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September 15, 2026EP EuropaceOpen Access

Late arrhythmias following Fontan completion: insights from a Korean Multicentre Fontan Registry of over 1000 extracardiac conduit surgeries

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Key result

Atriopulmonary and lateral tunnel Fontans linked to up to ~489% higher arrhythmia risk versus extracardiac conduit.

  • HR 5.89
  • 95% CI 3.75-9.25
  • P<0.001
  • n=1,492

Why the study?

The impact of surgical type and risk factors on arrhythmia development after Fontan surgery remains incompletely understood.

Does extracardiac conduit (ECC) Fontan surgery reduce the risk of late arrhythmias compared to atriopulmonary connection or lateral tunnel Fontan in post-Fontan patients?

Population

1492 Fontan patients from the Korean multicentre registry

Comparison

AP vs LT vs ECC Fontan surgery

Design

Retrospective multicentre registry study

Follow-up

Median 14 years

Authors

JYJa Kyoung YoonPediatric / Congenital CardiologyKAKyung Jin AhnGachon University Gil Medical CenterSKSoo‐Jin KimPediatric / Congenital Cardiology

Discussion

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Overview

May favor extracardiac conduit Fontan to lower arrhythmia risk; hypothesis-generating for effects on mortality and failure pending prospective trials.

Key Points

  • To investigate the incidence, risk factors, and prognostic impact of late arrhythmias across different surgical types of Fontan procedures.
  • Retrospectively evaluated 1492 Fontan patients from a Korean multicentre registry (1979–2019) followed for a median of 14 years.
  • Categorized patients by surgical strategy: atriopulmonary connection (AP, n = 106), lateral tunnel (LT, n = 234), and extracardiac conduit (ECC, n = 1143).
  • Assessed independent risk factors for late arrhythmias and their association with all-cause mortality and Fontan failure using multivariable analysis.
  • Overall arrhythmias occurred in 13.3% of patients at a median age of 17.3 years; 20-year freedom from any arrhythmia, tachyarrhythmia, and bradyarrhythmia was 82.5%, 86.9%, and 90.5%, respectively.
  • Compared with ECC, multivariable analysis showed significantly higher arrhythmia risk for AP (HR 5.89, 95% CI 3.75–9.25; P < 0.001) and LT (HR 2.85, 95% CI 1.93–4.21; P < 0.001), with older age at surgery also independently elevating risk (HR 1.06, 95% CI 1.03–1.10; P < 0.001).
  • All-cause mortality was 9.3% and Fontan failure was 20.0%, with late-onset arrhythmias significantly associated with both increased mortality (P = 0.003) and Fontan failure (P < 0.001).

Study Design

Type

Cohort (n=1,492)

Multicenter

Yes

Structured PICO

Does extracardiac conduit (ECC) Fontan surgery reduce the risk of late arrhythmias compared to atriopulmonary connection or lateral tunnel Fontan in post-Fontan patients?

P
Population
1,492 Fontan patients from a Korean multicenter registry followed for a median of 14 years to assess long-term arrhythmia complications.
E
Exposure
Extracardiac conduit (ECC) Fontan surgery
C
Comparator
Atriopulmonary connection (AP) Fontan or lateral tunnel (LT) Fontan surgery
O
Outcome
Development of late arrhythmias (tachyarrhythmias and bradyarrhythmias)hard clinical

Main Result

Hazard Ratio: 5.89 (95% CI 3.75–9.25)

p-value: p=<0.001

Extracardiac conduit Fontan surgery is associated with a significantly lower risk of late arrhythmias compared to atriopulmonary connection and lateral tunnel techniques, with arrhythmias serving as a marker for mortality and Fontan failure.

Cite This Study

Yoon et al. (2026) conducted a cohort in Post-Fontan surgery patients (n=1,492). Atriopulmonary connection (AP) or lateral tunnel (LT) Fontan surgery vs. Extracardiac conduit (ECC) Fontan surgery was evaluated on Arrhythmia (HR 5.89, 95% CI 3.75-9.25, p=<0.001). Atriopulmonary connection and lateral tunnel Fontan surgeries were associated with a significantly higher risk of arrhythmias compared with extracardiac conduit Fontan (HR 5.89 and 2.85; P<0.001).

synapsesocial.com/papers/6aa90187eed42882c1fc19abhttps://doi.org/10.1093/europace/euag123
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prevalence of atrial tachyarrhythmia in adults after Fontan operation2015 · 88 citations
  2. 2Long-term incidence of arrhythmias in extracardiac conduit Fontan and comparison between systemic left and right ventricle2024 · 17 citations
  3. 3Revisiting the rhythm: A systematic review and meta-analysis of long-term arrhythmia outcomes after extracardiac versus intracardiac Fontan completion2026 · 2 citations
  4. 4Comparison of Arrhythmia Prevalence and Incidence in Adult Patients with Lateral Tunnel and Extra-Cardiac Fontan Circulation2025 · 2 citations
  5. 5Preliminary Analysis of Arrhythmias after the Fontan Operation with Extracardiac Conduit Compared with Intra-atrial Lateral Tunnel*2001 · 51 citations