Details

Autor(en) / Beteiligte

• Pickup, L
• Quinton, E
• Thorne, S
• Bowater, S
• Clift, P
• de Bono, JP
• Hudsmith, L

Titel

20 Do atriopulmonary (AP) fontan dimensions using CMR influence the development of atrial tachyarrhythmia?

Ist Teil von

• Heart (British Cardiac Society), 2016-05, Vol.102 (Suppl 3), p.A14-A15

Ort / Verlag

London: BMJ Publishing Group LTD

Erscheinungsjahr

2016

Quelle

BMJ Journals Archiv - DFG Nationallizenzen

Beschreibungen/Notizen

• IntroductionAtrial tachyarrhythmia is regarded as a late consequence of the Fontan circulation, particularly in those with an AP Fontan and is associated with significant morbidity and mortality. Developing methods to recognise those at the highest risk will allow early intervention, improving patient outcomes.PurposeTo establish relationship between AP Fontan chamber (FC) dimensions, ventricular volumes and function and the development of atrial arrhythmia (AR).MethodsModified AP Fontan patients with CMR (1.5T, Avanto, Siemens) were reviewed (Figure 1). Horizontal long axis (HLA, TrueFISP cine, flip angle 80, TR/TE 50/1.26ms, retrospective ECG gating) and transaxial 3D MRA non-contrast (Modified Siemens Whole Heart coronary artery sequence, respiratory navigator, ECG-triggered, free breathing, slice thickness 2.00mm) of the FC and the left atrium were examined.Abstract 20 Figure 1HLA of 48 year old male with 5 ablations. End-diastolic area of 69cm2. Slow flow can be seen in the FCResults55 patients 58% female and 42% male, mean age 33yrs (SD 7.9). 32 patients suffered a documented AR, most commonly atrial flutter (79%). There was a significant difference in age between the two groups with those having an AR tending to be older (36yrs vs 29yrs p < 0.05) the age of procedure was also younger in the AR group (6yrs vs. 10yrs p < 0.05)  (Table 1). There was no difference in ventricular ejection fraction (p > 0.05). There were no significant differences in atrial parameters between the two groups (p > 0.05), however all measures of the FC were statistically different with larger measures occurring in the AR group (p < 0.05). Receiver operator characteristic curves were constructed for each of the atrium and FC variables. Only end diastolic area and FC longitudinal dimension produced statistically significant results (ROC 0.745 P < 0.05 and 0.719 p < 0.05). Using an upper limit of 27cm2 for end diastolic FC area odds ratio of AR was 8.57 (p < 0.05) with a sensitivity of 0.596 and a specificity of 0.870.Abstract 20 Table 1Patient demographics and CMR parameters Non-arrhythmia group N=23 (Standard deviation) Arrhythmia Group N=32 (Standard Deviation) Age (yrs) 29(5)36(9)P < 0.05 * Age of Fontan Procedure (yrs) 6(4)1 (9)P < 0.05 * Ejection fraction (%) 55(11)55(12)P > 0.05 * End Diastolic Area of Fontan chamber (cm 2 ) 19(8)30(16)P < 0.05 * End Diastolic Longitudinal Value of Fontan Chamber (cm 2 ) 4(1)6(2)P < 0.05 * End Systolic Area of Fontan Chamber (cm 2 ) 23(11)32(16)P < 0.05 * End Systolic longitudinal Value Fontan Chamber (cm 2 ) 5(1)6(2)P < 0.05 * *P values represent significance level of between group t-testsConclusionsIncreasing AP FC size is associated with increased risk of AR.