Evolving electroanatomic substrate and intra-atrial reentrant tachycardia late after Fontan surgery
Abstract
INTRODUCTION: The prevalence of intra-atrial reentrant tachycardia (IART) increases with age in Fontan patients. This study aimed to characterize the atrial electroanatomic substrate for IART late after Fontan surgery. METHODS AND RESULTS: Detailed electroanatomic mapping of the right atrium (RA) was performed in 11 consecutive patients (33 ± 9 years) with older style Fontan circulation (atriopulmonary and atrioventricular connection) who underwent their first radiofrequency catheter ablation (RFCA) for IART. A comparative group of 30 non-Fontan congenital heart disease (CHD) patients were also studied. Fontan patients had larger RA (P = 0.004), larger low-voltage area ≤ 0.5 mV (P = 0.01), and more fractionated potentials (P < 0.001) than non-Fontan CHD patients. RA enlargement correlated significantly with both low-voltage zones (Spearman ρ= 0.68, P < 0.001) and fractionated potentials (Spearman ρ= 0.48, P = 0.001). Among Fontan patients, both age and time since Fontan surgery were significantly correlated to the amount of low-voltage areas (Spearman ρ= 0.87, P < 0.001; Spearman ρ= 0.63, P = 0.04, respectively). Successful RFCA was accomplished in 30 (73%) patients and was less likely in Fontan patients (54% vs 83%, P = 0.04). Larger RA was significantly associated with a lower success rate (P = 0.04). During a follow-up duration of 2.3 ± 1.6 years, IART recurred in 47% of patients. Larger RA size and larger low-voltage areas predicted IART recurrence after RFCA. CONCLUSION: Fontan patients demonstrate progressive adverse atrial electrical remodeling with increasing age and time since surgery. Newer strategies beyond surgical incisions, such as pharmacotherapies that retard the progression of atrial fibrosis, may be required to reduce the long-term risk of atrial arrhythmias.
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Catheter ablation of AT or AFL are associated with lower success rates, 65% to 82%, as compared with those in the absence of CHD.
“Catheter ablation of AT or AFL are associated with lower success rates, 65% to 82%, as compared with those in the absence of CHD, 362,363,365 although higher success rates have been achieved with the advent of advanced mapping and ablation techniques.366”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [365]
Both Fontan and Mustard repairs have been associated with less successful ablation results as compared to other ACHD anomalies, related to low success rate (54% vs 83% for other CHD) and high recurrence rate (50% vs 32%) after an initial successful ablation procedure.
“Both Fontan and Mustard repairs have been associated with less successful ablation results as compared to other ACHD anomalies, related not only to the low success rate of catheter ablation (54% vs. 83% for other CHD) but also to a high recurrence rate (50% vs. 32%) after an initial successful ablation procedure.363,365”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [365]
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Self-citation
- Authors
- YAP, S., HARRIS, L., DOWNAR, E., NANTHAKUMAR, K., SILVERSIDES, C. K., & CHAUHAN, V. S.
- Affiliations
- University Health Network (CA)
- Corresponding author
- CHAUHAN, VIJAY S.
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2011-10-28
- Volume
- 23
- Issue
- 4
- Pages
- 339-345
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2106050283
- Cited by
- 68
- References
- 17
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 3 · 2018: 9 · 2017: 10 · 2016: 6 · 2015: 10 · 2014: 4 · 2013: 7 · 2012: 1
- FWCI
- 2.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- intra-atrial reentrant tachycardia, Fontan circulation, right atrial enlargement, low-voltage areas, fractionated potentials, atrial electrical remodeling, atrial fibrosis, radiofrequency catheter ablation, atrial arrhythmia recurrence, congenital heart disease
- MeSH terms
- Action Potentials, Adult, Age Factors, Female, Heart Atria, Heart Conduction System, Humans, Male, Middle Aged, Ontario, Recurrence, Risk Factors, Tachycardia, Supraventricular, Time Factors, Chi-Square Distribution, Logistic Models, Proportional Hazards Models, Odds Ratio, Case-Control Studies, Treatment Outcome, Catheter Ablation, Risk Assessment, Fontan Procedure, Electrophysiologic Techniques, Cardiac, Young Adult, Voltage-Sensitive Dye Imaging
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