Inamura Noboru, Matsushita Tohru, Fukunami Masatake, Sano Tetsuya, Takeuchi Makoto, Kurotobi Shunji, Miura Takuya, Matsuda Hikaru, Okada Shintaro
Department of Developmental Medicine (Pediatrics), Osaka University Graduate School of Medicine, Osaka.
J Cardiol. 2002 Feb;39(2):101-7.
Supraventricular arrhythmias are one of the most common and fatal sequelae of the Fontan operation. P wave triggered signal averaged electrocardiography was performed in patients undergoing the Fontan operation to evaluate the presence of atrial degeneration, and to clarify which factors affected the development of atrial arrhythmias.
P wave triggered signal averaged electrocardiography was recorded in 14 patients after the Fontan-type operation (conventional atriopulmonary connection in 5 and total cavopulmonary connection in 9) and 15 healthy controls. The duration and area of the filtered P wave, and the signal magnitudes (M20, M30) at 20 Hz and 30 Hz obtained from the frequency domain analysis of the P wave (M20, M30) were evaluated and compared with the hemodynamic data.
The duration and area of the filtered P wave, M20 and M30 in patients after atriopulmonary connection were significantly greater than in those after total cavopulmonary connection and the control subjects (p < 0.05). M20 was significantly greater in patients after total cavopulmonary connection than in the control subjects. Right atrial volume in patients after atriopulmonary connection was significantly (p < 0.001) larger than in patients after total cavopulmonary connection (p < 0.05). There were no significant differences in other indices including atrial pressure between the two groups.
Our results suggest that the substrate for atrial arrhythmias such as atrial myocardial degeneration and fibrosis is frequently present in patients after the Fontan operation, especially after atriopulmonary connection. Thus, the enlarged right atrium may be involved in the presence of a substrate for atrial arrhythmias. The developmental risk for late atrial arrhythmias seems to be present even in patients after total cavopulmonary connection.
室上性心律失常是Fontan手术最常见且致命的后遗症之一。对接受Fontan手术的患者进行P波触发信号平均心电图检查，以评估心房变性的存在，并阐明哪些因素影响房性心律失常的发生。
对14例接受Fontan型手术的患者（5例行传统心房肺连接术，9例行全腔静脉肺动脉连接术）和15名健康对照者进行P波触发信号平均心电图检查。评估滤波后P波的持续时间和面积，以及从P波频域分析获得的20Hz和30Hz处的信号幅度（M20、M30），并与血流动力学数据进行比较。
心房肺连接术后患者滤波后P波的持续时间和面积、M20和M30显著大于全腔静脉肺动脉连接术后患者和对照组（p<0.05）。全腔静脉肺动脉连接术后患者的M20显著大于对照组。心房肺连接术后患者的右心房容积显著（p<0.001）大于全腔静脉肺动脉连接术后患者（p<0.05）。两组间其他指标（包括心房压力）无显著差异。
我们的结果表明，Fontan手术后患者，尤其是心房肺连接术后患者，常存在房性心律失常的基质，如心房心肌变性和纤维化。因此，右心房扩大可能与房性心律失常基质的存在有关。即使是全腔静脉肺动脉连接术后的患者，似乎也存在晚期房性心律失常的发生风险。
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