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Optimal timing of the Fontan conversion: change in the P-wave characteristics precedes the onset of atrial tachyarrhythmias in patients with atriopulmonary connection.
J Thorac Cardiovasc Surg. 2007 May; 133(5):1295-302.JT

Abstract

OBJECTIVES

Atrial tachyarrhythmia is a common complication late after the atriopulmonary connection Fontan procedure. The P-wave duration and dispersion have been regarded as useful markers for its prediction. The purpose of this study was to analyze change in the P-wave characteristics over time after the atriopulmonary connection Fontan procedure, with a special emphasis on the timing of the Fontan conversion.

METHODS

We reviewed clinical and electrocardiographic data in 18 patients with classic tricuspid atresia who underwent the atriopulmonary connection Fontan procedure. Their median age at operation was 4.1 years (range, 1.1-22 years), and the median follow-up period was 18.1 years (range, 10-25 years). We measured the P-wave duration, dispersion, and axis from consecutive 12-lead electrocardiograms in each patient.

RESULTS

There was a significant increase in the maximum P-wave duration as well as the P-wave dispersion over time. Transient ectopic atrial rhythm was observed in 16 patients during follow-up. Atrial tachyarrhythmia developed subsequent to transient ectopic atrial rhythm in 8 patients. Ten patients underwent the conversion. Atrial tachyarrhythmia recurred in 2 patients who had sustained arrhythmia (6.0 and 8.0 years) before the conversion. In contrast, the other 8 patients with transient ectopic atrial rhythm alone or nonsustained atrial tachyarrhythmia have been free from arrhythmia after the conversion.

CONCLUSIONS

Patients commonly and increasingly had prolonged P-wave duration, larger P-wave dispersion, and ectopic atrial rhythm, along with an atrial tachyarrhythmia propensity, late after the atriopulmonary connection Fontan procedure. These P-wave characteristics were informative when considering the Fontan conversion before a sustained atrial tachyarrhythmia ensued.

Authors+Show Affiliations

Department of Cardiovascular Surgery, the National Cardiovascular Center, Osaka, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17467444

Citation

Koh, Masahiro, et al. "Optimal Timing of the Fontan Conversion: Change in the P-wave Characteristics Precedes the Onset of Atrial Tachyarrhythmias in Patients With Atriopulmonary Connection." The Journal of Thoracic and Cardiovascular Surgery, vol. 133, no. 5, 2007, pp. 1295-302.
Koh M, Yagihara T, Uemura H, et al. Optimal timing of the Fontan conversion: change in the P-wave characteristics precedes the onset of atrial tachyarrhythmias in patients with atriopulmonary connection. J Thorac Cardiovasc Surg. 2007;133(5):1295-302.
Koh, M., Yagihara, T., Uemura, H., Kagisaki, K., Hagino, I., Ishizaka, T., & Kitamura, S. (2007). Optimal timing of the Fontan conversion: change in the P-wave characteristics precedes the onset of atrial tachyarrhythmias in patients with atriopulmonary connection. The Journal of Thoracic and Cardiovascular Surgery, 133(5), 1295-302.
Koh M, et al. Optimal Timing of the Fontan Conversion: Change in the P-wave Characteristics Precedes the Onset of Atrial Tachyarrhythmias in Patients With Atriopulmonary Connection. J Thorac Cardiovasc Surg. 2007;133(5):1295-302. PubMed PMID: 17467444.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimal timing of the Fontan conversion: change in the P-wave characteristics precedes the onset of atrial tachyarrhythmias in patients with atriopulmonary connection. AU - Koh,Masahiro, AU - Yagihara,Toshikatsu, AU - Uemura,Hideki, AU - Kagisaki,Koji, AU - Hagino,Ikuo, AU - Ishizaka,Toru, AU - Kitamura,Soichiro, Y1 - 2007/03/19/ PY - 2006/04/27/received PY - 2006/12/01/revised PY - 2006/12/18/accepted PY - 2007/5/1/pubmed PY - 2007/5/26/medline PY - 2007/5/1/entrez SP - 1295 EP - 302 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 133 IS - 5 N2 - OBJECTIVES: Atrial tachyarrhythmia is a common complication late after the atriopulmonary connection Fontan procedure. The P-wave duration and dispersion have been regarded as useful markers for its prediction. The purpose of this study was to analyze change in the P-wave characteristics over time after the atriopulmonary connection Fontan procedure, with a special emphasis on the timing of the Fontan conversion. METHODS: We reviewed clinical and electrocardiographic data in 18 patients with classic tricuspid atresia who underwent the atriopulmonary connection Fontan procedure. Their median age at operation was 4.1 years (range, 1.1-22 years), and the median follow-up period was 18.1 years (range, 10-25 years). We measured the P-wave duration, dispersion, and axis from consecutive 12-lead electrocardiograms in each patient. RESULTS: There was a significant increase in the maximum P-wave duration as well as the P-wave dispersion over time. Transient ectopic atrial rhythm was observed in 16 patients during follow-up. Atrial tachyarrhythmia developed subsequent to transient ectopic atrial rhythm in 8 patients. Ten patients underwent the conversion. Atrial tachyarrhythmia recurred in 2 patients who had sustained arrhythmia (6.0 and 8.0 years) before the conversion. In contrast, the other 8 patients with transient ectopic atrial rhythm alone or nonsustained atrial tachyarrhythmia have been free from arrhythmia after the conversion. CONCLUSIONS: Patients commonly and increasingly had prolonged P-wave duration, larger P-wave dispersion, and ectopic atrial rhythm, along with an atrial tachyarrhythmia propensity, late after the atriopulmonary connection Fontan procedure. These P-wave characteristics were informative when considering the Fontan conversion before a sustained atrial tachyarrhythmia ensued. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/17467444/Optimal_timing_of_the_Fontan_conversion:_change_in_the_P_wave_characteristics_precedes_the_onset_of_atrial_tachyarrhythmias_in_patients_with_atriopulmonary_connection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(06)02290-2 DB - PRIME DP - Unbound Medicine ER -