[II-TSPCJS-1] The Outcome of Catheter Ablation of Arrhythmias after Fontan Surgery
Keywords:catheter ablation, Fontan, conduit puncture
Background The acute success rate of ablation after Fontan procedure reported in 2010 was 53%, a poor result. Since then, the conduit puncture approach has been developed and the success rate has improved.
Objective: To determine the results of ablation of arrhythmias after Fontan surgery.Subjects Fifteen patients and 19 sessions in which ablation was performed for arrhythmias after Fontan surgery from 2011 to 2023 were included. All cases in which conduit puncture was desirable were ablated with conduit puncture. Age, arrhythmias treated, and effectiveness of ablation were analized.
Results Age (median) 19 years, 9 cases of extra-cardiac Fontan procedure (EC), 2 cases of lateral tunnel (LT), 4 cases of atrio-pulmonary connection (APC), 3 cases of tachycardia involving two AV nodes (Twin AVN), 1 case of atrioventricular reciprocating tachycardia, 6 cases of atrioventricular nodal reentrant tachycardia, 6 cases of intraatrial reentrant tachycardia (IART) in 6 patients, ventricular extrasystole/ventricular tachycardia (PVC/VT) in 2 patients, and junctional tachycardia (JET) in 1 patient. There were 15 successful sessions, 2 unsuccessful and 2 unevaluable sessions, resulting in no arrhythmia recurrence in 12 of the 15 patients; conduit puncture was performed in 16 EC, LT, and APC patients, and puncture was successful in all cases.Conclusion: The success rate of arrhythmia after Fontan procedure was 80%, which is better than previous reports. Conduit puncture was successful in all patients. Even if access can be achieved, ablation itself is difficult in arrhythmias involving unique conduction systems, such as those seen in single ventricles. Future issues are whether it is advisable to treat patients with arrhythmia risk before Fontan and to clarify safe ablation methods for unique conduction systems.
Objective: To determine the results of ablation of arrhythmias after Fontan surgery.Subjects Fifteen patients and 19 sessions in which ablation was performed for arrhythmias after Fontan surgery from 2011 to 2023 were included. All cases in which conduit puncture was desirable were ablated with conduit puncture. Age, arrhythmias treated, and effectiveness of ablation were analized.
Results Age (median) 19 years, 9 cases of extra-cardiac Fontan procedure (EC), 2 cases of lateral tunnel (LT), 4 cases of atrio-pulmonary connection (APC), 3 cases of tachycardia involving two AV nodes (Twin AVN), 1 case of atrioventricular reciprocating tachycardia, 6 cases of atrioventricular nodal reentrant tachycardia, 6 cases of intraatrial reentrant tachycardia (IART) in 6 patients, ventricular extrasystole/ventricular tachycardia (PVC/VT) in 2 patients, and junctional tachycardia (JET) in 1 patient. There were 15 successful sessions, 2 unsuccessful and 2 unevaluable sessions, resulting in no arrhythmia recurrence in 12 of the 15 patients; conduit puncture was performed in 16 EC, LT, and APC patients, and puncture was successful in all cases.Conclusion: The success rate of arrhythmia after Fontan procedure was 80%, which is better than previous reports. Conduit puncture was successful in all patients. Even if access can be achieved, ablation itself is difficult in arrhythmias involving unique conduction systems, such as those seen in single ventricles. Future issues are whether it is advisable to treat patients with arrhythmia risk before Fontan and to clarify safe ablation methods for unique conduction systems.