Fontan Conversion

Early survival after the Fontan operation has improved significantly after staged interventional strategies that have been instrumental in preparing favorable ventricular compliance, pulmonary artery resistance, and systemic venous connections for a lifetime of Fontan circulation. The introduction of catheter ablation techniques for arrhythmia therapy coincided with the first generation of adolescent and young adult survivors of early atriopulmonary Fontan repairs. Atrial and ventricular lead implantation at the time of Fontan conversion avoids the need for late reoperation, and allows for rate responsiveness and atrial antitachycardia pacing algorithms should they become necessary. Achievement of acceptable pacing thresholds in the atrium may be challenging because of the extensive resection, reconstruction, and ablative lesions. Multiple centers have demonstrated that Fontan conversion with concomitant arrhythmia surgery can be accomplished with selected patients resulting in low operative mortality.