Endocardial Atrial Pacing Lead Implantation and Midterm Follow-Up in Young Patients with Sinus Node Dysfunction After the Fontan Procedure

Background: Atrial pacing is commonly used for sinus node dysfunction (SND) after Fontan surgery. The preferred route of lead implant has been debated. We compare procedural and clinical outcomes of transvenous (TV) and epicardial (Epi) atrial lead implants in this population. Methods: All Fontan patients having an atrial lead implant without other associated surgery between 1992 and 2007 were studied. Demographics, pacing lead performance data and procedural outcome were retrospectively analyzed. Results: 78 patients (22 TV and 56 Epi) had 90 leads implanted (25 TV/ 65 Epi). Mean follow-up was 3.3±4.1 yrs (TV) and 4.4±3.6 yrs (Epi). TV leads were implanted in older patients (mean age: 23.9 vs. 13.8 yrs, p<0.001), at longer interval after Fontan surgery (mean: 15.1 vs. 5.7 yrs, p<0.001). Indication for TV was more likely to be SND, while Epi pacing was indicated for AV block. Pacing modes were exclusively AAI/AAI-T in TV and mostly DDD in Epi leads. Acute complication occurred in 2/25 (8%) of TV (pneumothorax n=1, skin erosion n=1) and 12/65 (19%, p=0.23) of Epi implants (effusions n=5, heart failure n=1, retained foreign body n=1, pneumothorax n=1, hematoma n=1, disconnection n=1, sepsis n=1, blood loss n=1). Median hospital stay was shorter in TV (2.0 vs 4.5 days, p=0.03). All TV patients and 43 Epi (77%) were anticoagulated. At follow-up, pocket infection occurred in one Epi patient. No clinical thromboembolic event was observed in either group. 3 TV leads failed in 2 patients (9%), while 12 Epi leads failed in 10 patients (18%); however, mean duration of freedom from lead failure was not significantly different (TV 9.9 vs. Epi 8.0 yrs, P=ns). The mean energy threshold was lower at implant for TV leads (0.9 vs 2.2 μJ, P=0.049), but similar for both leads on follow-up (1.2 vs 2.6 μJ, P=0.35). Atrial sensing was unchanged over time for TV (2.2 to 2.0 mV, P=ns), but significantly decreased in Epi (3.4 to 2.4 mV, p=0.006). Conclusions: Transvenous atrial pacing leads may be placed in Fontan patients with lower procedural morbidity than epicardial leads, and equivalent expectation of lead performance and longevity. Although the thromboembolic event rate appears low in anticoagulated patients with both lead types, the present study design cannot fully address this important issue.

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A comparison of AAIR versus DDDR pacing for patients with sinus node dysfunction: a long-term follow-up study

CardioVascular Journal of Africa ◽

10.5830/cvja-2020-040 ◽

2021 ◽

Vol 32 (1) ◽

pp. 19-22

Author(s):

Reuben Kato Mutagaywa ◽

Basil Tumaini ◽

Ashley Chin

Keyword(s):

Sinus Node ◽

Sinus Node Dysfunction ◽

Follow Up Study ◽

Long Term Follow Up

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Sinus node dysfunction after heart transplantation-An analysis of risk factors and atrial pacing burden

Clinical Transplantation ◽

10.1111/ctr.13202 ◽

2018 ◽

Vol 32 (3) ◽

pp. e13202 ◽

Cited By ~ 3

Author(s):

Florian E. M. Herrmann ◽

Petra Wellmann ◽

Sebastian Sadoni ◽

René Schramm ◽

Christian Hagl ◽

...

Keyword(s):

Risk Factors ◽

Heart Transplantation ◽

Sinus Node ◽

Sinus Node Dysfunction ◽

Atrial Pacing

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Prevalence and predictors of atrial arrhythmias in patients with sinus node dysfunction and atrial pacing

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-018-0463-7 ◽

2018 ◽

Vol 53 (3) ◽

pp. 365-371 ◽

Cited By ~ 3

Author(s):

Abdallah Bukari ◽

Eisha Wali ◽

Amrish Deshmukh ◽

Zaid Aziz ◽

Michael Broman ◽

...

Keyword(s):

Sinus Node ◽

Sinus Node Dysfunction ◽

Atrial Pacing ◽

Atrial Arrhythmias

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Cardiovascular events follow-up analysis in patients with sinus node dysfunction and implanted pacemaker

Russian Journal of Cardiology ◽

10.15829/1560-4071-2019-2-53-57 ◽

2019 ◽

pp. 53-57

Author(s):

E. A. Badykova ◽

M. R. Badykov ◽

V. V. Plechev ◽

I. Sh. Sagitov ◽

I. A. Lakman ◽

...

Keyword(s):

Cardiovascular Events ◽

Sinus Node ◽

Sinus Node Dysfunction ◽

Implanted Pacemaker

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Midterm Outcomes of Surgical Repair of Partial Anomalous Pulmonary Venous Connection to SVC

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1700882 ◽

2019 ◽

Vol 68 (01) ◽

pp. 024-029

Author(s):

Jie Hu ◽

Renjie Hu ◽

Haibo Zhang ◽

Lei Zhang ◽

Wen Zhang ◽

...

Keyword(s):

Surgical Repair ◽

Sinus Node ◽

Vena Cava ◽

Young Patients ◽

Preschool Age ◽

Patch Repair ◽

Group A ◽

Group B ◽

Anomalous Pulmonary Venous Connection

Abstract Objectives We explore midterm results after surgical treatment of partial anomalous pulmonary venous connection (PAPVC) to superior vena cava (SVC) in our institution. Methods From 2008 to 2017, 78 patients underwent surgical repair for PAPVC to SVC. Patients were divided into three groups based on surgical techniques: Single-patch repair (n = 20, group A), double-patch repair (n = 31, group B), and Warden repair (n = 27, group C). Their median age was 1.9 years (range: 3 months–13.8 years); median weight was 11.4 kg (range: 4.4–39.7 kg). Clinical, electrocardiographic and echocardiographic were available for all patients. Results There were no early or late mortality. The mean follow-up duration was 1.8 ± 2.1 years (range: 0.6 months to 8 years). No pulmonary venous obstruction occurred and no residual left-to-right shunts sustained during the follow-up. Reoperation for SVC obstruction was required: 1 (5.3%) in group A, 1 (3.2%) in group B, and 2 (7.4%) in group C (p = 0.78). Four patients (3 in group B, 1 in group C, p = 0.7) presented transient rhythm disturbance at discharge and one patient in group B remains nonsinus rhythm during follow-up. Pacemaker was not required in all patients. Conclusion PAPVC to SVC can be safely managed by multiple techniques. Careful manipulation nearby sinus node must be emphasized during double-patch repair to prevent injury of sinus node. Obstruction of postoperative SVC stenosis should be paid attention to after Warden procedure. For young patients, operation should not be performed that early, but until preschool age.

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Abstract 15680: Sinus Node Dysfunction in Associated With Higher Symptom Burden and Increased Risk of Progression to Permanent Atrial Fibrillation: Results From ORBIT-AF Registry

Circulation ◽

10.1161/circ.130.suppl_2.15680 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Larry R Jackson ◽

Sung Hee Kim ◽

Jonathan P Piccini ◽

Bernard J Gersh ◽

Gerald V Naccarelli ◽

...

Keyword(s):

Quality Of Life ◽

Atrial Fibrillation ◽

Sinus Bradycardia ◽

Sinus Node ◽

Sinus Node Dysfunction ◽

Left Ventricular Ejection ◽

Increased Risk ◽

Risk Of Progression

Background: Patients with sinus node dysfunction (SND) are at increased risk of atrial tachyarrhythmias, including atrial fibrillation (AF). Whether the presence of SND is also associated with worse outcomes among those with AF has not been well described. Methods: The ORBIT-AF registry enrolled patients with AF from a range of clinical practices across the US. SND was defined clinically, based on the presence of sinus bradycardia, severe sinus bradycardia, sinus arrest, sinoatrial exit block, or features of tachycardia-bradycardia syndrome. Descriptive statistics and multivariable logistic regression analysis were used to describe treatment patterns and outcomes for patients with and without SND and AF. Results: Overall, 1,710 (17.7%) patients had SND at enrollment. Patients with SND had lower left-ventricular ejection fractions, higher CHA 2 DS 2 -VASc risk scores, and more prior cerebrovascular events. Patients with SND had more severe symptoms (EHRA class IV: 17.5% vs. 13.9%; p=0.007) and poorer quality of life (median AFEQT 77.5 vs. 81.1; p=0.008) as compared to those without. SND patients were more frequently treated with oral anticoagulants (79.2% vs. 75.9%, p=0.004) and had more often received interventional therapy for AF (16.1% vs. 10.5%, p<0.0001). There were no differences in the current AF management strategy between patients with SND and those without [rate control (69.7% vs. 67.7%), rhythm control (30.0% vs. 32.0%); P=0.11]. After adjustment, significantly more patients with SND had progressed from paroxysmal AF at baseline to persistent or permanent AF at any follow-up or persistent AF at baseline to permanent AF at any follow-up than those without (OR 1.23, 95% CI 1.01-1.49, p=0.035). Conclusion: Sinus node dysfunction is associated worse symptoms, lower quality of life, and higher risk of progression to permanent AF. However, SND is not associated with increased risk of all-cause hospitalization, incident stroke, or all-cause death.

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