Occurrence and management of atrial arrhythmia after long-term Fontan circulation

Autor: Ruediger Lange, Martin Kostolny, Annett Wacker, Christian Schreiber, John Hess, Christian Noebauer, Joachim Weipert, Bernhard Zrenner
Rok vydání: 2004
Předmět:
Tachycardia
Male
Pulmonary Circulation
Heart disease
medicine.medical_treatment
Fontan Procedure
law.invention
Postoperative Complications
law
Risk Factors
Germany
Child
Cardiopulmonary Bypass
Anastomosis
Surgical
Treatment Outcome
Cardiology
cardiovascular system
Catheter Ablation
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Electrophysiologic Techniques
Cardiac
Pulmonary and Respiratory Medicine
Heart Defects
Congenital
medicine.medical_specialty
Adolescent
Heart Ventricles
Child Welfare
Catheter ablation
Pulmonary Artery
Time
Fontan procedure
Internal medicine
medicine
Cardiopulmonary bypass
Ventricular Pressure
Humans
Tachycardia
Atrioventricular Nodal Reentry
Tricuspid atresia
cardiovascular diseases
Heart Atria
Pulmonary Wedge Pressure
Risk factor
Survival analysis
business.industry
medicine.disease
Survival Analysis
Surgery
Multivariate Analysis
Vascular Resistance
business
Follow-Up Studies
Zdroj: The Journal of thoracic and cardiovascular surgery. 127(2)
ISSN: 0022-5223
Popis: Objectives In patients after the Fontan operation, we determined risk factors for late failure and for intra-atrial re-entrant tachycardia at 15 to 20 years' follow-up. Midterm results after electrophysiologic ablation therapy for these tachycardias were also evaluated. Methods Current follow-up was available in 162 patients (2005 patient-years) with a wide range of underlying diagnoses operated on between February 1978 and May 1995. Risk factor analysis included patient-related and procedure-related variables, with late failure and the incidence of re-entrant tachycardia as outcome parameters. Results Forty late failures were observed (2.0 per 100 patient-years). At 15 years, Kaplan-Meier estimated survival was significantly (P = .007) better for patients with tricuspid atresia (93%) compared with that for patients with complex congenital malformation (71%). The sole multivariable risk factor for Fontan failure was the type of underlying diagnosis. At 20 years' follow-up, overall freedom from tachycardia was estimated to be 46% ± 12%. Acute success of electrophysiologic ablation was seen in 25 (83%) of 30 patients, and Kaplan-Meier estimated freedom from recurrent tachycardia was 81% ± 10% at 3 years. Multivariate analysis identified duration of Fontan circulation as the sole risk factor for re-entrant tachycardias. Conclusion After the modified Fontan operation, long-term survival in patients with tricuspid atresia was significantly better compared with that in patients with complex congenital malformations. As first-choice therapy for atrial re-entrant tachycardias, we recommend electrophysiologic ablation therapy.
Databáze: OpenAIRE
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