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Updated: Jan 6, 2026
Wireless Telemetry Device Implantation in a Fontan Ovine Model for Continuous and Long-Term Hemodynamic Monitoring
Published on: May 2, 2025
Permanent pacing post-Fontan is not associated with reduced long-term survival
Sally J Hall1, Damien Cullington1, John D R Thomson1
1Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK.
Insights
Pacemaker implantation after the Fontan procedure does not impact long-term survival, despite increased early complications and interventions. This finding challenges the view of pacemakers as a negative prognostic indicator in Fontan patients.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- The Fontan procedure is a critical palliative surgery for single-ventricle circulation.
- Rhythm disturbances requiring pacemakers are common post-Fontan, historically viewed as a negative prognostic sign.
Purpose of the Study:
- To investigate the long-term impact of pacemaker requirement on survival and complications after the Fontan procedure.
- To re-evaluate the prognostic significance of permanent pacemaker implantation in Fontan patients.
Main Methods:
- A retrospective case-control study of 167 Fontan patients at a single center (1990-2015).
- Compared outcomes (survival, complications, interventions, oxygen saturation) between patients with and without pacemakers.
- Excluded patients with pre-procedure pacemakers.
Main Results:
- No significant difference in 30-day or 1-year survival between pacemaker and sinus rhythm groups.
- Pacemaker group had higher incidence of early cerebral/renal complications (acute kidney injury).
- No difference in long-term complications (protein-losing enteropathy) or follow-up oxygen saturation; however, paced patients required more interventions, including cardiopulmonary bypass.
Conclusions:
- Pacemaker requirement after Fontan procedure is not associated with reduced long-term survival.
- While early complications and need for re-intervention increase, pacemakers do not appear to be a negative prognostic indicator for Fontan survival.
Background:
The Fontan procedure is the final stage of surgical palliation for a single-ventricle circulation. Significant complications are common including rhythm disturbance necessitating implantation of a permanent pacemaker. This has been widely considered a negative prognostic indicator.
Methods:
This single-centre, retrospective case control study involved all patients who underwent the Fontan procedure at the Leeds Congenital Heart Unit between 1990 and 2015 and have had regular follow-up in Yorkshire and Humber, United Kingdom. 167 Fontan patients were identified of which 2 were excluded for having a pre-procedure pacemaker. Of the remainder, 23 patients required a pacemaker. Outcomes were survival, early and late complications, need for further intervention and oxygen saturation in long-term follow-up.
Results:
There was no difference in survival (30-day survival pacemaker 92.6%, sinus rhythm 90.5%, p = 0.66, 1-year pacemaker 11.1%, sinus rhythm 10.1%, p = 1). The pacemaker group was more likely to have cerebral or renal complications in the first-year post-procedure (acute kidney injury: sinus rhythm 0.8%, pacemaker 19.1%, p = 0.002). No difference was observed in longer term complications including protein losing enteropathy (sinus rhythm 3.5%, pacemaker 0% p = 1). There was no difference in saturations between the two groups at follow-up. Paced patients were more likely to have required further intervention, with a higher incidence of cardiopulmonary bypass procedures (sinus rhythm 6.3%, pacemaker 35%, p < 0.001).
Conclusions:
Despite an increase in early complications and the need for further interventions, pacemaker requirement does not appear to affect long-term survival following the Fontan procedure.
