Atrial and ventricular electromechanical function in 1-ventricle hearts: Influence of atrial flutter and Fontan procedure

Objective: Echocardiography was used to study electromechanical atrial and ventricular function in adult patients with a 1-ventricle heart who were in sinus rhythm to better understand the recurrence of atrial nutter fn these conditions. Patients who had recent atrial flutter, with and without the F ontan procedure, were compared with those who had no arrhythmia. Methods: This was a prospective study that used M-mode and 2-dimensional Do ppler echocardiography and electrocardiography. Conventional measurements w ere used to evaluate ventricular long-axis function Basic data were drawn f rom case notes. The setting was a designated quaternary service for grown-u p congenital heart patients (GUCH) In a tertiary referral center for cardio logy and cardiac surgery. From January 1997 to February 1998, 26 consecutiv e adult patients (aged >16 years) with a heart with one functioning ventric le and a history of atrial nutter were studied: group 1, with non-Fontan pa lliative surgery or no surgery (10 patients), and group 2, with Fontan-type repair (16 patients). Also studied were 20 patients with a 1-ventricle hea rt but no history of atrial flutter. These 20 patients were divided into 2 groups: control 1, which comprised 14 patients with previous shunts or no s urgery, and control 2, which consisted of 6 patients with Fontan repair. Results: P-wave duration on the electrocardiogram was similar in the 4 pati ent groups, but the amplitude was reduced in group 2 and control 2 (patient s with Fontan surgery) (P < .016). Bind P wave was seen in 5 (50%) of to pa tients in group 1 and hn 6 (43%) of 14 patients in control 1, but it was no t seen hn patients with Fontan (P < .01). Ventricular systolic and diastoli c dimensions and fractional shortening were not different between patients and controls. Right atrial transverse dimensions were greater in group 2 pa tients compared with those in controls. Significant atrioventricular valve regurgitation was seen in 9 of 10 group 1 patients but in none of the other s. Right-sided total long-axis excursion and atrial A-wave amplitude were d epressed in group 2 patients compared with tbe values in the others. The on set of right atrial shortening was delayed by 50 ms In group 2 compared wit h control 2, whereas the lee atrial shortening was delayed by 30 ms in grou p 1 compared with control 1. This particular disturbance remained 6 months after cardioversion. Conclusion: In 1-ventricle hearts, significant atrioventricular valve regur gitation is commonly associated with atrial nutter in patients who did not undergo the Fontan procedure, and with electromechanical disturbances In th ose who did Recognition of disturbances hn ventricular ions-arts function m ay thus assist In the identification of patients with a l-ventricle heart w ho are prone to atrial flutter.