Surgical Maze Procedures for Atrial Arrhythmias in Univentricular Hearts, from Maze History to Conversion–Fontan

In general, symptoms of atrial fibrillation are an indication for intervention, the most important being the elevated risk for thrombo-embolism. While pharmaco-medical treatment for atrial fibrillation is aimed at either rate or rhythm control (van Gelder et al., 2002), invasive treatment for atrial fibrillation is aimed at rhythm control. An invasive approach may consist of percutaneous catheter techniques, various surgical approaches or hybrid approaches. With regard to the Fontan circulation, the lateral tunnel has been introduced as primary surgical technique to reduce later atrial enlargement and Fontan constructions with an atrio-pulmonary or atrio-ventricular connection are changed into a Fontan with a lateral tunnel or with an extra-cardiac conduit (Fontan & Baudet, 1971; de Leval et al., 1998; Mavroudis et al., 1998). This chapter concentrates on surgical maze procedures for atrial fibrillation occurring late after Fontan surgery.