Primary surgical prevention of post-operative atrial re-entry tachycardia

Abstract Despite continual improvements in the results of the repair of congenital heart defects, atrial re-entry tachycardia remains a significant source of morbidity. Certain subsets of patients following surgical repair, such as those with a Fontan palliation, tetralogy of Fallot, or Ebstein's anomaly, are at higher risk for the development of post-operative tachyarrhythmia. An improved understanding of the etiology of atrial re-entry tachycardia has led to attempts at preventing arrhythmia during the initial repair. These techniques include the addition of surgical or cryolesions along areas of potential re-entry pathways, and the use of the extracardiac Fontan modification. Atrial pacing to restore a regular atrial rate is another technique known to decrease the incidence of atrial tachyarrhythmia. Ongoing research is improving our understanding of the role of these prophylactic approaches as primary prevention of atrial re-entry tachycardia.