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J Am Coll Cardiol, 2001; 37:231-237
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY: PEDIATRIC CARDIOLOGY

Inducibility of intra-atrial reentrant tachycardia after the first two stages of the Fontan sequence

Ian H. Law, MDa, Peter S. Fischbach, MDa, Caren Goldberg, MDa, Ralph S. Mosca, MD, FACCa, Edward L. Bove, MD, FACCa, Thomas R. Lloyd, MD, FACCa, Albert P. Rocchini, MD, FACCa and Macdonald Dick, II, MD, FACCa

a University of Michigan Congenital Heart Center and Departments of Pediatrics and Surgery, University of Michigan Health Systems, Ann Arbor, Michigan, USA

Manuscript received March 9, 2000; revised manuscript received August 9, 2000, accepted September 28, 2000.

Reprint requests and correspondence: Dr. Macdonald Dick II, Division of Pediatric Cardiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0204
mdick{at}umich.edu

OBJECTIVES

We sought to examine the incidence and possible factors for inducible intra-atrial reentrant tachycardia (IART) in a group of patients after two stages of the Fontan sequence but before the operation.

BACKGROUND

Intra-atrial reentrant tachycardia occurs in 10% to 40% of patients after the Fontan operation. No data are available regarding the potential for IART after the first two stages of the Fontan sequence but before the operation.

METHODS

The IART induction protocol included programmed extrastimulation and rapid atrial pacing, with and without isoproterenol.

RESULTS

The median age of the study group (n = 44, 27 males) was 1.7 years (range 1.2 to 5.2). Forty patients were in sinus rhythm. Twelve patients (27%) had inducible, sustained (>1 min) IART. Three patients (8%) had inducible, nonsustained IART. Bivariate analysis revealed that patients with sustained IART were significantly older at their second operation (median 0.54 vs. 0.40 years, p = 0.05). Multivariate logistic modeling revealed that older age (≥0.55 years) at the second palliative operation (p = 0.04), older age (≥1.95 years) at evaluation before the Fontan sequence (p = 0.04) and female gender (p = 0.03) were independently associated with sustained IART. A trend toward a greater frequency of sustained IART was seen in those patients with moderate or severe atrioventricular valve regurgitation (p = 0.07) and in those with resection of the atrial septum (p = 0.06).

CONCLUSIONS

The rate of inducible, sustained IART in a group of patients before the Fontan operation is 27% and is associated with older age at the time of second-stage palliation, older age at pre-Fontan evaluation and female gender.

Abbreviations and Acronyms
  BDG = bidirectional Glenn operation
  HFP = hemi-Fontan procedure
  IART = intra-atrial reentrant tachycardia
  SNRT = sinus node recovery time
  SVC = superior vena cava
  TSACT = total sinoatrial conduction time






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