Modification to the Fontan procedure for the prophylaxis of intra-atrial reentrant tachycardia: short-term results of a prospective randomized blinded trial.

Abstract

OBJECTIVES:

We evaluated the feasibility, safety, and short-term efficacy of an interventional atrial incision placed at the time of the Fontan operation to reduce the development of intra-atrial reentrant tachycardia.

METHODS:

This prospective randomized blinded trial was conducted in patients with congenital heart disease undergoing an initial lateral tunnel Fontan. Intervention patients underwent a lateral tunnel Fontan with an interventional atrial incision/cryoablation from the atriotomy to the right atrioventricular annulus. Controls underwent a standard lateral tunnel Fontan. Safety of the intervention was monitored. Short-term efficacy was determined by comparisons of conduction block across the incision area and spontaneous or inducible atrial arrhythmias.

RESULTS:

There were no significant differences between intervention (n = 21, median 2.4 years, range 0.8-3.9) and controls (n = 21, median 2.7 years, range 1.5-13.9) in age, type of heart disease, surgical parameters, or postoperative outcomes. Safety parameters showed no difference between groups in number or severity of adverse events. Short-term efficacy included evidence of conduction block with a longer conduction time across the incision area in intervention patients (median 97 ms, range 35-160) compared with controls (median 40 ms, range 8-77, P =.0001). No intervention patients had spontaneous or inducible intra-atrial reentrant tachycardia versus 2 controls (0/21 versus 2/21, P = NS).

CONCLUSIONS:

An interventional atrial incision to reduce intra-atrial reentrant tachycardia in the Fontan operation was feasible and safe. The intervention changed the atrial substrate as shown by an increase in conduction time. Short-term results showed a low incidence of intra-atrial reentrant tachycardia in all patients. Longer follow-up is necessary to assess clinical efficacy.

• Authors: Kathryn K Collins, Edward K Rhee, Janet M Delucca, Mark E Alexander, Laura M Bevilacqua, Charles I Berul, Edward P Walsh, John E Mayer, Richard A Jonas, Pedro J del Nido, John K Triedman
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 127 Issue 3 Pg. 721-9 (Mar 2004) ISSN: 0022-5223 [Print] United States
• PMID: 15001900 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Child
• Child, Preschool
• Double-Blind Method
• Female
• Fontan Procedure (adverse effects, methods)
• Heart Atria (surgery)
• Heart Conduction System (physiopathology)
• Heart Defects, Congenital (surgery)
• Humans
• Male
• Neural Conduction
• Prospective Studies
• Tachycardia, Supraventricular (etiology, physiopathology, prevention & control)