Open Access

ARTICLE

Pacemaker treatment after Fontan surgery—A Swedish national study

Jenny Alenius Dahlqvist¹, Jan Sunnegårdh², Katarina Hanséus³, Eva Strömvall Larsson², Anders Nygren², Magnus Dalén^4,5, Håkan Berggren⁶, Jens Johansson Ramgren⁷, Urban Wiklund⁸, Annika Rydberg¹

1 Department of Clinical Sciences, Umeå University, Umeå, Sweden
2 Department of Cardiology, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
3 Department of Clinical Sciences Lund, Children’s Heart Center, Skåne University Hospital, Lund University, Lund, Sweden
4 Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
5 Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
6 Department of Pediatric Cardiac Surgery, Children’s Heart Center, The Queen Silvia Children’s Hospital, Gothenburg, Sweden
7 Department of Pediatric Cardiac Surgery, Children’s Heart Center, Skånes University Hospital, Lund, Sweden
8 Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden

* Corresponding Author: Jenny Alenius Dahlqvist, Department of Clinical Sciences, Umeå University, 901 85 Umeå, Sweden. Email:

Congenital Heart Disease 2019, 14(4), 582-589. https://doi.org/10.1111/chd.12766

Abstract

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.

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