From the Section of Pediatric Cardiology (K.D., C.J.P., F.C., D.J.D.),
Section of Biostatistics (K.P.O., J.M.S.), and the Division of Thoracic and
Cardiovascular Surgery (F.J.P., H.V.S., G.K.D.), Mayo Clinic and Mayo
Foundation, Rochester, Minn. Dr Cetta is currently at the Section of Pediatric
Cardiology, Loyola Medical Center, Maywood, Ill.
Correspondence to Co-burn J. Porter, MD, Section of Pediatric Cardiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Background—The objectives of our
study were to determine the frequency of supraventricular
tachyarrhythmias (SVTAs) among modifications of the
Fontan operation and identify risk factors for developing
SVTA.
Methods and Results—The population consisted of all patients who
had any modification of the Fontan operation at the Mayo Clinic between
1985 and 1993. Clinically significant SVTAs were those requiring
initiation or change of antiarrhythmic treatment, and they were divided
into early SVTAs (<30 days after the operation) and late SVTAs (
Conclusions—Postoperative SVTA continues to be a significant
problem. Risk factors for SVTA are AV valve
regurgitation, abnormal AV valve, preoperative SVTA,
and age at operation. Frequency of SVTA does not appear to be related
to type of Fontan procedure except for slightly lower frequency in
patients with atriopulmonary connection with lateral tunnel
compared with those with total cavopulmonary connection.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Predictors of Early- and Late-Onset Supraventricular Tachyarrhythmias After Fontan Operation
30
days after the operation). Clinical histories were reviewed, and health
status questionnaires were sent. Four hundred ninety-nine patients had
various modifications of the Fontan operation. Frequency of early SVTA
was 15%. Risk factors identified by multivariate
analysis for early SVTA were AV valve
regurgitation, abnormal AV valve, and preoperative
SVTA. Frequency of late SVTA was 6% by 1 year, 12% by 3 years, and
17% by 5 years. Risk factors for late SVTA were age at operation (<3
or 10 years) and systemic AV valve replacement. By
univariate and multivariate
analysis, the type of Fontan operation was not a significant
risk factor for late SVTA when all 6 modifications were considered.
However, when we analyzed the frequency of late SVTA for the 2
recently used modifications, we found a lower frequency of late SVTA in
patients with atriopulmonary connection with lateral tunnel
compared with those with total cavopulmonary connection.
Key Words: arrhythmia • Fontan procedure • pediatrics • tachyarrhythmias
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