Prevalence of atrial tachyarrhythmia in adults after Fontan operation
Abstract
OBJECTIVES: The Fontan procedure provides palliation for patients with complex congenital heart disease. A late complication is the development of a pro-arrhythmogenic environment. Modifications to the surgical technique try and reduce the incidence of late arrhythmia. This study aims to establish incidence and outcome of arrhythmias in Fontan patients with long-term follow-up. METHODS: Retrospective analysis of adult patients with a Fontan circulation cared for by University Hospitals Birmingham between 2001 and 2013. RESULTS: 166 patients, mean age 29.1 years, were identified (63% atriopulmonary (AP) Fontan, 13% lateral tunnel (LT), 24% extracardiac total cavopulmonary connection (TCPC)). The mean follow-up since Fontan surgery was 18.6 years. 42% (70 patients) had suffered at least one tachyarrhythmia, with 100% incidence of arrhythmia in AP Fontan patients surviving at least 26 years following surgery. The most common arrhythmia was intra-atrial re-entrant tachycardia (66%). There was also a significant incidence of arrhythmia in the LT and TCPC groups (23% at mean follow-up of 19.6 years and 13.6 years, respectively). 44 patients had undergone electrical cardioversion, 30 had ablations and 10 had undergone Fontan conversion surgery. Survival analysis showed only age at the time of Fontan as a significant predictor for arrhythmia onset (p<0.001) irrespective of surgical approach. CONCLUSIONS: There is a significant, increasing arrhythmia burden in adult patients with a Fontan circulation. Arrhythmia development could be regarded as an inevitable consequence of an AP Fontan. There remains a high incidence of arrhythmia with more modern surgical approaches. The long-term future of these patients is unclear and their care poses significant challenges.
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Atrial flutter or AF can develop in up to 42% of patients, whereas the most common atrial tachyarrhythmia is an incision-related (incisional) atrial tachycardia (66%).
“Atrial flutter or AF can develop in up to 42% of patients, whereas the most common atrial tachyarrhythmia is an incision-related (incisional) atrial tachycardia (66%).393”
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 [393]
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- Authors
- Quinton, E., Nightingale, P., Hudsmith, L., Thorne, S., Marshall, H., Clift, P., & de Bono, J.
- Affiliations
- University Hospitals Birmingham NHS Foundation Trust (GB)
- University Hospitals Birmingham, Birmingham, UK
- Congenital Electrophysiology Group, Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2015-08-19
- Volume
- 101
- Issue
- 20
- Pages
- 1672-1677
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W1906870369
- Cited by
- 88
- References
- 29
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 5 · 2023: 9 · 2022: 7 · 2021: 5 · 2020: 6 · 2019: 10 · 2018: 7 · 2017: 18 · 2016: 12 · 2015: 1
- FWCI
- 9.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Keywords
- Fontan circulation, atrial tachyarrhythmia, lateral tunnel Fontan, total cavopulmonary connection, arrhythmia incidence, long-term follow-up, adult congenital heart disease, electrical cardioversion, catheter ablation
- MeSH terms
- Adolescent, Adult, Aged, Electrocardiography, Female, United Kingdom, Heart Atria, Heart Defects, Congenital, Humans, Male, Middle Aged, Postoperative Complications, Prognosis, Retrospective Studies, Tachycardia, Prevalence, Survival Rate, Fontan Procedure, Young Adult
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