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Pacemaker treatment after Fontan surgery-A Swedish national study

Artikel i vetenskaplig tidskrift
Författare J. A. Dahlqvist
Jan Sunnegårdh
K. Hanseus
Eva Strömvall-Larsson
Anders Nygren
M. Dalen
H. Berggren
J. J. Ramgren
U. Wiklund
A. Rydberg
Publicerad i Congenital Heart Disease
Volym 14
Nummer/häfte 4
Sidor 582-589
ISSN 1747-079X
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper
Sidor 582-589
Språk en
Länkar dx.doi.org/10.1111/chd.12766
Ämnesord congenital heart disease, Fontan circulation, pacemaker, sinus node dysfunction, extracardiac conduit, lateral tunnel, arrhythmias, prevalence, multicenter, Cardiovascular System & Cardiology
Ämneskategorier Kardiovaskulär medicin

Sammanfattning

ObjectiveFontan 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. MethodsWe retrospectively reviewed all Swedish patients who underwent Fontan surgery from 1982 to 2017 (n=599). ResultsAfter a mean follow-up of 12.2years, 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). ConclusionsThirteen 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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