CLINICAL RESEARCH: CONGENITAL HEART DISEASE
Long-Term outcomes of cardiac pacing in adults with congenital heart disease
Fiona Walker, MD* ,
Samuel C. Siu, MD, SM, FACC*,
Shane Woods*,
Douglas A. Cameron, MD*,
Gary D. Webb, MD, FACC* and
Louise Harris, MB, ChB, FACC*,*
* Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Ontario, Canada
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Manuscript received August 15, 2003;
revised manuscript received December 17, 2003,
accepted December 23, 2003.
* Reprint requests and correspondence: Dr. Louise Harris, Peter Munk Cardiac Centre 3-562, Toronto General Hospital, 150 Gerrard Street West, Toronto, ON M5G 2C4, Canada.
louise.harris{at}uhn.on.ca
OBJECTIVES: The purpose of this retrospective study was to define long-term outcomes after pacemaker therapy in adults with congenital heart disease (CHD).
BACKGROUND: Adults with CHD represent a unique and expanding population. Many will require pacemaker or implantable defibrillator therapy, with a lifelong need for re-intervention and follow-up. They pose technical and management challenges not encountered in other groups receiving pacing, and the complication and re-intervention rates specific to this population are not well-defined.
METHODS: We reviewed outcomes of 168 adults with CHD, 89 females, mean age 40 years, in whom a pacemaker or anti-tachycardia device was implanted.
RESULTS: Mean age at implant was 28 years with mean pacing duration 11 years at follow-up (range, 0.5 to 38.0). Seventy-two (42%) received initial dual-chamber devices and remained in this mode, while 23 (14%) went from ventricular to dual-chamber pacing in follow-up. Initial mode of pacing did not have a significant effect on subsequent atrial arrhythmia. Patients receiving an initial epicardial system were younger than those paced endocardially (17 ± 12 years vs. 35 ± 16 years, p < 0.001) and more likely to undergo re-intervention (p = 0.019). Difficulty with vascular access was encountered in 25 patients (15%), while 45 (27%) experienced lead-related complications. No significant predictors of lead complications were identified.
CONCLUSIONS: Lead complications were not significantly different for epicardial versus endocardial, nor physiologic versus ventricular pacing, but a trend toward improved lead survival in patients receiving endocardial leads at first implant was observed. Adults with CHD remain at risk for atrial arrhythmias regardless of pacing mode.
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Abbreviations and Acronyms
| | AT | = atrial arrhythmias | | ATD | = anti-tachycardia device therapy | | AV | = atrio-ventricular | | CHD | = congenital heart disease | | EP | = electrophysiologic | | PPM | = permanent pacemaker | | TCCCA | = Toronto Congenital Cardiac Centre for Adults |
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