Management of atrial flutter after the fontan procedure

Seshadri Balaji, Thomas B. Johnson, Robert M. Sade, Christopher L. Case, Paul C. Gillette

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Objectives. The purpose of this study was to review the management of atrial flutter occurring after the Fontan procedure. Background. Atrial flutter occurs frequently after the Fontan procedure and is often hemodynamically poorly tolerated. Methods. The patients' charts were reviewed for relevant information. Results. Between 1984 and 1992, 18 patients had atrial flutter after the Fontan procedure. The underlying heart defect was tricuspid atresia in nine, mitral atresia in six and double inlet left ventricle in three. All but three patients had undergone previous palliative surgery. The time interval from Fontan operation to atrial flutter was 1 flutter configuration. Digoxin and a variety of other antiarrhythmic agents (mean 2.7 drugs/patient) were tried with poor results. Only digoxia, amiodarone, flecainide and propafenone showed some benefit when used alone or in combination. Antitachyrardia pacemakers were implanted in 16 patients (endocardial 14, epicardial 2) and, with drugs, were useful in 8 (50%). Because atrial flutter was resistant to treatment, right atriectomy was performed in three patients (with benefit in two, one death), successful radiofrequency catheter His bundle ablation in one patient and catheter ablation of atrial flutter in three patients (two failed, one partial success). One patient underwent heart transplantation, and two died suddenly. Another died of complications after an elective epicardial pacemaker replacement procedure. Conclusions. Atrial flutter after the Fontan procedure is difficult to control. Aggressive drug and antitachycardia pacemaker therapy help about half of the patients. When these measures fail, other options, such as atriectomy, His bundle ablation or catheter ablation of atrial flutter, need consideration. The risk of sudden death justifies the use of such aggressive treatment methods.

Original languageEnglish (US)
Pages (from-to)1209-1215
Number of pages7
JournalJournal of the American College of Cardiology
Volume23
Issue number5
DOIs
StatePublished - 1994
Externally publishedYes

Fingerprint

Fontan Procedure
Atrial Flutter
Bundle of His
Catheter Ablation
Tricuspid Atresia
Pharmaceutical Preparations
Propafenone
Flecainide
Amiodarone
Digoxin
Patient Rights
Heart Transplantation
Sudden Death
Palliative Care
Heart Ventricles
Catheters

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Management of atrial flutter after the fontan procedure. / Balaji, Seshadri; Johnson, Thomas B.; Sade, Robert M.; Case, Christopher L.; Gillette, Paul C.

In: Journal of the American College of Cardiology, Vol. 23, No. 5, 1994, p. 1209-1215.

Research output: Contribution to journalArticle

Balaji, Seshadri ; Johnson, Thomas B. ; Sade, Robert M. ; Case, Christopher L. ; Gillette, Paul C. / Management of atrial flutter after the fontan procedure. In: Journal of the American College of Cardiology. 1994 ; Vol. 23, No. 5. pp. 1209-1215.
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N2 - Objectives. The purpose of this study was to review the management of atrial flutter occurring after the Fontan procedure. Background. Atrial flutter occurs frequently after the Fontan procedure and is often hemodynamically poorly tolerated. Methods. The patients' charts were reviewed for relevant information. Results. Between 1984 and 1992, 18 patients had atrial flutter after the Fontan procedure. The underlying heart defect was tricuspid atresia in nine, mitral atresia in six and double inlet left ventricle in three. All but three patients had undergone previous palliative surgery. The time interval from Fontan operation to atrial flutter was 1 flutter configuration. Digoxin and a variety of other antiarrhythmic agents (mean 2.7 drugs/patient) were tried with poor results. Only digoxia, amiodarone, flecainide and propafenone showed some benefit when used alone or in combination. Antitachyrardia pacemakers were implanted in 16 patients (endocardial 14, epicardial 2) and, with drugs, were useful in 8 (50%). Because atrial flutter was resistant to treatment, right atriectomy was performed in three patients (with benefit in two, one death), successful radiofrequency catheter His bundle ablation in one patient and catheter ablation of atrial flutter in three patients (two failed, one partial success). One patient underwent heart transplantation, and two died suddenly. Another died of complications after an elective epicardial pacemaker replacement procedure. Conclusions. Atrial flutter after the Fontan procedure is difficult to control. Aggressive drug and antitachycardia pacemaker therapy help about half of the patients. When these measures fail, other options, such as atriectomy, His bundle ablation or catheter ablation of atrial flutter, need consideration. The risk of sudden death justifies the use of such aggressive treatment methods.

AB - Objectives. The purpose of this study was to review the management of atrial flutter occurring after the Fontan procedure. Background. Atrial flutter occurs frequently after the Fontan procedure and is often hemodynamically poorly tolerated. Methods. The patients' charts were reviewed for relevant information. Results. Between 1984 and 1992, 18 patients had atrial flutter after the Fontan procedure. The underlying heart defect was tricuspid atresia in nine, mitral atresia in six and double inlet left ventricle in three. All but three patients had undergone previous palliative surgery. The time interval from Fontan operation to atrial flutter was 1 flutter configuration. Digoxin and a variety of other antiarrhythmic agents (mean 2.7 drugs/patient) were tried with poor results. Only digoxia, amiodarone, flecainide and propafenone showed some benefit when used alone or in combination. Antitachyrardia pacemakers were implanted in 16 patients (endocardial 14, epicardial 2) and, with drugs, were useful in 8 (50%). Because atrial flutter was resistant to treatment, right atriectomy was performed in three patients (with benefit in two, one death), successful radiofrequency catheter His bundle ablation in one patient and catheter ablation of atrial flutter in three patients (two failed, one partial success). One patient underwent heart transplantation, and two died suddenly. Another died of complications after an elective epicardial pacemaker replacement procedure. Conclusions. Atrial flutter after the Fontan procedure is difficult to control. Aggressive drug and antitachycardia pacemaker therapy help about half of the patients. When these measures fail, other options, such as atriectomy, His bundle ablation or catheter ablation of atrial flutter, need consideration. The risk of sudden death justifies the use of such aggressive treatment methods.

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