Current Treatment Options of Fontan Arrhythmias: Management

Purpose of the review: Arrhythmias are a common complication of patients with single ventricle anatomy who undergo the Fontan operation. This review will address current management strategies for acute and chronic arrhythmias. Recent findings: Alterations to surgical techniques, newer antiarrhythmic medications, and improvements in catheter ablation procedures have improved the management of patients with arrhythmias following Fontan palliation. Summary: Arrhythmias predict poor prognosis for Fontan patients. Early and aggressive management of arrhythmias improve patient outcomes. For bradyarrhythmias, management strategies strive to maximize atrial pacing and minimize ventricular pacing. For tachyarrhythmias, urgent evaluation and aggressive interventions strive to convert and maintain sinus rhythm. Strategies include antiarrhythmic medications, catheter ablation, and early referral for Fontan conversion and arrhythmia surgery for those who do not respond. There is much interest in prophylactic arrhythmia surgery at the time of initial Fontan operation; however, the future role remains to be elucidated.