INVITED COMMENTARY

Abstract

There is compelling logic to the argument that the extracardiac conduit approach to the Fontan procedure should minimize or avoid arrhythmias. Compared with the lateral tunnel approach, the extracardiac conduit limits atrial suture lines, and avoids exposure of any portion of the atrium to high pressure. At first glance, the report of Nürnberg and colleagues supports this argument: extracardiac conduit patients had lower rates of sinus node dysfunction and supraventricular tachycardia both in-hospital, and during follow-up. This report contains a large amount of information and deserves careful scrutiny. Several points are of interest. Despite the minimization of atrial surgery, patients undergoing an extracardiac conduit Fontan procedure have an incidence of sinus node dysfunction at the time of hospital discharge of approximately 15%. This has been a consistent observation (summarized in their Table 1), being seen in the current report (16%), as well as in reports from the Hospital for Sick Children, Toronto (15%), Children's Hospital of Philadelphia (13%), and Medical University of South Carolina (17%). The reasons for this are unclear, but may include the effects of atrial incisions for associated procedures or fenestration placement, or damage to the sinus node or its blood supply during redissection.