Pediatric/Adult Congenital Heart Disease -> Adult Congenital Heart Disease D-MP08 - Pediatric and Arrhythmia & Device Management (ID 12) Moderated ePoster

D-MP08-02 - Procedural Aspects And Outcomes Of Pulmonary Venous Entry For Catheter Ablation After The Extracardiac Fontan Operation (ID 1475)

 R.G. Gallotti: Nothing relevant to disclose.


Background: The extracardiac total cavo-pulmonary connection (E-TCPC) operation isolates the systemic venous circulation from potential atrial arrhythmia substrates. The optimal approach to pulmonary venous atrial (PVA) entry has not been evaluated.
Objective: To determine the characteristics and outcomes of PVA entry after E-TCPC.
Methods: A single center retrospective study was performed.
Results: A total of 25 procedures were performed in 19 E-TCPC patients (median 27 yrs, 47% male). E-TCPC surgery (conduit size 19 mm [IQR 17-20]) was performed at a median age of 10 yrs [IQR 5-22], including 7 (37%) with prior Fontan conversion. Entry into the PVA was performed in 23 cases for inducible tachycardia. The technique was trans-caval (TC) puncture in 11 (48%), direct conduit puncture in 6 (26%), passage through a fenestration in 5 (22%), and pulmonary puncture in 1 (4%). Patients who underwent TC as compared to conduit puncture were significantly younger at time of E-TCPC surgery (7 vs 13 yrs, p=0.01). Pre-operative advanced imaging was utilized in 15 (65%), and TEE in 13 or ICE in 4 was used at the time of the E-TCPC puncture. There were no complications from PVA entry, regardless of approach. On follow-up echocardiogram, no residual E-TCPC shunts were visualized and O2 saturations were not significantly different.
Conclusion: Direct entry into the PVA is uniformly possible for patients with E-TCPC anatomy. The direct TC approach appears to be safe and effective, and is most relevant to those undergoing E-TCPC at a younger age.