Epicardial pacemaker implantation and follow-up in patients with a single ventricle after the Fontan operation

Objectives: There is an increasing incidence of sinus node dysfunction afte r the Fontan procedure. Inability to maintain atrioventricular synchrony af ter the Fontan operation has been associated with an adverse late outcome. Although pacing may be helpful as a primary or adjunct modality after the F ontan procedure, the effects of performing a late thoracotomy or sternotomy for epicardial pacemaker implantation are unknown. In addition, little is known about the long-term effectiveness of epicardial leads in patients wit h single ventricles. The purpose of this study was to compare the hospital course and follow-up of epicardial pacing lead implantation in patients wit h Fontan physiology and patients with 2-ventricle physiology. Methods: We retrospectively reviewed all isolated epicardial pacemaker impl antations and outpatient evaluations performed between January 1983 and Jun e 2000. Results: There was no difference in the perioperative course for the 31 Fon tan patients (27 atrial and 41 ventricular leads [68 total]) compared with the 56 non-Fontan subjects (9 atrial and 61 ventricular leads [70 total]). The median length of stay in Fontan and non-Fontan patients was 3 and 3 day s, respectively. There was no early mortality in either group. Pleural drai nage for 5 days or longer was reported in 4% of the Fontan cohort and 3% of the non-Fontan group. Late pleural effusions were identified in only 7, pa tients in the Fontan group and 2 patients in the non-Fontan group. There wa s no significant difference in epicardial lead survival between the Fontan group and the non-Fontan group (1 year, 96%; 2 years, 90%; 5 years, 70%). T he overall incidence of lead failure was 17% (24/138). Conclusions: Epicardial leads can be safely placed in Fontan patients at no additional risk compared to patients with biventricular physiology. Sensin g and pacing qualities were relatively constant in both the Fontan and nonF ontan groups over the first 2 years after implantation.