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Pacemaker treatment after Fontan surgery—A Swedish national study

Alenius Dahlqvist, Jenny ; Sunnegårdh, Jan ; Hanséus, Katarina LU ; Strömvall Larsson, Eva ; Nygren, Anders ; Dalén, Magnus ; Berggren, Håkan ; Johansson Ramgren, Jens LU ; Wiklund, Urban and Rydberg, Annika (2019) In Congenital Heart Disease 14(4). p.582-589
Abstract

Objective: Fontan surgery is performed in children with univentricular heart defects. Previous data regarding permanent pacemaker implantation frequency and indications in Fontan patients are limited and conflicting. We examined the prevalence of and risk factors for pacemaker treatment in a consecutive national cohort of patients after Fontan surgery in Sweden. Methods: We retrospectively reviewed all Swedish patients who underwent Fontan surgery from 1982 to 2017 (n = 599). Results: After a mean follow-up of 12.2 years, 13% (78/599) of the patients with Fontan circulation had received pacemakers. Patients operated with the extracardiac conduit (EC) type of total cavopulmonary connection had a significantly lower prevalence of... (More)

Objective: Fontan surgery is performed in children with univentricular heart defects. Previous data regarding permanent pacemaker implantation frequency and indications in Fontan patients are limited and conflicting. We examined the prevalence of and risk factors for pacemaker treatment in a consecutive national cohort of patients after Fontan surgery in Sweden. Methods: We retrospectively reviewed all Swedish patients who underwent Fontan surgery from 1982 to 2017 (n = 599). Results: After a mean follow-up of 12.2 years, 13% (78/599) of the patients with Fontan circulation had received pacemakers. Patients operated with the extracardiac conduit (EC) type of total cavopulmonary connection had a significantly lower prevalence of pacemaker implantation (6%) than patients with lateral tunnel (LT; 17%). Mortality did not differ between patients with (8%) and without pacemaker (5%). The most common pacemaker indication was sinus node dysfunction (SND) (64%). Pacemaker implantation due to SND was less common among patients with EC. Pacemaker implantation was significantly more common in patients with mitral atresia (MA; 44%), double outlet right ventricle (DORV; 24%) and double inlet left ventricle (DILV; 20%). In contrast, patients with pulmonary atresia with intact ventricular septum and hypoplastic left heart syndrome were significantly less likely to receive a pacemaker (3% and 6%, respectively). Conclusions: Thirteen percent of Fontan patients received a permanent pacemaker, most frequently due to SND. EC was associated with a significantly lower prevalence of pacemaker than LT. Permanent pacemaker was more common in patients with MA, DORV, and DILV.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
congenital heart disease, Fontan circulation, pacemaker, sinus node dysfunction
in
Congenital Heart Disease
volume
14
issue
4
pages
8 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:85071021376
  • pmid:30883035
ISSN
1747-079X
DOI
10.1111/chd.12766
language
English
LU publication?
yes
id
c1c186ea-ca9c-425e-b231-8985a81abf66
date added to LUP
2019-09-09 11:03:45
date last changed
2020-01-26 05:41:49
@article{c1c186ea-ca9c-425e-b231-8985a81abf66,
  abstract     = {<p>Objective: Fontan surgery is performed in children with univentricular heart defects. Previous data regarding permanent pacemaker implantation frequency and indications in Fontan patients are limited and conflicting. We examined the prevalence of and risk factors for pacemaker treatment in a consecutive national cohort of patients after Fontan surgery in Sweden. Methods: We retrospectively reviewed all Swedish patients who underwent Fontan surgery from 1982 to 2017 (n = 599). Results: After a mean follow-up of 12.2 years, 13% (78/599) of the patients with Fontan circulation had received pacemakers. Patients operated with the extracardiac conduit (EC) type of total cavopulmonary connection had a significantly lower prevalence of pacemaker implantation (6%) than patients with lateral tunnel (LT; 17%). Mortality did not differ between patients with (8%) and without pacemaker (5%). The most common pacemaker indication was sinus node dysfunction (SND) (64%). Pacemaker implantation due to SND was less common among patients with EC. Pacemaker implantation was significantly more common in patients with mitral atresia (MA; 44%), double outlet right ventricle (DORV; 24%) and double inlet left ventricle (DILV; 20%). In contrast, patients with pulmonary atresia with intact ventricular septum and hypoplastic left heart syndrome were significantly less likely to receive a pacemaker (3% and 6%, respectively). Conclusions: Thirteen percent of Fontan patients received a permanent pacemaker, most frequently due to SND. EC was associated with a significantly lower prevalence of pacemaker than LT. Permanent pacemaker was more common in patients with MA, DORV, and DILV.</p>},
  author       = {Alenius Dahlqvist, Jenny and Sunnegårdh, Jan and Hanséus, Katarina and Strömvall Larsson, Eva and Nygren, Anders and Dalén, Magnus and Berggren, Håkan and Johansson Ramgren, Jens and Wiklund, Urban and Rydberg, Annika},
  issn         = {1747-079X},
  language     = {eng},
  number       = {4},
  pages        = {582--589},
  publisher    = {Wiley-Blackwell},
  series       = {Congenital Heart Disease},
  title        = {Pacemaker treatment after Fontan surgery—A Swedish national study},
  url          = {http://dx.doi.org/10.1111/chd.12766},
  doi          = {10.1111/chd.12766},
  volume       = {14},
  year         = {2019},
}