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Permanent pacing in Ebstein's anomaly

M R Allen1, D L Hayes, C A Warnes

  • 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.

Pacing and Clinical Electrophysiology : PACE
|May 1, 1997
PubMed
Summary
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Permanent pacemakers are needed for 3.7% of Ebstein's anomaly patients, primarily for conduction disease. Pacing in these patients, often with tricuspid valve issues, presents challenges and potential complications.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Congenital Heart Disease

Background:

  • Ebstein's anomaly presents unique anatomical challenges for permanent pacemaker implantation.
  • Tricuspid valve abnormalities and previous surgical interventions are common in these patients.

Purpose of the Study:

  • To review the experience with permanent pacing in patients diagnosed with Ebstein's anomaly.
  • To identify indications, methods, outcomes, and complications associated with permanent pacing in this specific patient population.

Main Methods:

  • Retrospective review of patients with Ebstein's anomaly who underwent permanent pacemaker implantation between 1976 and 1993.
  • Analysis of patient demographics, pacing indications, lead types (epicardial vs. transvenous), device programming (VVI vs. DDD), and associated surgical procedures.

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Main Results:

  • Permanent pacemakers were required in 3.7% of identified Ebstein's anomaly patients (15 out of 401).
  • Atrioventricular (AV) block was the primary indication for pacing (11 patients), followed by sinus node dysfunction (4 patients).
  • Ninety-three percent of patients had undergone tricuspid valve replacement, and 27% experienced complications requiring surgical intervention.

Conclusions:

  • Permanent pacing is necessary in a small but significant percentage of Ebstein's anomaly patients, mainly due to intrinsic conduction disease.
  • The presence of complex cardiac anatomy and frequent tricuspid valve disease makes permanent pacing challenging.
  • Experienced physicians are crucial for managing permanent pacemaker implantation and potential complications in patients with Ebstein's anomaly.