Published Online
on July 8, 2002

A more recent version of this article appeared on July 30, 2002

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Submitted on February 22, 2002
Revised on May 13, 2002
Accepted on May 17, 2002

Comparison of Anatomic Isthmus Block With the Modified Right Atrial Maze Procedure for Late Atrial Tachycardia in Fontan Patients

Barbara J. Deal MD^*, Constantine Mavroudis MD, Carl L. Backer MD, Scott H. Buck MD, and Christopher Johnsrude MD

From the Divisions of Cardiology (B.J.D., S.H.B., C.J.) and Cardiovascular-Thoracic Surgery (C.M., C.L.B.), Children's Memorial Hospital; and the Departments of Pediatrics (B.J.D., S.H.B., C.J.) and Surgery (C.M., C.L.B.), Northwestern University Medical School, Chicago, Ill.

^* To whom correspondence should be addressed. E-mail: bdeal{at}northwestern.edu.

Background—Late atrial reentry tachycardia (AT) after Fontan repair is common, with limited efficacy of medical therapy in preventing AT recurrence. In this study, two approaches to surgical arrhythmia ablation in patients with refractory AT undergoing Fontan revision are compared: cryoablation of the inferomedial right atrium (RA), and a more extensive modified RA maze procedure designed to eliminate all potential RA reentrant circuits.

Methods and Results—Fontan revision was performed in 23 patients with AT, using inferomedial RA cryoablation (Group 1, n=8) and modified RA maze procedure (Group 2, n=15). There was no difference in age at initial Fontan, age at Fontan revision, age at onset of AT, or number of failed antiarrhythmic medications. Patients underwent preoperative, intraoperative, and postoperative electrophysiological studies. Thirty-eight different tachycardia circuits were induced in preoperative studies with 3 major areas of RA involvement: the lower lateral RA, the atrial septum, and the inferomedial RA. At postoperative electrophysiological study, AT was inducible in 62% of Group 1 patients but only 7% of Group 2 patients (P<0.02). With mean follow-up of 43 months, 5 of 8 patients in Group 1 experienced AT recurrence compared with none in Group 2 (P<0.001). There was no significant difference in length of hospital stay or complication rate comparing the two groups.

Conclusion—Modified RA maze procedure is superior to anatomic isthmus block in treating reentrant AT in postoperative Fontan patients. The modified RA maze has eliminated AT recurrence at mid-term follow-up with low morbidity and mortality.

Key words: atrial tachycardia • Fontan operation • arrhythmia surgery

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