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Congenital heart disease
Original research
Atrial arrhythmias and thromboembolic complications in adults post Fontan surgery
  1. Darryl Wan,
  2. Jasmine Grewal,
  3. Amanda Barlow,
  4. Marla Kiess,
  5. Derek Human,
  6. Andrew D Krahn,
  7. Mounir Riahi and
  8. Santabhanu Chakrabarti
  1. Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Santabhanu Chakrabarti; schakrabarti{at}providencehealth.bc.ca

Abstract

Objective Patients with Fontan surgery experience late complications in adulthood. We studied the factors associated with the development and maintenance of atrial arrhythmias and thromboembolic complications in an adult population with univentricuar physiology post Fontan surgery.

Methods Single centre retrospective cohort study of patients ≥18 years of age with Fontan circulation followed at our quaternary care centre for more than 1 year were included. Univariate and multivariate regression models were used where applicable to ascertain clinically significant associations between risk factors and complications.

Results 93 patients were included (age 30.2±8.8 years, 58% men). 28 (30%) had atriopulmonary Fontan connection, 35 (37.6%) had lateral tunnel Fontan and 29 (31.1%) had extracardiac Fontan pathway. After a mean of 7.27±5.1 years, atrial arrhythmia was noted in 37 patients (39.8%), of which 13 developed had atrial fibrillation (14%). The presence of atrial arrhythmia was associated with the number of prior cardiac surgeries/procedures, increasing age and prior atriopulmonary Fontan operation. Thromboembolic events were present in 31 patients (33%); among them 14 had stroke (45%), 3 had transient ischaemic attack (9.7%), 7 had pulmonary embolism (22.6%) and 5 had atrial thrombus with imaging (16.1%). The presence of thromboembolic events was only associated with age and the presence of cirrhosis in multivariate analysis.

Conclusions Atrial arrhythmias are common in adults with Fontan circulation at an early age, and are associated with prior surgical history and increasing age. Traditional risk factors may not be associated with atrial arrhythmia or thromboembolism in this cohort.

  • congenital heart disease
  • atrial fibrillation
  • arrhythmias
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2019-001224

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    Footnotes

    • Contributors This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Approval from institutional Research Ethics Board (REB) was obtained prior to initiation of this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data is not in a repository but is available upon request from the corresponding author.