Clinical Electrophysiology -> Ventricular Arrhythmias -> Clinical Trials / Outcomes D-PO05 - Poster Session V (ID 39) Poster

D-PO05-228 - Survival Analysis Of Fontan Patients With Ventricular Tachycardia (ID 600)


Background: With the advent of more intensive rhythm monitoring strategies, ventricular tachycardia (VT) is increasingly detected in Fontan patients. However, the clinical and prognostic implications of VT in this population are poorly understood.
Objective: To assess the prevalence of VT in a cohort of Fontan patients and the implications upon transplant-free survival.
Methods: All Fontan patients followed at a single center between 2008 - 2019 were identified. Medical records and ECGs were individually reviewed to identify episodes of VT, defined as >4 wide complex beats. Ventricular fibrillation (VF) and perioperative VT (<30 days post cardiac surgery) were excluded. The impact of VT was assessed using Cox Regression with the diagnosis of VT as a time-varying covariate.
Results: A total of 455 Fontan patients were reviewed with median follow-up 8.1 (IQR 2.1-15.1) years post Fontan. Fourty-four (10%) patients had VT (43 non-sustained VT, 1 VT). The first VT episode occurred 15.4 years (IQR 10.7- 23.5) years post Fontan surgery with 7 receiving an ICD and 2 Life Vests. In the VT group, there were 10 transplants (23%) and 1 death (2%) occurring at median 9 (IQR 2-37) months after VT diagnosis. Amongst controls, there were 9 deaths (2%) and 27 transplants (7%) occurring at a median 6.3 (IQR 2.2-10.3) years after Fontan surgery. Non-VT group had approximately 80% survival rate at 25 years post Fontan. VT diagnosis was associated with increased risk of transplant or death (p<0.001).
Conclusion: VT occurred in 10% of Fontan patients on long-term follow-up and was associated with increased risk of transplant or death. VT suggests a late and ominous sign that heralds end stage Fontan physiology.