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J Thorac Cardiovasc Surg 2004;127:721-729
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Modification to the Fontan procedure for the prophylaxis of intra-atrial reentrant tachycardia: short-term results of a prospective randomized blinded trial

^a University of California, San Francisco, Calif, USA
^b St Louis Children's Hospital, Washington University in St Louis, St Louis, Mo, USA
^c Children's Hospital, Boston, Harvard University, Boston, Mass, USA

Presented at the American Heart Association meetings in New Orleans, La, November 12-15, 2000.

Received for publication February 5, 2003; revisions received March 25, 2003; revisions received June 2, 2003; accepted for publication June 18, 2003.

^* Address for reprints: John K. Triedman, MD, Department of Cardiology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
John.triedman{at}cardio.chboston.org

OBJECTIVES: We evaluated the feasibility, safety, and short-term efficacy of an interventional atrial incision placed at the time of the Fontan operation to reduce the development of intra-atrial reentrant tachycardia.

METHODS: This prospective randomized blinded trial was conducted in patients with congenital heart disease undergoing an initial lateral tunnel Fontan. Intervention patients underwent a lateral tunnel Fontan with an interventional atrial incision/cryoablation from the atriotomy to the right atrioventricular annulus. Controls underwent a standard lateral tunnel Fontan. Safety of the intervention was monitored. Short-term efficacy was determined by comparisons of conduction block across the incision area and spontaneous or inducible atrial arrhythmias.

RESULTS: There were no significant differences between intervention (n = 21, median 2.4 years, range 0.8-3.9) and controls (n = 21, median 2.7 years, range 1.5-13.9) in age, type of heart disease, surgical parameters, or postoperative outcomes. Safety parameters showed no difference between groups in number or severity of adverse events. Short-term efficacy included evidence of conduction block with a longer conduction time across the incision area in intervention patients (median 97 ms, range 35-160) compared with controls (median 40 ms, range 8-77, P = .0001). No intervention patients had spontaneous or inducible intra-atrial reentrant tachycardia versus 2 controls (0/21 versus 2/21, P = NS).

CONCLUSIONS: An interventional atrial incision to reduce intra-atrial reentrant tachycardia in the Fontan operation was feasible and safe. The intervention changed the atrial substrate as shown by an increase in conduction time. Short-term results showed a low incidence of intra-atrial reentrant tachycardia in all patients. Longer follow-up is necessary to assess clinical efficacy.

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