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Transvenous Versus Epicardial Pacing in Fontan Patients.

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In Fontan patients, both epicardial and transvenous pacemakers show comparable efficacy. Transvenous systems may offer trends toward longer lead longevity, with similar safety profiles for these complex cardiac patients.

Keywords:
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Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Cardiac Electrophysiology

Background:

  • Up to 10% of patients with a Fontan circulation require pacemaker implantation.
  • Historically, epicardial pacing has been the preferred method.
  • Transvenous pacing presents potential risks including Fontan pathway obstruction and thromboembolism, with limited data on its safety and efficacy.

Purpose of the Study:

  • To compare the safety and efficacy of epicardial versus transvenous pacemaker systems in Fontan patients.
  • To evaluate device performance, including lead and generator longevity.
  • To assess the rate of adverse events and need for system revision.

Main Methods:

  • Retrospective review of Fontan pacemaker patients (1985-2017) at a single institution.
  • Comparison of lead sensing, longevity, and generator longevity between epicardial and transvenous systems.
  • Analysis of complication rates, antithrombotic therapy, and system revisions.

Main Results:

  • Twenty-six patients had epicardial systems, five had transvenous systems.
  • No significant difference in average atrial lead sensing between groups (p=0.52).
  • Trends toward longer lead longevity (atrial p=0.56, ventricular p=0.3) and generator longevity (p=0.16) in transvenous systems.
  • One major complication in transvenous, two minor in epicardial; no thromboembolic events.
  • System revision rates were 13/26 for epicardial and 5/5 for transvenous patients.

Conclusions:

  • Transvenous pacemakers can be safely and effectively utilized in Fontan patients.
  • Transvenous systems demonstrate comparable efficacy to epicardial systems.
  • A trend towards improved lead longevity suggests potential benefits of the transvenous approach in this population.