Atrioventricular Junction Ablation and Pacemaker Therapy in Patients with Drug-Resistant Atrial Tachyarrhythmias after the Fontan Operation

• Published in: Journal of cardiovascular electrophysiology Vol. 16; no. 1; pp. 24 - 29
• Main Authors: FRIEDMAN, RICHARD A., WILL, JOACHIM C., FENRICH, ARNOLD L., KERTESZ, NAOMI J.
• Format: Journal Article
• Language: English
• Published: 350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK Blackwell Science Inc 01.01.2005
• Subjects: Adolescent; Adult; Atrial Fibrillation - etiology; Atrial Fibrillation - therapy; atrial tachycardia; atrioventricular nodal ablation; Atrioventricular Node - surgery; Cardiac Pacing, Artificial - methods; Catheter Ablation - methods; Combined Modality Therapy - methods; Drug Resistance; Female; Fontan operation; Fontan Procedure - adverse effects; Humans; Male; Pacemaker, Artificial; Postoperative Care - methods; Retrospective Studies; Tachycardia - etiology; Tachycardia - therapy; Treatment Outcome
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1046/j.1540-8167.2005.03272.x

Introduction: Drug‐resistant intraatrial reentrant tachycardia (IART) occurs frequently after the Fontan operation and is a major cause of morbidity and rarely mortality. We describe our experience with AV junction ablation after pacemaker implantation in postoperative Fontan patients with drug‐resistant IART. Methods and Results: We performed retrospective analysis of Fontan patients with IART and attempted radiofrequency ablation (RFA) of the AV junction. Seven patients (6 male) were identified, with a mean age at Fontan of 9.3 years (range 5.8–13.3) and a median age at RFA of 18 years (range 14.5–23.3). Mean follow‐up prior to RFA was 764 ± 235 days and after RFA 1,541 ± 1,235 days. IART was refractory to antiarrhythmic drugs in all patients, and all had undergone pacemaker placement. Mean onset of IART was 44.1 months (range 0–142) after Fontan. Mean duration of atrial arrhythmia prior to RFA was 72 ± 48 m (range 16–148). Ablation of the AV junction was successful or partially successful in all patients. Complete AV block occurred in 6 patients. Normal AV conduction was not seen during a mean follow‐up of 1,541 days. The mean number of antiarrhythmic medications decreased from 2.8 ± 1.5 to 0.7 ± 0.8 (P < 0.05). Conclusion: In Fontan patients with drug‐resistant IART, RFA of the AV junction with prior pacemaker implant is an effective therapeutic option. Despite the introduction of pacemaker dependence, this option should be considered in patients who did not respond to RFA of IART or who are at high operative risk for Fontan conversion.