Comparison of anatomic isthmus block with the modified right atrial maze procedure for late atrial tachycardia in Fontan patients

Late atrial reentry tachycardia (AT) after Fontan repair is common, with limited efficacy of medical therapy in preventing AT recurrence. In this study, two approaches to surgical arrhythmia ablation in patients with refractory AT undergoing Fontan revision are compared: cryoablation of the inferome...

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Published in:Circulation (New York, N.Y.) N.Y.), 2002-07, Vol.106 (5), p.575-579
Main Authors: DEAL, Barbara J, MAVROUDIS, Constantine, BACKER, Carl L, BUCK, Scott H, JOHNSRUDE, Christopher
Format: Article
Language:English
Subjects:
Adolescent
Biological and medical sciences
Body Surface Potential Mapping
Cardiac Surgical Procedures - methods
Child
Cryosurgery
Defibrillators, Implantable
Electrophysiologic Techniques, Cardiac
Follow-Up Studies
Fontan Procedure - adverse effects
Heart Atria - physiopathology
Heart Atria - surgery
Humans
Medical sciences
Pacemaker, Artificial
Recurrence
Reoperation
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Tachycardia - etiology
Tachycardia - physiopathology
Tachycardia - surgery
Treatment Outcome
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Summary:Late atrial reentry tachycardia (AT) after Fontan repair is common, with limited efficacy of medical therapy in preventing AT recurrence. In this study, two approaches to surgical arrhythmia ablation in patients with refractory AT undergoing Fontan revision are compared: cryoablation of the inferomedial right atrium (RA), and a more extensive modified RA maze procedure designed to eliminate all potential RA reentrant circuits. Fontan revision was performed in 23 patients with AT, using inferomedial RA cryoablation (Group 1, n=8) and modified RA maze procedure (Group 2, n=15). There was no difference in age at initial Fontan, age at Fontan revision, age at onset of AT, or number of failed antiarrhythmic medications. Patients underwent preoperative, intraoperative, and postoperative electrophysiological studies. Thirty-eight different tachycardia circuits were induced in preoperative studies with 3 major areas of RA involvement: the lower lateral RA, the atrial septum, and the inferomedial RA. At postoperative electrophysiological study, AT was inducible in 62% of Group 1 patients but only 7% of Group 2 patients (P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.0000025876.82336.26