Abstract 14959: Electrophysiological Characteristics in Different Types of Univentricular Physiology
Background Both classic Fontan (right atrium (RA) to pulmonary artery (PA)) and total cavopulmonary connection (TCPC) are surgical options for physiological univentricular heart. Although demographic analysis has shown that TCPC provides better long-term outcome than classical Fontan in terms of supraventricular tachycardia (SVT) occurrence, little is known about electrophysiological characteristics after these surgeries. The aim of this study was to assess clinical and electrophysiological differences in patients with these two types of operations.
Methods A total of 37 procedures in 25 patients with univentricular physiology who underwent catheter ablation procedures using electroanatomic mapping system (EAM) were enrolled. The patients comprised of two groups; 1) classical Fontan (group A; 26 procedures in 17 patients, median age 31 yrs, male 10) and 2) TCPC (group B; 11 procedures in 8 patients, median age 24 yrs, male 6). Electrophysiological characteristics and procedural data were compared.
Results Median interval between the last surgery and the ablation procedure was significantly different between two groups (22 vs 16 yrs, p = 0.007). Pre-procedural cardiac magnetic resonance (CMR) image and EAM demonstrated significantly larger RA (21 vs 6 cm2, p < 0.001 in CMR, 222 vs 38 ml, p = 0.002 in EAM) with greater extent of scars (67 vs 14 cm2, p = 0.014) in group A, resulting in a greater number of targeted SVTs (1.5 vs 1 SVT /procedure / patient, p < 0.001) in this group. Whilst most of the ablation regions in group A were in the RA, SVTs predominantly arose from the “excluded” RA in group B, which required retrograde aortic access using remote magnetic navigation (RMN). Acute procedure success was achieved 78 % in group A and 77 % in group B (p = NS).
Conclusion Patients after Fontan operation had larger RA with more extensive scar, as compared to those after TCPC operation, contributing to a greater number of inducible SVTs. RMN can successfully treat SVTs in TCPC patients using a retrograde approach to the “excluded” RA.
- © 2012 by American Heart Association, Inc.