@Article{,
AUTHOR = {Kavitha N. Pundi, Krishna N. Pundi, Jonathan N. Johnson, Joseph A. Dearani, Zhuo Li, BS, David J. Driscoll, Philip L. Wackel, Christopher J. McLeod, Frank Cetta, Bryan C. Cannon},
TITLE = {Sudden cardiac death and late arrhythmias after the Fontan operation},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {12},
YEAR = {2017},
NUMBER = {1},
PAGES = {17--23},
URL = {http://www.techscience.com/schd/v12n1/38719},
ISSN = {3071-1738},
ABSTRACT = {<b>Objectives:</b> We sought to examine the incidence and predictors of arrhythmias and sudden
cardiac death (SCD) after Fontan operation.<br/>
<b>Background:</b> Arrhythmias and SCD have been reported following operations for congenital heart
disease, but the incidence and risk factors have not been well defined in patients after a Fontan
operation.<br/>
<b>Methods:</b> We reviewed records of all patients who had a Fontan operation from 1973 to 2012
(n 5 1052) at our institution. A questionnaire was mailed to patients who were not known to be
deceased at the initiation of the study. Late arrhythmias were classified as bradyarrhythmias or
tachyarrhythmias requiring treatment >30 days after operation.<br/>
<b>Results:</b> We included 996/1052 (95%) patients with no arrhythmia diagnosis prior to Fontan.
Overall 10-, 20-, and 30-year freedom from arrhythmias was 71%, 42%, and 24%, respectively. Of
864 patients who survived >30 days after Fontan, 304 (35%) had atrial flutter, 161 (19%) had
atrial fibrillation, 108 (13%) had atrial tachycardia, 37 (4%) had reentrant supraventricular tachycardia, 40 (5%) had ventricular tachycardia, and 113 (13%) had sinus node dysfunction. Predictors of
late arrhythmias included an atriopulmonary Fontan, age at operation (>16 years) or atrial arrhythmias postoperatively. During follow-up, 52/1052 (5%) patients had SCD, with 51 having
documentation available; 8 patients died suddenly within 30 days and the remaining 43 had an
average time to SCD of 6.9 ± 6.7 years (median was 3.8 years). Arrhythmias were documented in
28/43 (65%) patients prior to SCD. Predictors of SCD included atrioventricular valve replacement
and post-bypass Fontan pressures >20 mm Hg; preoperative sinus rhythm was protective.<br/>
<b>Conclusions:</b> Arrhythmias and SCD are significant concerns among Fontan patients and specific
risk factors may warrant closer follow-up and earlier consideration for therapy.},
DOI = {}
}