JACC: Clinical Electrophysiology
Dual-Site Ventricular Pacing in Patients With Fontan Physiology and Heart BlockDoes It Mitigate the Detrimental Effects of Single-Site Ventricular Pacing?
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Author + information
- Edward T. O’Leary, MDa,
- Kimberlee Gauvreau, ScDa,
- Mark E. Alexander, MDa,
- Puja Banka, MDa,
- Vassilios J. Bezzerides, MDa,
- Francis Fynn-Thompson, MDb,
- John K. Triedman, MDa,
- Edward P. Walsh, MDa and
- Douglas Y. Mah, MDa,∗ (douglas.mah{at}cardio.chboston.org)
- aDepartment of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- bDepartment of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Douglas Y. Mah, Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115.
Graphical abstract
Abstract
Objectives The study sought to determine the long-term effect of dual-site ventricular pacing (i.e., cardiac resynchronization therapy [CRT]) versus single-site pacing in patients with Fontan physiology and high-grade atrioventricular block (AVB).
Background Chronic single-site ventricular pacing in Fontan patients is associated with significant morbidity and mortality.
Methods The study conducted a retrospective review of all Fontan patients with high-grade AVB who received pacemakers at a single institution between 1990 and 2016 with follow-up of 12 months or greater. The primary study outcome was a composite of death or heart transplantation.
Results Nineteen patients received CRT devices and 43 patients received single-site ventricular pacemakers (SVPMs), with a median follow-up of 4.9 years (range 1.1 to 11.3 years) and 10.4 years (range 1.1 to 26.8), respectively. One (5.3%) CRT patient and 11 (25.6%) SVPM patients reached the composite endpoint of death or transplant (odds ratio: 0.16; 95% confidence interval: 0.02 to 1.36; p = 0.09). Kaplan-Meier analysis showed similar rates of freedom from death or transplant between the 2 study groups over a 5-year follow-up period (p = 0.08). The proportion of SVPM patients with abnormal ventricular systolic function before device implantation (9.3%) and at follow-up (32.5%) significantly increased (p = 0.015). The CRT cohort had less change in their ventricular function (42.1% before device implant, 36.8% at follow-up; p = 1.0); however, a Kaplan-Meier analysis over a 5-year follow-up period found no difference in the presence of abnormal ventricular systolic function between groups (p = 0.27).
Conclusions There was no significant difference in long-term outcomes between Fontan patients who were single- or dual-site paced for high-grade AVB.
Footnotes
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received January 4, 2018.
- Revision received June 25, 2018.
- Accepted July 6, 2018.
- 2018 American College of Cardiology Foundation
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