Outcomes of cardiac pacing in adult patients after a Fontan operation

Alexander Egbe, Geoffery D. Huntley, Heidi M. Connolly, Naser M. Ammash, Abhishek J. Deshmukh, Arooj R. Khan, Sameh M. Said, Emmanuel Akintoye, Carole A. Warnes, Suraj Kapa

Research output: Contribution to journalArticle

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Abstract

Background Cardiac pacing can be challenging after a Fontan operation, and limited data exist regarding pacing in adult Fontan patients. The objectives of our study were to determine risk factors for pacing and occurrence of device-related complications (DRCs) and pacemaker reinterventions. Methods We performed a retrospective review of Fontan patients from 1994 through 2014. We defined DRCs as lead failure, lead recall, cardiac perforation, lead thrombus/vegetation, or device-related infection, and cardiovascular adverse events (CAEs) as venous thrombosis, stroke, death, or heart transplant. Pacemaker reintervention was defined as lead failure or recall. Results Of 439 patients, 166 (38%) had pacemakers implanted (79 during childhood; 87, adulthood); 114 patients (69%) received epicardial leads initially, and 52 (31%), endocardial leads. Pacing was initially atrial in 52 patients (31%); ventricular, 30 (18%); or dual chamber, 84 (51%). There were 37 reinterventions (1.9% per year) and 48 DRCs (2.4% per year). Pacemaker implantation during childhood was a risk factor for DRCs (hazard ratio, 2.01 [CI, 1.22-5.63]; P =.03). There were 70 CAEs (venous thrombosis, 5; stroke, 11; transplant, 8; and death, 46), yielding a rate of 3.5% per year. DRCs, CAEs, and reintervention rates were comparable for patients with epicardial or endocardial leads. Conclusions More than one-third of adult Fontan patients referred to Mayo Clinic had pacemaker implantation. Epicardial leads were associated with high rate of pacemaker reinterventions but similar DRC rates in comparison to endocardial leads.

Original languageEnglish (US)
Pages (from-to)92-98
Number of pages7
JournalAmerican Heart Journal
Volume194
DOIs
StatePublished - Dec 1 2017

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Fontan Procedure
Equipment and Supplies
Venous Thrombosis
Cardiovascular Infections
Stroke
Transplants
Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Egbe, A., Huntley, G. D., Connolly, H. M., Ammash, N. M., Deshmukh, A. J., Khan, A. R., ... Kapa, S. (2017). Outcomes of cardiac pacing in adult patients after a Fontan operation. American Heart Journal, 194, 92-98. https://doi.org/10.1016/j.ahj.2017.08.019

Outcomes of cardiac pacing in adult patients after a Fontan operation. / Egbe, Alexander; Huntley, Geoffery D.; Connolly, Heidi M.; Ammash, Naser M.; Deshmukh, Abhishek J.; Khan, Arooj R.; Said, Sameh M.; Akintoye, Emmanuel; Warnes, Carole A.; Kapa, Suraj.

In: American Heart Journal, Vol. 194, 01.12.2017, p. 92-98.

Research output: Contribution to journalArticle

Egbe, A, Huntley, GD, Connolly, HM, Ammash, NM, Deshmukh, AJ, Khan, AR, Said, SM, Akintoye, E, Warnes, CA & Kapa, S 2017, 'Outcomes of cardiac pacing in adult patients after a Fontan operation', American Heart Journal, vol. 194, pp. 92-98. https://doi.org/10.1016/j.ahj.2017.08.019
Egbe A, Huntley GD, Connolly HM, Ammash NM, Deshmukh AJ, Khan AR et al. Outcomes of cardiac pacing in adult patients after a Fontan operation. American Heart Journal. 2017 Dec 1;194:92-98. https://doi.org/10.1016/j.ahj.2017.08.019
Egbe, Alexander ; Huntley, Geoffery D. ; Connolly, Heidi M. ; Ammash, Naser M. ; Deshmukh, Abhishek J. ; Khan, Arooj R. ; Said, Sameh M. ; Akintoye, Emmanuel ; Warnes, Carole A. ; Kapa, Suraj. / Outcomes of cardiac pacing in adult patients after a Fontan operation. In: American Heart Journal. 2017 ; Vol. 194. pp. 92-98.
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abstract = "Background Cardiac pacing can be challenging after a Fontan operation, and limited data exist regarding pacing in adult Fontan patients. The objectives of our study were to determine risk factors for pacing and occurrence of device-related complications (DRCs) and pacemaker reinterventions. Methods We performed a retrospective review of Fontan patients from 1994 through 2014. We defined DRCs as lead failure, lead recall, cardiac perforation, lead thrombus/vegetation, or device-related infection, and cardiovascular adverse events (CAEs) as venous thrombosis, stroke, death, or heart transplant. Pacemaker reintervention was defined as lead failure or recall. Results Of 439 patients, 166 (38{\%}) had pacemakers implanted (79 during childhood; 87, adulthood); 114 patients (69{\%}) received epicardial leads initially, and 52 (31{\%}), endocardial leads. Pacing was initially atrial in 52 patients (31{\%}); ventricular, 30 (18{\%}); or dual chamber, 84 (51{\%}). There were 37 reinterventions (1.9{\%} per year) and 48 DRCs (2.4{\%} per year). Pacemaker implantation during childhood was a risk factor for DRCs (hazard ratio, 2.01 [CI, 1.22-5.63]; P =.03). There were 70 CAEs (venous thrombosis, 5; stroke, 11; transplant, 8; and death, 46), yielding a rate of 3.5{\%} per year. DRCs, CAEs, and reintervention rates were comparable for patients with epicardial or endocardial leads. Conclusions More than one-third of adult Fontan patients referred to Mayo Clinic had pacemaker implantation. Epicardial leads were associated with high rate of pacemaker reinterventions but similar DRC rates in comparison to endocardial leads.",
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AU - Egbe, Alexander

AU - Huntley, Geoffery D.

AU - Connolly, Heidi M.

AU - Ammash, Naser M.

AU - Deshmukh, Abhishek J.

AU - Khan, Arooj R.

AU - Said, Sameh M.

AU - Akintoye, Emmanuel

AU - Warnes, Carole A.

AU - Kapa, Suraj

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N2 - Background Cardiac pacing can be challenging after a Fontan operation, and limited data exist regarding pacing in adult Fontan patients. The objectives of our study were to determine risk factors for pacing and occurrence of device-related complications (DRCs) and pacemaker reinterventions. Methods We performed a retrospective review of Fontan patients from 1994 through 2014. We defined DRCs as lead failure, lead recall, cardiac perforation, lead thrombus/vegetation, or device-related infection, and cardiovascular adverse events (CAEs) as venous thrombosis, stroke, death, or heart transplant. Pacemaker reintervention was defined as lead failure or recall. Results Of 439 patients, 166 (38%) had pacemakers implanted (79 during childhood; 87, adulthood); 114 patients (69%) received epicardial leads initially, and 52 (31%), endocardial leads. Pacing was initially atrial in 52 patients (31%); ventricular, 30 (18%); or dual chamber, 84 (51%). There were 37 reinterventions (1.9% per year) and 48 DRCs (2.4% per year). Pacemaker implantation during childhood was a risk factor for DRCs (hazard ratio, 2.01 [CI, 1.22-5.63]; P =.03). There were 70 CAEs (venous thrombosis, 5; stroke, 11; transplant, 8; and death, 46), yielding a rate of 3.5% per year. DRCs, CAEs, and reintervention rates were comparable for patients with epicardial or endocardial leads. Conclusions More than one-third of adult Fontan patients referred to Mayo Clinic had pacemaker implantation. Epicardial leads were associated with high rate of pacemaker reinterventions but similar DRC rates in comparison to endocardial leads.

AB - Background Cardiac pacing can be challenging after a Fontan operation, and limited data exist regarding pacing in adult Fontan patients. The objectives of our study were to determine risk factors for pacing and occurrence of device-related complications (DRCs) and pacemaker reinterventions. Methods We performed a retrospective review of Fontan patients from 1994 through 2014. We defined DRCs as lead failure, lead recall, cardiac perforation, lead thrombus/vegetation, or device-related infection, and cardiovascular adverse events (CAEs) as venous thrombosis, stroke, death, or heart transplant. Pacemaker reintervention was defined as lead failure or recall. Results Of 439 patients, 166 (38%) had pacemakers implanted (79 during childhood; 87, adulthood); 114 patients (69%) received epicardial leads initially, and 52 (31%), endocardial leads. Pacing was initially atrial in 52 patients (31%); ventricular, 30 (18%); or dual chamber, 84 (51%). There were 37 reinterventions (1.9% per year) and 48 DRCs (2.4% per year). Pacemaker implantation during childhood was a risk factor for DRCs (hazard ratio, 2.01 [CI, 1.22-5.63]; P =.03). There were 70 CAEs (venous thrombosis, 5; stroke, 11; transplant, 8; and death, 46), yielding a rate of 3.5% per year. DRCs, CAEs, and reintervention rates were comparable for patients with epicardial or endocardial leads. Conclusions More than one-third of adult Fontan patients referred to Mayo Clinic had pacemaker implantation. Epicardial leads were associated with high rate of pacemaker reinterventions but similar DRC rates in comparison to endocardial leads.

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