Congenital heart diseaseCohort study
Late arrhythmias following Fontan completion: insights from a Korean Multicentre Fontan Registry of over 1000 extracardiac conduit surgeries
- Retrospective cohort study
- multicentre
- registry
Authors' conclusion
This large, long-term registry shows that ECC Fontan confers a lower arrhythmia risk than LT or AP, and arrhythmias serve as a marker of Fontan failure and mortality in post-Fontan patients.
Study context
- Population
- Fontan patients, Korean multicentre registry, 1979–2019
- Participants
- 1,492 patients
- Exposure
- AP vs lateral tunnel (LT) vs extracardiac conduit (ECC) Fontan
- APn = 106
- LTn = 234
- ECCn = 1,143reference
- Outcome
- Late arrhythmia
- Follow-up
- Median 14 years
Main finding
As reported in the abstract
Any arrhythmia (multivariable)
Each group vs ECCHazard ratio (95% CI)P value
AP
5.89(3.75–9.25)
P < 0.001LT
2.85(1.93–4.21)
P < 0.001- Arrhythmias overall
- 13.3%
- Freedom from any arrhythmia at 20 years
- 82.5%
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Older age at Fontan surgery and arrhythmia | 1.06 (1.03–1.10) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
| Outcome | HR | P value |
|---|---|---|
| Tachyarrhythmias and bradyarrhythmias — LT vs ECC · tachyarrhythmias | 2.99 | P < 0.001 |
| Tachyarrhythmias and bradyarrhythmias — AP vs ECC · tachyarrhythmias | 8.20 | P < 0.001 |
| Tachyarrhythmias and bradyarrhythmias — LT vs ECC · bradyarrhythmias | 2.63 | P < 0.001 |
| Tachyarrhythmias and bradyarrhythmias — AP vs ECC · bradyarrhythmias | 5.47 | P < 0.001 |
- Tachyarrhythmias and bradyarrhythmias — Tachyarrhythmias
- 9.9%
- Tachyarrhythmias and bradyarrhythmias — Bradyarrhythmias
- 6.8%
- Tachyarrhythmias and bradyarrhythmias — Freedom from tachyarrhythmia at 20 years
- 86.9%
- Tachyarrhythmias and bradyarrhythmias — Freedom from bradyarrhythmia at 20 years
- 90.5%
All-cause mortality and Fontan failure
- All-cause mortality
- 9.3% (0.69 per 100 patient-years)
- Fontan failure
- 20.0% (1.61 per 100 patient-years)
- Late-onset arrhythmias associated with mortality
- P = 0.003
- Late-onset arrhythmias associated with Fontan failure
- P < 0.001
Original publication
Late arrhythmias following Fontan completion: insights from a Korean Multicentre Fontan Registry of over 1000 extracardiac conduit surgeries. Europace. Published 14 September 2026. doi:10.1093/europace/euag123
Summarised from the published abstract; every number is checked against it