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Extremely short setting of optimal sensed atrioventricular interval in patients after Fontan procedure with implanted

Aya Miyazaki1,2, Shin-Ichiro Yoshimura1, Hayato Matsutani3

  • 1Congenial Heart Disease Center, Tenri Hospital, Tenri, Nara, Japan.

Cardiology in the Young
|September 12, 2019
PubMed

Insights

Optimizing atrioventricular intervals in dual-chamber pacemakers is crucial for patients with congenital heart disease (CHD) and Fontan circulation. Careful consideration of atrial rhythm origin and lead placement is essential for effective pacing.

Area of Science:

  • Cardiology
  • Biomedical Engineering

Background:

  • Atrioventricular (AV) interval optimization is critical in dual-chamber pacing, particularly for heart failure patients.
  • In congenital heart disease (CHD) with Fontan circulation, systemic atrial contraction significance is heightened compared to those without structural heart disease.

Observation:

  • Two patients post-Fontan procedure with dual-chamber pacemakers underwent evaluation for optimal sensed AV interval.
  • Echocardiography indicated extremely short optimal sensed AV intervals (25 and 30 ms).
  • Actual P wave and ventricular pacing intervals were significantly longer (180 and 140 ms).

Findings:

  • Discrepancies between sensed and actual AV intervals resulted from atrial epicardial lead placement opposite the native atrial rhythm origin.
  • Intra-atrial conduction delay further contributed to the observed time differences.

Implications:

  • Accurate AV interval setting in complex CHD requires integrating electrocardiogram (ECG) and X-ray findings.
  • Consideration of atrial rhythm origin, epicardial atrial lead site, and intra-atrial conduction delay is vital for optimal pacemaker function.
Abstract

Keywords:
CHDepicardial pacing lead: Fontan operationintra-atrial conduction delayoptimal atrioventricular intervalsensed atrioventricular interval

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