Pacemaker treatment after Fontan surgery-A Swedish national study

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.