This Article Full Text Full Text (PDF) All Versions of this Article: 106/5/575    most recent 01.CIR.0000025876.82336.26v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Deal, B. J. Articles by Johnsrude, C. Search for Related Content PubMed PubMed Citation Articles by Deal, B. J. Articles by Johnsrude, C. Pubmed/NCBI databases Medline Plus Health Information Heart Surgery Related Collections Ablation/ICD/surgery Pediatric and congenital heart disease, including cardiovascular surgery

(Circulation. 2002;106:575.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Comparison of Anatomic Isthmus Block With the Modified Right Atrial Maze Procedure for Late Atrial Tachycardia in Fontan Patients

Barbara J. Deal, MD; Constantine Mavroudis, MD; Carl L. Backer, MD; Scott H. Buck, MD; Christopher Johnsrude, MD

From the Divisions of Cardiology (B.J.D., S.H.B., C.J.) and Cardiovascular-Thoracic Surgery (C.M., C.L.B.), Children’s Memorial Hospital; and the Departments of Pediatrics (B.J.D., S.H.B., C.J.) and Surgery (C.M., C.L.B.), Northwestern University Medical School, Chicago, Ill.

Correspondence to Barbara J. Deal, MD, Division of Cardiology, M/C #21, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614. E-mail bdeal{at}northwestern.edu

Background— Late atrial reentry tachycardia (AT) after Fontan repair is common, with limited efficacy of medical therapy in preventing AT recurrence. In this study, two approaches to surgical arrhythmia ablation in patients with refractory AT undergoing Fontan revision are compared: cryoablation of the inferomedial right atrium (RA), and a more extensive modified RA maze procedure designed to eliminate all potential RA reentrant circuits.

Methods and Results— Fontan revision was performed in 23 patients with AT, using inferomedial RA cryoablation (Group 1, n=8) and modified RA maze procedure (Group 2, n=15). There was no difference in age at initial Fontan, age at Fontan revision, age at onset of AT, or number of failed antiarrhythmic medications. Patients underwent preoperative, intraoperative, and postoperative electrophysiological studies. Thirty-eight different tachycardia circuits were induced in preoperative studies with 3 major areas of RA involvement: the lower lateral RA, the atrial septum, and the inferomedial RA. At postoperative electrophysiological study, AT was inducible in 62% of Group 1 patients but only 7% of Group 2 patients (P<0.02). With mean follow-up of 43 months, 5 of 8 patients in Group 1 experienced AT recurrence compared with none in Group 2 (P<0.001). There was no significant difference in length of hospital stay or complication rate comparing the two groups.

Conclusion— Modified RA maze procedure is superior to anatomic isthmus block in treating reentrant AT in postoperative Fontan patients. The modified RA maze has eliminated AT recurrence at mid-term follow-up with low morbidity and mortality.

Key Words: atrial tachycardia • Fontan operation • arrhythmia surgery

This article has been cited by other articles:

				H. Laks, D. Marelli, M. Plunkett, and J. Myers Adult Congenital Heart Disease Card. Surg. Adult, January 1, 2008; 3(2008): 1431 - 1464. [Full Text]

				C. Mavroudis, B. J. Deal, C. L. Backer, R. D. Stewart, W. H. Franklin, S. Tsao, K. M. Ward, and R. A. DeFreitas 111 Fontan Conversions with Arrhythmia Surgery: Surgical Lessons and Outcomes Ann. Thorac. Surg., November 1, 2007; 84(5): 1457 - 1466. [Abstract] [Full Text] [PDF]

				M. Rubenfire, V. V. McLaughlin, R. P. Allen, G. Elliott, M. H. Park, M. Wade, and R. Schilz Transition From IV Epoprostenol to Subcutaneous Treprostinil in Pulmonary Arterial Hypertension: A Controlled Trial Chest, September 1, 2007; 132(3): 757 - 763. [Abstract] [Full Text] [PDF]

				E. P. Walsh Interventional Electrophysiology in Patients With Congenital Heart Disease Circulation, June 26, 2007; 115(25): 3224 - 3234. [Full Text] [PDF]

				M. Koh, T. Yagihara, H. Uemura, K. Kagisaki, I. Hagino, T. Ishizaka, and S. Kitamura Optimal timing of the Fontan conversion: Change in the P-wave characteristics precedes the onset of atrial tachyarrhythmias in patients with atriopulmonary connection J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1295 - 1302. [Abstract] [Full Text] [PDF]

				T. Karamlou, I. Silber, R. Lao, B. W. McCrindle, L. Harris, E. Downar, G. D. Webb, J. M. Colman, G. S. Van Arsdell, and W. G. Williams Outcomes after late reoperation in patients with repaired tetralogy of fallot: the impact of arrhythmia and arrhythmia surgery. Ann. Thorac. Surg., May 1, 2006; 81(5): 1786 - 1793. [Abstract] [Full Text] [PDF]

				C. Mavroudis, R. D. Stewart, C. L. Backer, B. J. Deal, L. Young, and W. H. Franklin Atrioventricular Valve Procedures with Repeat Fontan Operations: Influence of Valve Pathology, Ventricular Function, and Arrhythmias on Outcome Ann. Thorac. Surg., July 1, 2005; 80(1): 29 - 36. [Abstract] [Full Text] [PDF]

				J. H. Nurnberg, S. Ovroutski, V. Alexi-Meskishvili, P. Ewert, R. Hetzer, and Peter. E. Lange New Onset Arrhythmias After the Extracardiac Conduit Fontan Operation Compared With the Intraatrial Lateral Tunnel Procedure: Early and Midterm Results Ann. Thorac. Surg., December 1, 2004; 78(6): 1979 - 1988. [Abstract] [Full Text] [PDF]

				J. Weipert, C. Noebauer, C. Schreiber, M. Kostolny, B. Zrenner, A. Wacker, J. Hess, and R. Lange Occurrence and management of atrial arrhythmia after long-term Fontan circulation J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 457 - 464. [Abstract] [Full Text] [PDF]

				H. Laks, D. Marelli, M. Plunkett, J. Odim, and J. Myers Adult Congenital Heart Disease Card. Surg. Adult, January 1, 2003; 2(2003): 1329 - 1358. [Full Text]