{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T01:02:51Z","timestamp":1789347771077,"version":"build-2803163510"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"SNUH Lee Kun-hee Child Cancer"},{"name":"Rare Disease Project, Republic of Korea","award":["23C-030-0100"],"award-info":[{"award-number":["23C-030-0100"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Awareness of long-term arrhythmia complications after Fontan surgery is increasing, but the impact of surgical type and risk factors on arrhythmia development remain incompletely understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We retrospectively analysed 1492 Fontan patients from the Korean multicentre registry (1979\u20132019), categorized into atriopulmonary connection (AP) (n = 106), lateral tunnel (LT) (n = 234), and extracardiac conduit (ECC) (n = 1143) with a median follow-up of 14 years. Arrhythmias occurred in 13.3% of patients at a median age of 17.3 years (tachyarrhythmias 9.9%, bradyarrhythmias 6.8%). At 20 years, freedom from any arrhythmia, tachyarrhythmia, and bradyarrhythmia was 82.5%, 86.9%, and 90.5%, respectively. On multivariable analysis, AP (HR 5.89, 95% CI 3.75\u20139.25; P &amp;lt; 0.001) and LT (HR 2.85, 95% CI 1.93\u20134.21; P &amp;lt; 0.001) were associated with a higher risk of arrhythmia compared with ECC. Older age at Fontan surgery also independently increased arrhythmia risk (HR 1.06, 95% CI 1.03\u20131.10; P &amp;lt; 0.001). Compared with ECC Fontan, LT Fontan and AP Fontan were associated with a progressively higher risk of both tachyarrhythmias (HR 2.99 and 8.20, respectively) and bradyarrhythmias (HR 2.63 and 5.47, respectively; all P &amp;lt; 0.001). The all-cause mortality rate and Fontan failure rate were 9.3% (0.69 per 100 patient-years) and 20.0% (1.61 per 100 patient-years), respectively. Late-onset arrhythmias were associated with an increased risk of mortality and Fontan failure (P = 0.003 and P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag123","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:47:11Z","timestamp":1779882431000},"source":"Crossref","is-referenced-by-count":0,"title":["Late arrhythmias following Fontan completion: insights from a Korean Multicentre Fontan Registry of over 1000 extracardiac conduit surgeries"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6104-5259","authenticated-orcid":false,"given":"Ja-Kyoung","family":"Yoon","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6286-3157","authenticated-orcid":false,"given":"Kyung-Jin","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Gachon University Gil Medical Center , Incheon ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9671-6019","authenticated-orcid":false,"given":"Soo-Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Sejong General Hospital , Bucheon ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8401-7971","authenticated-orcid":false,"given":"Chang-Ha","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital , Bucheon ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4264-0826","authenticated-orcid":false,"given":"I Seok","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9660-5949","authenticated-orcid":false,"given":"Jinyoung","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4523-9632","authenticated-orcid":false,"given":"June","family":"Huh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3071-2661","authenticated-orcid":false,"given":"Sang-Yun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children\u2032s Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0529-869X","authenticated-orcid":false,"given":"Mi Kyoung","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children\u2032s Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8146-2762","authenticated-orcid":false,"given":"Seung Min","family":"Baek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children\u2032s Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0083-8730","authenticated-orcid":false,"given":"Jae-Suk","family":"Baek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7470-9774","authenticated-orcid":false,"given":"Seul Gi","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8718-8904","authenticated-orcid":false,"given":"Chun Soo","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0618-4686","authenticated-orcid":false,"given":"Eun Seok","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5834-0900","authenticated-orcid":false,"given":"Hoon","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pusan National University Children\u2019s Hospital, Pusan National University School of Medicine , Yangsan ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1337-563X","authenticated-orcid":false,"given":"Se Yong","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5089-6093","authenticated-orcid":false,"given":"Joowon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University Bundang Hospital , Sungnam ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3347-0626","authenticated-orcid":false,"given":"Jae Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1631-574X","authenticated-orcid":false,"given":"Yeo Hyang","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kyungpook National University School of Medicine , Daegu ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0975-9577","authenticated-orcid":false,"given":"Young-Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Dong-A University Hospital , Pusan ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2134-151X","authenticated-orcid":false,"given":"Eun-Jung","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children\u2032s Hospital , Seoul ,","place":["Republic of 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