The Fontan operation was associated with early SVTA in 15% of patients and late SVTA in 17% by 5 years, driven by risk factors like AV valve regurgitation, preoperative SVTA, and age at operation.
Cohort (n=499)
No
What are the frequencies and risk factors for early- and late-onset supraventricular tachyarrhythmias after the Fontan operation?
Postoperative SVTA is a significant problem after the Fontan operation, with risk factors including AV valve abnormalities, preoperative SVTA, and age at operation, but generally not the type of Fontan modification.
BACKGROUND: The objectives of our study were to determine the frequency of supraventricular tachyarrhythmias (SVTAs) among modifications of the Fontan operation and identify risk factors for developing SVTA. METHODS AND RESULTS: The population consisted of all patients who had any modification of the Fontan operation at the Mayo Clinic between 1985 and 1993. Clinically significant SVTAs were those requiring initiation or change of antiarrhythmic treatment, and they were divided into early SVTAs (/=30 days after the operation). Clinical histories were reviewed, and health status questionnaires were sent. Four hundred ninety-nine patients had various modifications of the Fontan operation. Frequency of early SVTA was 15%. Risk factors identified by multivariate analysis for early SVTA were AV valve regurgitation, abnormal AV valve, and preoperative SVTA. Frequency of late SVTA was 6% by 1 year, 12% by 3 years, and 17% by 5 years. Risk factors for late SVTA were age at operation (/=10 years) and systemic AV valve replacement. By univariate and multivariate analysis, the type of Fontan operation was not a significant risk factor for late SVTA when all 6 modifications were considered. However, when we analyzed the frequency of late SVTA for the 2 recently used modifications, we found a lower frequency of late SVTA in patients with atriopulmonary connection with lateral tunnel compared with those with total cavopulmonary connection. CONCLUSIONS: Postoperative SVTA continues to be a significant problem. Risk factors for SVTA are AV valve regurgitation, abnormal AV valve, preoperative SVTA, and age at operation. Frequency of SVTA does not appear to be related to type of Fontan procedure except for slightly lower frequency in patients with atriopulmonary connection with lateral tunnel compared with those with total cavopulmonary connection.
Durongpisitkul et al. (Tue,) conducted a cohort in Supraventricular tachyarrhythmias after Fontan operation (n=499). Fontan operation was evaluated on Frequency of early (<30 days) and late (≥30 days) clinically significant supraventricular tachyarrhythmias. The Fontan operation was associated with early SVTA in 15% of patients and late SVTA in 17% by 5 years, driven by risk factors like AV valve regurgitation, preoperative SVTA, and age at operation.