Review of rhythm disturbances in patient after fontan completion: epidemiology, management, and surveillance
PurposeThe Fontan operation is commonly associated with alterations in heart rhythms, both tachycardic and bradycardic. Despite modifications to attempt to mitigate these complications, arrythmias still frequently occur. The purpose of this review is to examine the literature regarding the scope of...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1506690/full |
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| author | Kevin Wall Camden Hebson Roshan D’Souza Seshadri Balaji |
| author_facet | Kevin Wall Camden Hebson Roshan D’Souza Seshadri Balaji |
| author_sort | Kevin Wall |
| collection | DOAJ |
| description | PurposeThe Fontan operation is commonly associated with alterations in heart rhythms, both tachycardic and bradycardic. Despite modifications to attempt to mitigate these complications, arrythmias still frequently occur. The purpose of this review is to examine the literature regarding the scope of the problem, therapeutic options, and current recommendations regarding screening and surveillance.Recent findingsModifications to the original Fontan procedure, antiarrhythmic medications, and improvements in catheter ablation procedures have improved the management of patients with arrhythmias following Fontan palliation. There is growing interest in the role of junctional rhythm in the role of Fontan dysfunction. While chronotropic incompetence has often been blamed for poor exercise testing, there is evidence that decreased performance may be related to ventricular filling and Fontan hemodynamics.SummaryTachyarrhythmias are an important cause of mortality and morbidity after the Fontan operation. Prompt and aggressive management of arrhythmias with the goal of maintaining sinus rhythm is vital. Management strategies such as anti-arrhythmic medications, ablation, anti-tachycardia pacing and Fontan conversion should be seen as complementary and used early to prevent hemodynamic deterioration. Bradyarrythmias likely also contribute to Fontan failure. Pacing is the primary management strategy with evidence supporting use of atrial pacing. However, ventricular pacing seems to often lead to deleterious effects. Current guidelines recommend surveillance with Holter monitor every 2–3 years in adolescents and every 1–2 years in adults. Future directions for research include further assessment of junctional rhythm and its management as well as further identifying patients in which pacing would be beneficial. |
| format | Article |
| id | doaj-art-e6e5e1d7872d4fe0a9dd0894f2fb2314 |
| institution | OA Journals |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-e6e5e1d7872d4fe0a9dd0894f2fb23142025-08-20T02:12:37ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-02-011310.3389/fped.2025.15066901506690Review of rhythm disturbances in patient after fontan completion: epidemiology, management, and surveillanceKevin Wall0Camden Hebson1Roshan D’Souza2Seshadri Balaji3Department of Pediatrics, Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, United StatesDepartment of Pediatrics, Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, United StatesDepartment of Pediatrics, Division of Cardiology, Seattle Children’s Hospital, Seattle, WA, United StatesDepartment of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, OR, United StatesPurposeThe Fontan operation is commonly associated with alterations in heart rhythms, both tachycardic and bradycardic. Despite modifications to attempt to mitigate these complications, arrythmias still frequently occur. The purpose of this review is to examine the literature regarding the scope of the problem, therapeutic options, and current recommendations regarding screening and surveillance.Recent findingsModifications to the original Fontan procedure, antiarrhythmic medications, and improvements in catheter ablation procedures have improved the management of patients with arrhythmias following Fontan palliation. There is growing interest in the role of junctional rhythm in the role of Fontan dysfunction. While chronotropic incompetence has often been blamed for poor exercise testing, there is evidence that decreased performance may be related to ventricular filling and Fontan hemodynamics.SummaryTachyarrhythmias are an important cause of mortality and morbidity after the Fontan operation. Prompt and aggressive management of arrhythmias with the goal of maintaining sinus rhythm is vital. Management strategies such as anti-arrhythmic medications, ablation, anti-tachycardia pacing and Fontan conversion should be seen as complementary and used early to prevent hemodynamic deterioration. Bradyarrythmias likely also contribute to Fontan failure. Pacing is the primary management strategy with evidence supporting use of atrial pacing. However, ventricular pacing seems to often lead to deleterious effects. Current guidelines recommend surveillance with Holter monitor every 2–3 years in adolescents and every 1–2 years in adults. Future directions for research include further assessment of junctional rhythm and its management as well as further identifying patients in which pacing would be beneficial.https://www.frontiersin.org/articles/10.3389/fped.2025.1506690/fullfontanjunctional rhythmtachyarrhythmiaantiarrhythmic drugsarrhythmiacongenital heart disease |
| spellingShingle | Kevin Wall Camden Hebson Roshan D’Souza Seshadri Balaji Review of rhythm disturbances in patient after fontan completion: epidemiology, management, and surveillance Frontiers in Pediatrics fontan junctional rhythm tachyarrhythmia antiarrhythmic drugs arrhythmia congenital heart disease |
| title | Review of rhythm disturbances in patient after fontan completion: epidemiology, management, and surveillance |
| title_full | Review of rhythm disturbances in patient after fontan completion: epidemiology, management, and surveillance |
| title_fullStr | Review of rhythm disturbances in patient after fontan completion: epidemiology, management, and surveillance |
| title_full_unstemmed | Review of rhythm disturbances in patient after fontan completion: epidemiology, management, and surveillance |
| title_short | Review of rhythm disturbances in patient after fontan completion: epidemiology, management, and surveillance |
| title_sort | review of rhythm disturbances in patient after fontan completion epidemiology management and surveillance |
| topic | fontan junctional rhythm tachyarrhythmia antiarrhythmic drugs arrhythmia congenital heart disease |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1506690/full |
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