TY - EJOU
AU - Dahlqvist, Jenny Alenius
AU - Sunnegårdh, Jan
AU - Hanséus, Katarina
AU - Larsson, Eva Strömvall
AU - Nygren, Anders
AU - Dalén, Magnus
AU - Berggren, Håkan
AU - Ramgren, Jens Johansson
AU - Wiklund, Urban
AU - Rydberg, Annika
TI - Pacemaker treatment after Fontan surgery—A Swedish national study
T2 - Congenital Heart Disease
PY - 2019
VL - 14
IS - 4
SN - 1747-0803
AB - Objective: Fontan surgery is performed in children with univentricular heart defects.
Previous data regarding permanent pacemaker implantation frequency and indica‐
tions 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 preva‐
lence 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 atre‐
sia (MA; 44%), double outlet right ventricle (DORV; 24%) and double inlet left ventri‐
cle (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.
KW - congenital heart disease
KW - Fontan circulation
KW - pacemaker
KW - sinus node dysfunction
DO - 10.1111/chd.12766