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Pacemaker treatment after Fontan surgery-A Swedish national study.

Jenny Alenius Dahlqvist1, Jan Sunnegårdh2, Katarina Hanséus3

  • 1Department of Clinical Sciences, Umeå University, Umeå, Sweden.

Congenital Heart Disease
|March 19, 2019
PubMed
Summary

Thirteen percent of patients undergoing Fontan surgery required a permanent pacemaker, most often due to sinus node dysfunction. The extracardiac conduit technique was linked to fewer pacemaker implantations compared to the lateral tunnel method.

Keywords:
Fontan circulationcongenital heart diseasepacemakersinus node dysfunction

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Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Cardiac Surgery

Background:

  • Fontan surgery is a palliative procedure for complex univentricular heart defects.
  • Data on permanent pacemaker (PPM) implantation rates and indications in Fontan patients are limited.
  • Understanding risk factors for PPM is crucial for long-term Fontan patient management.

Purpose of the Study:

  • To determine the prevalence of PPM implantation in a national cohort of Fontan patients.
  • To identify risk factors associated with PPM implantation after Fontan surgery.
  • To compare PPM rates between different surgical techniques.

Main Methods:

  • Retrospective review of 599 Swedish patients who underwent Fontan surgery between 1982 and 2017.
  • Analysis of PPM implantation rates, indications, and associated patient characteristics.
  • Comparison of outcomes based on surgical technique (extracardiac conduit vs. lateral tunnel).

Main Results:

  • 13% of Fontan patients received a PPM after a median follow-up of 12.2 years.
  • Sinus node dysfunction (SND) was the most common indication for PPM (64%).
  • Extracardiac conduit (EC) technique had lower PPM rates (6%) compared to lateral tunnel (LT) (17%).
  • PPM was more frequent in patients with mitral atresia (44%), double outlet right ventricle (24%), and double inlet left ventricle (20%).

Conclusions:

  • PPM implantation is a significant concern in Fontan patients, with 13% requiring pacing.
  • SND is the primary indication for PPM, particularly in patients with specific complex heart defects.
  • The EC technique appears to reduce the need for PPM compared to the LT technique.