fibrillation in 18 (17%). The median duration of follow-up from the first episode of atrial arrhythmia was 14.9 (12.1–17.3) years, and during this period 64 (62%) patients had recurrent atrial arrhythmias (atrial flutter/tachycardia 51 [80%] and atrial fibrillation 13 [20%]) with annual incidence of 4.4%. Older age was a risk factor for arrhythmia recurrence while the use of a class III anti-arrhythmic drug was associated with a lower risk of recurrent arrhythmias. The incidence of thromboembolic complication was 0.6% per year, and the cumulative incidence was 4% and 7% at 5 and 10 years respectively from the time of first atrial arrhythmia diagnosis. There were no identifiable risk factors for thromboembolic complications in this cohort. Conclusions Although TCPC provides superior flow dynamics and lower risk of incident atrial arrhythmias, there is a significant risk of recurrent arrhythmias among TCPC patients with a prior history of atrial arrhythmias. These patients may require more intensive arrhythmia surveillance as compared to other TCPC patients.

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Section: Discussionmentioning

confidence: 68%

Recurrent sustained atrial arrhythmias and thromboembolism in Fontan patients with total cavopulmonary connection

Egbe

Miranda

Devara

et al. 2021

IJC Heart & Vasculature

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“…Arrhythmias and heart failure manifest especially complex behaviour within this population and require unique expertise to understand their presentation and treatment 21 . As supraventricular arrhythmias are common following Fontan and atrial switch procedures, 22 – 24 it is not surprising that half of the patients in this study had consultations from the electrophysiology service. With regard to heart failure, this represents a different process in single-ventricle physiology or in a patient after atrial switch procedure with a subaortic right ventricle compared with that which occurs in heart failure associated with acquired heart disease 22 …”

Section: Discussionmentioning

confidence: 92%

Revision: review of non-elective hospitalisations of adults with CHD

Soufi

Colman

et al. 2017

Cardiol Young

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“…Fontan conversion surgery has yielded promising results with relatively low rates of early arrhythmia recurrence, however this procedure is fraught with peri-operative morbidity and data on long term follow-up for recurrence of atrial arrhythmias are limited. 11 Catheterization based radiofrequency ablation of atrial arrhythmias is technically challenging, particularly in patients with extensive intraatrial surgical scarring. We observed clinical and functional improvement after restoration of sinus rhythm in such patients.…”

Section: Discussionmentioning

confidence: 99%

“…2 Having a morphologic right ventricle was also an independent predictor of recurrence-a finding not previously demonstrated after Fontan conversion or ablation therapy. 11 It remains controversial if the systemic right ventricle is more prone to ventricular failure after Fontan. [15][16][17] However, it was surprising to learn that the patients in our cohort with systemic right ventricles were less likely to have improved ventricular function after cardioversion.…”

Section: Discussionmentioning

confidence: 99%

Improved Ventricular Function after TEE-guided Cardioversion of Atrial Arrhythmias in Patients after the Fontan Operation

Poterucha

Egbe

Johnson

et al. 2016

Congenital Heart Disease

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After the Fontan operation, cardioversion of atrial arrhythmias improves ventricular function, atrioventricular valve regurgitation grade, and NYHA class. Arrhythmia recurrence was common and patients with atrial flutter/intraatrial reentrant tachycardia, systemic right ventricle, or reduced ventricular function may be at risk of arrhythmia recurrence. Further studies are required to identify additional risk factors and protective factors for arrhythmia recurrence.

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Arrhythmia Recurrence in Adult Patients with Single Ventricle Physiology Following Surgical Fontan Conversion

Abstract: 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.

Cited by 48 publications

References 10 publications

Recurrent sustained atrial arrhythmias and thromboembolism in Fontan patients with total cavopulmonary connection

Recurrent sustained atrial arrhythmias and thromboembolism in Fontan patients with total cavopulmonary connection

Revision: review of non-elective hospitalisations of adults with CHD

Improved Ventricular Function after TEE-guided Cardioversion of Atrial Arrhythmias in Patients after the Fontan Operation

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