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| Optimal timing for Fontan conversion |
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Back to 86th Annual Meeting Back to Program Outline OBJECTIVE Intra-atrial reentery tachyarrhythmia (IART) is a common complication late after the classic atriopulmonary Fontan operation. Conversion to total cavopulmonary connection in association with cryosurgery is a viable option; however, its optimal timing remains controversial. The purposes of this study were to analyze the change of P wave characteristics after the atriopulmonary Fontan operation and to determine the optimal timing of the Fontan conversion. METHODS We reviewed clinical and electrocardiographic data of 18 patients with tricuspid atresia who underwent the atriopulmonary Fontan operation and were followed for more than 3 years. Their median age at operation was 4.1 years (range, 1 to 22 years), and the median follow-up period was 18.1 years (range, from 15 to 25 years). We measured P-wave axis, duration, dispersion, and amplitude from consecutive postoperative 12-lead electrocardiograms in each patient. Ectopic atrial rhythm was designated as a persistent shift in the P-wave axis greater than 45 degree as compared with the patient's preoperative electrocardiogram. RESULTS There was a significant increase in the maximum P-wave duration as well as P-wave dispersion over time after the classic atriopulmonary Fontan operation. Transient ectopic atrial rhythm was noticed in 16 patients during follow-up. Freedom from ectopic atrial rhythm was 83.8 ± 8.8% at 5 years, 38.9 ± 11.5% at 10 years, and 6.5 ± 6.2% at 15 years. Seven patients developed IART subsequent to transient ectopic atrial rhythm. Ten patients underwent the conversion operation 15.4 ± 2.9 years postoperatively. IART recurred in 2, who had sustained IART (6.0 and 8.0 years) prior to the conversion. In contrast, the other eight patients with transient ectopic atrial rhythm alone or non-sustained IART have been free from arrhythmia after the conversion. CONCLUSIONS Patients commonly have prolonged P-wave duration and ectopic atrial rhythm along with an increase in IART propensity late after the classic atriopulmonary Fontan operation. Electrical remodeling of the right atrium due to chronic pressure overload is inevitable in this setting. Optimally, early conversion should be undertaken before sustained IART ensues. 
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Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.