Impact of preoperative electrophysiological intervention on occurrence of peri/postoperative supraventricular tachycardia following Fontan surgery

Abstract Background Little is known about the effects of preoperative electrophysiological study (EPS) and catheter ablation (CA) in Fontan surgery candidates with supraventricular tachycardia (SVT). Objective This study aimed to investigate the clinical impact of EPS-guided intervention in Fontan surgery candidates with preceding SVT events. Methods A total of 109 consecutive patients with a history of SVT before Fontan surgery were divided into three groups: 44, in whom EPS with CA was attempted (CA group);21,in whom EPS without CA was attempted (EPS group); and 44,in whom EPS was not performed (N group). The incidence and diagnosis of SVT, acute success rate of CA, and risk factors of peri/postoperative SVT were retrospectively investigated. Results The total incidence of SVT within one year after Fontan surgery was 34% (n= 37), with 91% of cases occurring within one month. Among the 71 SVT incidences diagnosed with EPS, 31 were atrioventricular reentrant tachycardias (AVRTs) involving twin atrioventricular nodes, 12 were atrioventricular nodal reentrant tachycardias, 12 were atrial tachycardias, seven were orthodromic AVRTs via the accessory pathway, seven were atrial flutters, and two were junctional tachycardias. The acute success rate of CA was 91% (48/53). The rate of peri/postoperative atrioventricular-reciprocating SVT was significantly lower in the CA group than the N or EPS group (11% vs. 43% or 43%, p Conclusion Preoperative CA reduces peri/postoperative SVT occurrence in Fontan surgery candidates at high risk of SVT.