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Dual chamber epicardial pacing for the failing atriopulmonary Fontan patient

Ali Dodge-Khatami1, Mariette Rahn, René Prêtre

  • 1Division of Cardiovascular Surgery, University Children's Hospital Zürich, Zürich, Switzerland. ali.dodge-khatami@kispi.unizh.ch

The Annals of Thoracic Surgery
|September 27, 2005
PubMed

Insights

Dual chamber pacing offers a temporary solution for Fontan circulation patients experiencing arrhythmias or heart failure, improving hemodynamics and symptoms while delaying necessary conversion surgery.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Electrophysiology
  • Congenital Heart Disease Surgery

Background:

  • Atriopulmonary Fontan circulation is associated with complications like arrhythmias, heart failure, and protein-losing enteropathy.
  • These complications often necessitate conversion surgery, but patients may hesitate due to fear.

Purpose of the Study:

  • To evaluate dual chamber pacing as a temporizing measure in patients with atriopulmonary Fontan connection and sinus node dysfunction.
  • To assess the safety and efficacy of epicardial pacemaker systems in this patient population.

Main Methods:

  • Nine pediatric patients (6-18 years) with atriopulmonary Fontan connection and sinus node dysfunction received dual chamber epicardial pacemakers.
  • Indications included refractory arrhythmias, protein-losing enteropathy, heart failure, and exercise intolerance.
  • Data were compared pre- and post-pacemaker implantation.

Main Results:

  • No mortality or morbidity was observed.
  • Lead survival was 100% at a mean follow-up of 3.3 years, with stable or improved pacing characteristics.
  • Arrhythmias resolved in all patients, and medication was discontinued in three.
  • Protein-losing enteropathy, exercise intolerance, and heart failure symptoms showed improvement.

Conclusions:

  • Dual chamber pacing effectively improves single ventricle hemodynamics and manages decompensated Fontan patients.
  • It serves as a valuable time-buying strategy for patients delaying conversion surgery.
  • Left lateral thoracotomy is a safe and reliable approach for durable epicardial pacing in complex cases.
Abstract

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