• Jan Hendrik Nürnberg, Stanislav Ovroutski, Vladimir Alexi-Meskishvili, Peter Ewert, Roland Hetzer, and Peter E Lange.
• Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany. jan-hendrik.nuernberg@klinikum-bremen-ldw.de
• Ann. Thorac. Surg. 2004 Dec 1;78(6):1979-88; discussion 1988.

BackgroundArrhythmias are one of the main causes of postoperative morbidity superseding Fontan operations. Comparative data on the incidence of sinus node dysfunction after the extracardiac Fontan operation (ECFO) and the intraatrial lateral tunnel Fontan operation (LTFO) are very limited and controversial. The aim of this study was to evaluate whether ECFO decreases the risk of postoperative arrhythmias compared with LTFO.MethodsSeventy-four consecutive patients received either an LTFO (n = 29, 5 recordings in 1992 to 9 recordings in 1997) or an ECFO (n = 45, 11 recordings in 1995 to 5 recordings in 2001). The rhythm was documented preoperatively and postoperatively with standard electrocardiogram (ECG) recording and ECG monitoring. During follow-up all patients had 2-8 (median 3) standard ECG recordings per year. Additionally 45 patients (65%) had a Holter ECG at least once a year.ResultsMedian follow-up post-ECFO was 4.4 years (1.6-7.2) and post-LTFO it was 7.9 years (5.4-11.1). There were 5 early deaths (3 LTFO, 2 ECFO) and 1 late death (LTFO) (total mortality 8%). Sinus rhythm persisted in 37 ECFO patients (86%) as compared with 13 LTFO patients (50%) (p < 0.001). The incidence of new onset supraventricular tachyarrhythmias (SVTs) post-ECFO compared with LTFO was lower: 5 patients (11%) versus 11 patients (38%) early postoperatively (p < 0.001) and none versus 7 patients (27%) during follow-up (p < 0.001), respectively. Early postoperatively 10 LTFO patients (34%) and another 3 patients during follow-up required permanent pacemaker implantation due to bradyarrhythmias, but none of the ECFO patients required this.ConclusionsOur data suggest that ECFO decreases the incidence of postoperative new onset arrhythmias during early and midterm follow-up compared with LTFO.

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