High frequency of arrhythmias after Fontan operation indicates earlier anticoagulant therapy

Background: As patients began to survive for longer periods following modif ied Fontan operations (conventional atrio-pulmonary connection), the late m orbidity after this procedure became increasingly apparent. The purpose of the present study was to evaluate late sequelae of modified Fontan operatio ns in long-term survivors (n=14) at our institute, Methods and results: The cohort consisted of patients who underwent a modified Fontan operation bet ween 1981 and 1990. Thus. all patients were examined at least 10 years post operatively in this study. Early mortality, within 30 days of the operation , was 17.6% (three of 17 patients died from low output syndrome). Excluding these early deaths, the cumulative survival rate at 5 and 10 pears was 100 and 79%, respectively. Arrhythmias including atrial fibrillation or flutte r were the main late causes of morbidity. The arrhythmia-free rate at 5 and 10 years was 77 and 50%. respectively, Although the quality of life was co nsidered good because all patients (n=11) who survived for 10 years or more were in class I or II according to the New York Heart Association classifi cation, most of them in fact suffered from potentially life-threatening arr hythmias. Conclusions. Meticulous attention to and utilization of establish ed treatment strategies for arrhythmias including anti-arrhythmics, anticoa gulants. catheter ablation or re-operation converting the circulation to th e total cavopulmonary connection must be considered in long-term survivors following the modified Fontan operation. The fact that no one knows when th e thrombogenic arrhythmias occur suggests anticoagulants should be initiate d in the early postoperative period. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.