Inducibility of intra-atrial reentrant tachycardia after the first two stages of the fontan sequence

OBJECTIVES We sought to examine the incidence and possible factors for indu cible intra-atrial reentrant tachycardia (IART) in a group of patients afte r two stages of the Fontan sequence but before the operation. BACKGROUND Intra-atrial reentrant tachycardia occurs in 10% to 40% of patie nts after the Fontan operation. No data are available regarding the potenti al for IART after the first two stages of the Fontan sequence but before th e operation. METHODS The IART induction protocol included programmed extrastimulation an d rapid atrial pacing, with and without isoproterenol. RESULTS The median age of the study group (N = 44, 27 males) was 1.7 years (range 1.2 to 5.2). Forty patients were in sinus rhythm. Twelve patients (2 7%) had inducible, sustained (>1 min) IART. Three patients (8%) had inducib le, nonsustained IART. Bivariate analysis revealed that patients with susta ined IART were significantly older at their second operation (median 0.54 v s. 0.40 years, p = 0.05). Multivariate logistic modeling revealed that olde r age (greater than or equal to0.55 years) at the second palliative operati on (p = 0.04), older age (greater than or equal to1.95 years) at evaluation before the Fontan sequence (p = 0.04) and female gender (p = 0.03) were in dependently associated with sustained IART. A trend toward a greater freque ncy of sustained TART was seen in those patients with moderate or severe at rioventricular valve regurgitation (p = 0.07) and in those with resection o f the atrial septum (p = 0.06). CONCLUSIONS The rate of inducible, sustained IART in a group of patients be fore the Fontan operation is 27% and is associated with older age at the ti me of second-stage palliation, older age at pre-Fontan evaluation and femal e gender. CT Am Coil Cardiol 2001;37:231-7) (c) 2001 by the American Colleg e of Cardiology.