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Related Experiment Videos

DDD pacemaker implantation after Fontan-type operations.

Markus K Heinemann1, Matthias Gass, Johannes Breuer

  • 1Departments of Thoracic, Cardiac, and Vascular Surgery, University Hospital, Tübingen, Langenbeckstr. 1, # 505, 55131 Mainz, Germany. heinemann@unimainz.de

Pacing and Clinical Electrophysiology : PACE
|April 12, 2003
PubMed
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Bradyarrhythmias after Fontan operations can cause serious issues. Implanting DDD pacemakers (PM) effectively treats these, improving patient outcomes and avoiding repeat surgeries when placed during the initial Fontan procedure.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Electrophysiology
  • Congenital Heart Disease Surgery

Background:

  • Bradyarrhythmias significantly impair univentricular heart function post-Fontan-type operations, leading to symptoms like fatigue, ascites, and protein-losing enteropathy (PLE).
  • Transvenous pacemaker implantation is often challenging, leading to reluctance in pacing for these patients.

Purpose of the Study:

  • To evaluate the efficacy and safety of dual-chamber (DDD) pacemaker implantation in patients with Fontan-type operations.
  • To assess the long-term function of pacemakers and clinical outcomes, including the avoidance of repeat sternotomy.

Main Methods:

  • A cohort of 24 patients (mean age 9.5 years) with Fontan-type operations received DDD pacing systems with epicardial atrial and ventricular electrodes between 1997-2000.

Related Experiment Videos

  • Pacemaker implantation timing varied: during conversion, total cavopulmonary connection, or later.
  • Follow-up averaged 3.5 years.

    • Main Results:

    • The DDD pacing systems functioned well in 23 of 24 patients.
    • Repeat sternotomy was required in 10 patients with a mean hospital stay of 5 days; however, 3 avoided repeat sternotomy by concurrent atrial electrode placement.
    • All patients showed clinical improvement, with 4 experiencing resolution of protein-losing enteropathy.

    Conclusions:

    • Bradyarrhythmias pose significant morbidity after Fontan-type operations, warranting liberal indications for DDD pacemaker implantation.
    • Electrophysiological evaluation during follow-up is recommended.
    • Concurrent atrial electrode placement during the Fontan operation, particularly with right ventricular anatomy, effectively avoids repeat sternotomy.