PMID- 21087427
OWN - NLM
STAT- MEDLINE
DCOM- 20110304
LR  - 20110505
IS  - 1747-0803 (Electronic)
IS  - 1747-079X (Linking)
VI  - 5
IP  - 5
DP  - 2010 Sep-Oct
TI  - Arrhythmia recurrence in adult patients with single ventricle physiology 
      following surgical Fontan conversion.
PG  - 430-4
LID - 10.1111/j.1747-0803.2010.00443.x [doi]
AB  - OBJECTIVES: To evaluate the incidence of atrial tachy-arrhythmia (AT) recurrence 
      following conversion from right atrial-pulmonary artery (RA-PA) Fontan to total 
      cavopulmonary connection (TCPC) in adults. BACKGROUND: AT is a recognized sequel 
      of Fontan palliation, especially in RA-PA Fontans, and is associated with 
      significant morbidity. While catheter ablation achieves fairly reliable 
      short-term success with low morbidity, conversion to TCPC with arrhythmia surgery 
      is a highly effective treatment option for the classical Fontan patients with 
      incessant AT. METHODS: Single center retrospective review. RESULTS: Twenty-seven 
      adults underwent Fontan conversion from RA-PA to TCPC, mostly for AT indications 
      (n = 24). Nine (33%) underwent conversion to a lateral tunnel (LT) and 18 (67%) 
      to an extracardiac (EC) Fontan. Two patients died <30 days post-operatively. Both 
      had liver failure and had been turned down for cardiac/liver transplantation. 
      In-hospital complications occurred in 15/27 patients (55%), including recurrence 
      of AT requiring cardioversion in six patients (22%) and persistent pleural 
      effusions in 4 (15%). Mean follow-up was 4.2 years (range 3 months-14 years). 
      Functional capacity improved from mean New York Heart Association (NYHA) class 
      1.8 pre-conversion to 1.2 post-conversion (P= 0.008). Twenty-one patients had 
      concomitant arrhythmia surgery (MAZE in 12 patients with IART and Cox-MAZE in 
      nine patients with A-Fib +/- IART). Of these, 3/21 (14%) had AT recurrence >3 
      months following conversion. CONCLUSIONS: Conversion from RA-PA Fontan to TCPC, 
      with arrhythmia surgery, decreases AT recurrence and improves functional 
      capacity. The risk of peri-operative mortality is highest in patients with 
      cirrhosis. AT recurred in 14% of patients.
FAU - Aboulhosn, Jamil
AU  - Aboulhosn J
AD  - Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Medical Center, BH-307 
      CHS, 650 Charles Young Drive South, Los Angeles, CA, USA. 
      jaboulhosn@mednet.ucla.edu
FAU - Williams, Ryan
AU  - Williams R
FAU - Shivkumar, Kalyanam
AU  - Shivkumar K
FAU - Barkowski, Rakhi
AU  - Barkowski R
FAU - Plunkett, Mark
AU  - Plunkett M
FAU - Miner, Pamela
AU  - Miner P
FAU - Houser, Linda
AU  - Houser L
FAU - Laks, Hillel
AU  - Laks H
FAU - Reemtsen, Brian
AU  - Reemtsen B
FAU - Shannon, Kevin
AU  - Shannon K
FAU - Child, John
AU  - Child J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Congenit Heart Dis
JT  - Congenital heart disease
JID - 101256510
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - *Catheter Ablation/adverse effects/mortality
MH  - Female
MH  - *Fontan Procedure/adverse effects/mortality
MH  - Heart Defects, Congenital/mortality/*surgery
MH  - Heart Ventricles/abnormalities/*surgery
MH  - Hospital Mortality
MH  - Humans
MH  - Los Angeles
MH  - Male
MH  - Middle Aged
MH  - Palliative Care
MH  - Recurrence
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Tachycardia, Supraventricular/etiology/mortality/*surgery
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2010/11/23 06:00
MHDA- 2011/03/05 06:00
CRDT- 2010/11/20 06:00
PHST- 2010/11/20 06:00 [entrez]
PHST- 2010/11/23 06:00 [pubmed]
PHST- 2011/03/05 06:00 [medline]
AID - CHD443 [pii]
AID - 10.1111/j.1747-0803.2010.00443.x [doi]
PST - ppublish
SO  - Congenit Heart Dis. 2010 Sep-Oct;5(5):430-4. doi: 
      10.1111/j.1747-0803.2010.00443.x.