How is pediatric atrial flutter characterized in patients with a history of repaired congenital heart disease?

Updated: Feb 04, 2019
  • Author: M Silvana Horenstein, MD; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Answer

Understanding the specific anatomy and surgical repair for each patient is important. Certain types of repair are more commonly associated with late atrial flutter than others.

In Fontan-type operations, atriopulmonary connections are associated with a risk of atrial flutter that is 2.5-fold higher than with the total cavopulmonary connection. Extracardiac Fontan repairs may have an even lower frequency of atrial flutter.

The type of repair may influence the technical approach to electrophysiological study, pacemaker placement, potential radiofrequency ablation therapy, or potential Fontan surgical revision. For example, patients who have the classic Fontan operation are amenable to ablation attempts of the atrial flutter in the electrophysiology laboratory because the right atrium can be approached via the inferior and/or superior vena cava. In addition, endocardial pacemaker leads can be inserted if the patient has sinus node dysfunction.

However, patients who have an extracardiac Fontan repair in which the right atrium has been bypassed with a baffle require open-heart surgery if ablation is contemplated, which is performed at the time of their Fontan revision. In addition, only epicardial pacemaker leads can be placed in these patients.

Atrial flutter also has prognostic significance in this setting. Several studies have shown that atrial flutter in the early postoperative period in patients who have undergone the Fontan operation predicts both early operative mortality and recurrence of the arrhythmia.

In patients with congenital heart disease who have undergone surgery, episodes of atrial flutter have been shown to increase in frequency over time.


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