Document Detail


Comparison of anatomic isthmus block with the modified right atrial maze procedure for late atrial tachycardia in Fontan patients.
MedLine Citation:
PMID:  12147539     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Barbara J Deal; Constantine Mavroudis; Carl L Backer; Scott H Buck; Christopher Johnsrude
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  106     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-30     Completed Date:  2002-08-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  575-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Children's Memorial Hospital, Chicago, IL 60614, USA. bdeal@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Body Surface Potential Mapping
Cardiac Surgical Procedures / methods*
Child
Cryosurgery
Defibrillators, Implantable
Electrophysiologic Techniques, Cardiac
Follow-Up Studies
Fontan Procedure / adverse effects*
Heart Atria / physiopathology*,  surgery*
Humans
Pacemaker, Artificial
Recurrence
Reoperation
Retrospective Studies
Tachycardia / etiology*,  physiopathology,  surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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