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| Chronological Changes in P-wave Characteristics after the Fontan Procedure: Impact of Surgical Modification | |
Masahiro Koh1, Hideki Uemura2, Akiko Kada1, Koji Kagisaki1, Ikuo Hagino1, Toshikatsu Yagihara1; 1National Cardiovascular Center, Osaka, Japan; 2Royal Brompton Hospital, London, United Kingdom
Methods: A retrospective analysis was done on clinical and electrocardiographic data from 40 patients with tricuspid atresia or tricuspid stenosis who underwent the Fontan procedure and had follow-up of more than 5 years: 9 had EC, 13 IB, and 18 APC. Mean age at operation was 1.3 ± 0.4 for EC, 3.9 ± 2.5 for IB, and 5.3 ± 4.8 years for APC. Mean follow-up period was 8.0 ± 1.5 for EC, 13.3 ± 1.3 for IB, and 19.8 ± 4.5 years for APC. We measured P-wave duration, dispersion (difference between maximum and minimum duration), and amplitude from consecutive postoperative 12-lead electrocardiograms. Changes in maximum P-wave duration and P-wave dispersion were analyzed using a general linear mixed model with years as a fixed effect and patients as a random effect. Results: Atrial tachyarrhythmia was documented during follow-up in 9 APC, but not in any EC or IB patients. Freedom from arrhythmia in APC was 88.5 ± 11.5 %, 65.0 ± 35.1 %, 41.2 ± 51.8 % at 10, 15, and 20 years, respectively. Both P-wave maximum duration and P-wave dispersion slightly decreased over time in EC, while progressively increasing in IB and APC. EC patients had significantly shorter maximum P-wave duration (p < 0.001) and smaller P-wave dispersion (p = 0.004) than APC. IB patients had significantly shorter maximum P-wave duration than APC (p = 0.001). P-wave amplitude dropped dramatically immediately after surgery in IB and EC, but remained unchanged in APC. Conclusion: Changes in P-wave characteristics over time were different in EC compared with those in APC. The IB group showed an intermediate trend. These findings suggest that EC is the most promising modification of the Fontan procedure in terms of rhythm prognosis. 
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