PO-FPII-017 TWENTY FOUR YEAR FOLLOW UP OF PROSPECTIVE ANTI-ARRHYTHMIA STRATEGY TO PREVENT ATRIAL TACHYCARDIA AFTER FONTAN OPERATION

Amanda Krauss; Ian H. Law; David J. Bradley

doi:10.1016/j.hrthm.2026.03.239

Background Despite improvements in outcomes, atrial tachycardia (AT) remains a challenging sequela of Fontan surgery. A common AT circuit propagates around the atriotomy scar. Anti-arrhythmia surgery (AAS) consisting of a modified atriotomy lateral tunnel Fontan (LTF) was devised to exclude this circuit. Earlier reports of this cohort found a low incidence of AT overall (3.5% at 8.2 years) and no impact of the AAS. Objective This was a follow up study of a prospectively enrolled cohort of 134 patients randomized 1:1 to LTF with or without AAS between March 1998 and September 2003. We sought to examine the incidence of AT at late follow-up. Methods This study utilized readily available electronic records to assess clinical status documented within the preceding 3 years. The primary endpoint was occurrence of AT lasting >30 seconds any time post LTF. Categorical variables were reported as means and percentages. Baseline characteristics and AAS status were compared using independent t-tests. Categorical variables were evaluated using χ2. Results Of 45 patients with available data, 20 were in the group randomized to AAS. The average follow up was 24.4 years post Fontan. The overall incidence of AT was 40%, with no difference between standard LTF and AAS (36% vs. 45%, p=0.38). The average age at onset of IART was 17 +/- 8 years. Patients with oxygen saturation <93% were significantly more likely to develop AT (OR=5.38; p=0.02). Comparing patients with and without AT, the prevalence of abnormal function was similar (depressed in 44% with AT vs. 30% without AT; p=0.3). Again, comparing patients with and without AT, there was no difference in AV valve regurgitation (present in 83% with AT vs. 63% without AT; p=0.14). The average age of Fontan palliation was 23 months. Patients who developed IART were significantly older at the time of palliation (25 vs. 22 months, p <0.001). Conclusion AT is common in patients late after LTF, with a rise in incidence late in the second postoperative decade. Older age at LTF and hypoxemia were correlates of AT, though AAS failed to impact AT significantly. AV valve regurgitation trended towards correlation with AT.

PO-FPII-017 TWENTY FOUR YEAR FOLLOW UP OF PROSPECTIVE ANTI-ARRHYTHMIA STRATEGY TO PREVENT ATRIAL TACHYCARDIA AFTER FONTAN OPERATION

View Online

Abstract

Details

Metrics