Abstract 13760: Strategy to Reduce Intra-atrial Reentry Tachycardia Following the Fontan Operation
Background: Intra-atrial reentry tachycardia (IART) following the Fontan operation has a reported prevalence of 10-35% during early and intermediate follow up and poses substantial management challenges.
Methods: To reduce the prevalence of IART by interrupting potential reentry circuits preemptively at the Fontan procedure, we performed a randomized, double blind (to cardiologist and subject) study to evaluate the impact of an incision in the right atrium joining the lateral tunnel suture line and the tricuspid valve annulus by caudal extension of the atriotomy incision placed at the time of Fontan procedure.
Results: Between March, 1998 and July 2003, 134 subjects (mean age 1.9 yrs; 90, male) were randomly assigned to receive the interventional incision or not. There was one early death at Fontan (did not receive intervention incision), leaving 133 subjects. The clinical course, ECGs or Holters were available for review in 104 subjects at a median 9.8 yrs (range 2.6-13 yrs) follow-up. There were 90 subjects with hypoplastic left heart syndrome; 9, pulmonary atresia with intact ventricular septum and double inlet left ventricle each; 8, tricuspid atresia; 6, double outlet right ventricle; 1, Ebstein’s anomaly. There were 2 late deaths, neither subject had IART. The combined prevalence of sustained IART subjects was 3.8% (4/104). There was no difference in the occurrence of sustained IART in those subjects receiving the incision and those who did not (2 in each group) during follow-up.
Conclusion: Despite the fact that this trial was designed to reduce the prevalence of IART following the Fontan operation, the most important finding was that with current management, the incidence of IART is considerably lower than the early retrospective, observational studies suggested. No benefit to the selective incision was demonstrated, most likely due to the low frequency of IART.
- © 2013 by American Heart Association, Inc.