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Influence of Heart Rate on Hemodynamics in Fontan Circulation

Aya Miyazaki1,2,3, Yoshifumi Fujimoto4, Yasumi Nakashima5,6

  • 1Department of Adult Congenital Heart Disease, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-Ku, Hamamatsu, 430-8558, Japan. ayamiya@pc4.so-net.ne.jp.

Pediatric Cardiology
|September 18, 2025
PubMed

Insights

Standard heart rates (HR) in adults with Fontan circulation are established. Higher HR during activity correlates with better hemodynamics, suggesting HR management is crucial for Fontan patients.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The standard heart rate (HR) and its impact on Fontan circulation are not well-defined.
  • Fontan circulation requires careful hemodynamic management, with HR being a key factor.

Purpose of the Study:

  • To determine standard heart rate values in adults with Fontan circulation.
  • To investigate the relationship between heart rate and hemodynamic parameters in Fontan patients.
  • To compare heart rate profiles between patients with and without pacemakers (PM).

Main Methods:

  • Evaluated HR and hemodynamic parameters in 59 adults with Fontan circulation without a pacemaker.
  • Compared findings with 15 patients with a pacemaker.
  • Measured HR during various activities including sleep, rest, daily activity, and exercise (CPX).

Main Results:

  • Established standard HR values for adults with Fontan circulation: ~50 bpm (sleep), ~75 bpm (supine), ~80 bpm (Holter mean), ~85 bpm (sitting), ~140 bpm (max daily activity), ~165 bpm (exercise).
  • Higher HR during exercise and greater HR variability (ΔHR) between exercise and sleep were linked to favorable hemodynamics.
  • Pacemaker group showed higher sleep HR and lower HR during activities above sitting compared to the non-pacemaker group.

Conclusions:

  • Elevated heart rate during physical activity may support optimal Fontan circulation.
  • Pacemaker implantation in Fontan patients should consider settings for increased activity HR, narrow QRS duration, and atrioventricular synchrony.

Keywords:
Cardiopulmonary exerciseFontanHeart rateHolter monitoringPacemakerSinus node dysfunction

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