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(Circulation. 2007;115:1698-1700.)
© 2007 American Heart Association, Inc.

Editorial

The Fontan Right Atrium—In Context

Ronald J. Kanter, MD

From the Duke University School of Medicine, Durham, NC.

Correspondence to Ronald J. Kanter, MD, Duke University Medical Center, Duke North, Erwin Road, Room 7502, Box 3090, Durham, NC 27710. E-mail kante001@mc.duke.edu

Key Words: Editorials • ablation • atrial flutter • atrium • electrophysiology • Fontan procedure • tachyarrhythmias

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The original vision for what is still eponymously called the Fontan operation was to provide a subpulmonary pumping chamber for patients who lack 2 functional ventricles.¹ Thus began the era of the original atriopulmonary (or atrioventricular, in some patients who have tricuspid atresia) anastomosis. Beginning with de Leval’s seminal paper in 1988, which demonstrated that hydrodynamic advantage is conferred by surgical strategies that limit the interposition of atrial mass,² the phylogeny of Fontan-style operations has gone through several iterations. Currently favored is the extracardiac conduit, which results in the case where the entire atrial mass serves as the low-pressure pulmonary venous receptacle. The occurrence of atrial tachyarrhythmias long-term after these operations seems to parallel the magnitude of right atrial dilatation and hypertension. Not surprisingly, comparisons of medium-term incidences of atrial tachyarrhythmias have shown that the total cavopulmonary connection (also known as the "lateral tunnel," in which only a posterolateral portion of the right atrium is at pulmonary artery pressure) is better than the atriopulmonary (or atrioventricular) connection,^3,4 and that the extracardiac conduit is better than the total cavopulmonary connection.^5,6 Consistent with these clinical series is evidence for mechanoelectrical interactions within the enlarged right atria. Compared with asymptomatic Fontan patients, patients who have atrial tachyarrhythmias have longer P wave durations, greater P wave dispersions, and larger atrial dimensions.⁷

Article p 1738

Abrams and colleagues report in the current issue of Circulation the story of electroanatomic mapping of the giant, high-pressure right atrium long-term after the atriopulmonary (or atrioventricular)-style Fontan operation.⁸ No . . . [Full Text of this Article]