Lateral tunnel versus extracardiac conduit fontan procedure: a concurrent comparison

Kumar, Shital; Rubinstein, Catherine S.; Simsic, Janet M.; Taylor, Ashby B.; Saul, J. Philip; Bradley, Scott M.

doi:10.1016/s0003-4975(03)01010-5

Cited by 119 publications

(82 citation statements)

References 23 publications

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“…Among patients with RA-PA connection that was performed in the past, the proportion of patients with supraventricular arrhythmia at 20 years after the surgery may be as high as 50% [12,13]. In case of LT that was performed during a later period and currently preferred ECC, these proportions are 6-35% and 2-28%, respectively [14][15][16]. Thus, studies suggest that the incidence of arrhythmia is lower in patients with LT and ECC compared to those with RA-PA connection.…”

Section: Discussionmentioning

confidence: 99%

Atrial tachycardia ablation in patients with a functional single ventricle after the Fontan surgery

et al. 2016

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A b s t r a c tBackground: Atrial tachyarrhythmias are a leading source of morbidity and mortality after Fontan-type procedures and antiarrhythmic drug therapy is often ineffective in these patients. Aim:To evaluate short-and long-term outcomes of radiofrequency current ablation for atrial tachycardia (AT) in patients after the Fontan procedure, and to report clinical, electrophysiological and electroanatomical characteristics of these arrhythmias. Methods:We retrospectively analysed data obtained in 8 patients (5 males, 3 females) after the Fontan procedure who underwent ablation for AT between 2002 and 2013. In order to compare the clinical impact of arrhythmia before and after ablation, we used the modified arrhythmia score, ranging from 0 (no arrhythmia activity) to 12 (very severe arrhythmia). In all patients, electroanatomical mapping using the CARTO system was performed, allowing semiquantification of low-voltage (< 0.5 mV) areas and scars.Results: Seven patients had an atriopulmonary connection and 1 patient had an extracardiac conduit. The mean patient age was 9.4 ± 3.1 years at the time of the Fontan procedure and 26.2 ± 4.6 years at the time of the first ablation. A total of 18 ablations were performed with no complications, 1 to 4 (median 2.5) procedures per patient. In patients who had more than 1 ablation, the mean time from the first to the last procedure was 34.8 months (range 1-64 months). In individual patients, 1 to 4 (median 2.5) different ATs were observed, with the mean tachycardia cycle length of 334 ± 95 ms. In 6 patients, low-voltage area (< 0.5 mV) comprised 25-50% of the right atrium, and in two others it comprised 10-25% and < 10% of the right atrium, respectively. Seven procedures were fully successful (ablation of all ATs), 7 were partially successful (ablation of only some AT, including clinical arrhythmia, but not of all ATs) and 4 were unsuccessful (failed ablation of clinical AT). The mean procedural, fluoroscopy and ablation times were 176 ± 54.6, 13.7 ± 5.7 and 21.7 ± 11.9 min, respectively. Freedom from arrhythmia during the mean follow-up of 58.6 ± 46 months (range 11-127 months) since the last procedure was obtained in 4 patients. The median arrhythmia score after the last ablation was significantly reduced compared to baseline (4.5 vs. 8; p < 0.05).Conclusions: Catheter ablation of AT in patients after the Fontan procedure is safe but its acute and long-term efficacy is limited. Due to complex and extensive substrate, along with complex anatomy, recurrences are frequent and patients may require repeat ablation procedures. Suppression of arrhythmia is associated with an improved clinical status of the patients.

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Section: Discussionmentioning

confidence: 99%

Atrial tachycardia ablation in patients with a functional single ventricle after the Fontan surgery

et al. 2016

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“…Potential drawbacks of the extra-cardiac conduit Fontan modification include the lack of growth potential and the risk of thrombosis of the prosthetic conduit. Despite these concerns, midterm analyses have revealed essentially equivalent outcomes (Kumar et al, 2003).…”

Section: Work In Progressmentioning

confidence: 99%

Surgical Maze Procedures for Atrial Arrhythmias in Univentricular Hearts, from Maze History to Conversion-Fontan

Kik¹,

Bogers²

2012

Tachycardia

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“…In addition, while the purpose of the Extracardiac conduit was to lower the incidence of arrhythmias, many studies have shown the incidence of post-operative arrhythmias to be comparable to the Lateral Tunnel [9] [10]. Some studies have also shown an association between the use of the Extracardiac conduit and a higher incidence of sinus node dysfunction [11].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Changes and Clinical Outcomes after the Intra/Extracardiac Fenestrated Fontan Procedure

Menon¹,

Lin²,

Mesia³

et al. 2018

WJCS

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Lateral tunnel versus extracardiac conduit fontan procedure: a concurrent comparison

Cited by 119 publications

References 23 publications

Atrial tachycardia ablation in patients with a functional single ventricle after the Fontan surgery

Atrial tachycardia ablation in patients with a functional single ventricle after the Fontan surgery

Surgical Maze Procedures for Atrial Arrhythmias in Univentricular Hearts, from Maze History to Conversion-Fontan

Hemodynamic Changes and Clinical Outcomes after the Intra/Extracardiac Fenestrated Fontan Procedure

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