Permanent cardiac pacing after the Fontan procedure.

Area of Science:

• Cardiology
• Pediatric Cardiology
• Cardiac Electrophysiology

Background:

• The Fontan procedure creates complex cardiovascular anatomy, often necessitating permanent cardiac pacing postoperatively.
• Congenital heart defects and surgical interventions can lead to heart block or sick sinus syndrome, requiring pacing solutions.

Purpose of the Study:

• To evaluate the outcomes and current approach to permanent cardiac pacing in patients who have undergone a Fontan procedure.
• To identify challenges and effective strategies for pacemaker implantation in this complex patient group.

Main Methods:

• Retrospective review of 15 patients requiring permanent pacing after Fontan procedure at Mayo Clinic.
• Analysis of patient demographics, underlying cardiac defects, indications for pacing, pacemaker systems, lead types, and follow-up data.
• Description of the current institutional approach to pacing post-Fontan.

Main Results:

• Fifteen patients (mean age 16.5 years) required permanent pacing due to heart block or sick sinus syndrome.
• Epicardial ventricular leads were universally used; atrial leads were transvenous or epicardial.
• Three patients died from unrelated causes; survivors experienced minimal pacing complications, primarily loss of ventricular capture due to elevated thresholds.

Conclusions:

• Permanent pacing after Fontan procedure is feasible and can be managed effectively with specific strategies.
• Intraoperative placement of epicardial ventricular leads and use of programmable pulse generators with high output are crucial.
• A systematic approach involving temporary and permanent leads, tailored to individual needs, optimizes pacing outcomes in Fontan patients.