Pediatric Cardiology and Cardiac Surgery
Vol.25 No.2 2009 (139-145)

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Shuhei Fujita,1) Kazuhiro Takahashi,1) Daiji Takeuchi,1) Hiromi Kurosawa,2) and Toshio Nakanishi1)

Departments of 1)Pediatric Cardiology and 2)Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan


Background: In patients who are candidates for the Fontan operation, supraventricular tachycardia (SVT) may be a life-threatening problem in the peri-operative period.
Subjects: A retrospective review of 5 patients before Fontan operation who underwent electrophysiologic study/radiofrequency catheter ablation (EPS/RFCA) between 2005 and 2007 at our institution. Ages ranged from 8 months to 6 years, and body weight ranged from 7.2 kg to 22 kg. They included 2 cases of asplenia. Underlying cardiac defects were double-outlet right ventricle in 3, right single ventricle in 2, and tricuspid atresia in 1.
Results: Palliative surgical procedures were Blalock-Taussig shunt in 1, pulmonary banding in 2, and bi-directional Glenn shunt in 2 at EPS. The indication for EPS/RFCA was a history of tachyarrhythmia (n = 4) or 2 different types of QRS complex without pre-excitation suspecting twin atrioventricular node (AVN) (n = 1). At EPS, SVT was induced in all patients. The mechanisms of arrhythmia were atrioventricular re-entrant tachycardia (AVRT) due to accessory pathway (n = 2), intra-atrial re-entrant tachycardia (IART; n = 1), atrial flutter (AFL; n = 1), and bi-directional AVN-AVN reentrant tachycardia (n = 1). In 3 patients ablation was successful (AVRT due to accessory pathway, IART and AVRT due to twin AVNs). In 2 patients whose ablation failed, the oral prophylactic amiodarone was used before and during the Fontan operation. At Fontan operation, the RF procedure was performed. No patients had recurrent tachycardia before or during the Fontan operation.
Conclusion: In patients with tachycardia or suspected twin AVN, it is important to manage SVT before and during the operation, by performing EPS/RFCA prior to Fontan operation. RFCA can be performed for patients after Glenn operation as well.