Abstract 1871: Atrial Tachyarrhythmias Late After Fontan Operation Are Related to Increase in Mortality and Hospitalization
Background Atrial tachyarrhythmias are a common complication late after Fontan operation. We assessed the prognostic significance of atrial tachyarrhythmias in adults who had a Fontan-type operation.
Methods All patients with previous Fontan operation followed at our institution since 1999 were identified from the electronic database. Demographic and clinical characteristics including history of atrial arrhythmias were recorded at the earliest full clinical assessment and patients were followed thereafter for all-cause mortality and hospitalization.
Results A total of 98 patients, mean age 31.5±8.9 years, 43.8% male, 31.6% with a total cavopulmonary connection (TCPC) were identified. A history of atrial arrhythmia was present at baseline in 60.2% of patients who were older (33.0±8.3 vs 29.1±9.4 years, p=0.002), less likely to have a TCPC (13.5% vs 58.9%, p<0.001), and more symptomatic in terms of NYHA class (51.9% vs 26.7%, p=0.007) compared to arrhythmia-free patients. During a median follow-up of 6.7 years 18 patients died and 64 patients were hospitalized. Even after adjustment for the baseline clinical characteristics, atrial tachyarrhythmia was an independent predictor of death (propensity score adjusted HR 9.35, 95% CI: 1.10 –79.18, p=0.04) and the composite of death or hospitalization (propensity score adjusted HR 5.00, 95% CI: 2.47–10.09, p<0.0001).
Conclusions In adult patients with a Fontan-type operation, the presence of atrial tachyarrhythmias is associated with a higher morbidity and mortality at mid-term follow-up. Whether early arrhythmia targeting intervention may improve clinical outcome needs to be studied in a prospective manner.