Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan. pediatrics
J Cardiol. 2009 Jun;53(3):410-6. doi: 10.1016/j.jjcc.2009.01.009. Epub 2009 Mar 9.
The optimal management of atrial tachyarrhythmia (AT) late after Fontan operation has not yet been established.
Of 199 patients who were followed for more than 10 years after Fontan operation, 60 patients in whom late postoperative arrhythmias were observed were the subjects of this study. These arrhythmias were managed with anti-arrhythmic drugs. Twenty-one of 60 patients (35%) did not respond to the drugs and they needed further interventions. Fourteen catheter ablation procedures were performed in nine patients (atrial fibrillation in one patient, AT in eight patients) and the success rate was 44%. Conversion to total cavopulmonary connection (TCPC) was performed in 14 patients and Maze operation was performed at the time of Fontan conversion in 6 patients. Sinus rhythm or pacemaker rhythm was maintained in 7 of 14 (50%) patients postoperatively.
Although arrhythmogenic substrates accumulate and tachyarrhythmia becomes frequent over the long-term following Fontan operation, most patients with AT can be managed medically. The success rate of catheter ablation and Maze operation is low but those interventions may be indicated in patients with intractable arrhythmias.
Fontan 手术后晚期房性心动过速（AT）的最佳治疗方法尚未确定。
在 Fontan 手术后随访超过 10 年的 199 例患者中，观察到 60 例患者出现晚期术后心律失常，这些患者是本研究的对象。这些心律失常采用抗心律失常药物进行治疗。60 例患者中的 21 例（35%）对药物无反应，需要进一步干预。在 9 例患者（1 例心房颤动，8 例 AT）中进行了 14 次导管消融术，成功率为 44%。14 例患者转为全腔静脉肺动脉连接（TCPC），6 例患者在 Fontan 转换时行迷宫手术。14 例患者中有 7 例（50%）术后维持窦性心律或起搏器节律。
尽管 Fontan 手术后随着时间的推移，心律失常的发生机制逐渐积累，心动过速变得频繁，但大多数 AT 患者可以通过药物治疗。导管消融和迷宫手术的成功率较低，但这些干预措施可能适用于难治性心律失常患者。
