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Permanent pacing post-Fontan is not associated with reduced long-term survival

Published online by Cambridge University Press:  11 October 2019

Sally J. Hall Open the ORCID record for Sally J. Hall [Opens in a new window] ,
Damien Cullington ,
John D. R. Thomson  and
James R. Bentham
Sally J. Hall
Affiliation:
Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
Damien Cullington
Affiliation:
Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
John D. R. Thomson
Affiliation:
Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
James R. Bentham*
Affiliation:
Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
*
Author for correspondence: Dr J. Bentham, Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK. Tel: +44 (0) 1133928239; E-mail: Jamie.bentham@nhs.net
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Abstract

Background:

The Fontan procedure is the final stage of surgical palliation for a single-ventricle circulation. Significant complications are common including rhythm disturbance necessitating implantation of a permanent pacemaker. This has been widely considered a negative prognostic indicator.

Methods:

This single-centre, retrospective case control study involved all patients who underwent the Fontan procedure at the Leeds Congenital Heart Unit between 1990 and 2015 and have had regular follow-up in Yorkshire and Humber, United Kingdom. 167 Fontan patients were identified of which 2 were excluded for having a pre-procedure pacemaker. Of the remainder, 23 patients required a pacemaker. Outcomes were survival, early and late complications, need for further intervention and oxygen saturation in long-term follow-up.

Results:

There was no difference in survival (30-day survival pacemaker 92.6%, sinus rhythm 90.5%, p = 0.66, 1-year pacemaker 11.1%, sinus rhythm 10.1%, p = 1). The pacemaker group was more likely to have cerebral or renal complications in the first-year post-procedure (acute kidney injury: sinus rhythm 0.8%, pacemaker 19.1%, p = 0.002). No difference was observed in longer term complications including protein losing enteropathy (sinus rhythm 3.5%, pacemaker 0% p = 1). There was no difference in saturations between the two groups at follow-up. Paced patients were more likely to have required further intervention, with a higher incidence of cardiopulmonary bypass procedures (sinus rhythm 6.3%, pacemaker 35%, p < 0.001).

Conclusions:

Despite an increase in early complications and the need for further interventions, pacemaker requirement does not appear to affect long-term survival following the Fontan procedure.

Keywords

Congenital heart diseaseFontan procedurepacemaker
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1432 - 1434
Copyright
© Cambridge University Press 2019 

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