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