| Comparison of anatomic isthmus block with the modified right atrial maze procedure for late atrial tachycardia in Fontan patients. | |
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MedLine Citation:
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PMID: 12147539 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Barbara J Deal; Constantine Mavroudis; Carl L Backer; Scott H Buck; Christopher Johnsrude |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Circulation Volume: 106 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2002 Jul |
Date Detail:
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Created Date: 2002-07-30 Completed Date: 2002-08-07 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 575-9 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, Children's Memorial Hospital, Chicago, IL 60614, USA. bdeal@northwestern.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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