Pacemakers are associated with a higher risk of late death and transplantation in the Fontan population
| Autor: | Patrick Disney, Chin L. Poh, David S. Celermajer, Andrew Bullock, Jonathan M. Kalman, David S. Winlaw, Dorothy J. Radford, Yves d'Udekem, Thomas L. Gentles, Leeanne Grigg, Karin du Plessis, Mark A. McGuire |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty Adolescent medicine.medical_treatment Population 030204 cardiovascular system & hematology Fontan Procedure Cohort Studies Fontan procedure 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Humans Medicine Registries cardiovascular diseases 030212 general & internal medicine Mortality Child education Survival analysis Heart transplantation education.field_of_study business.industry Surrogate endpoint Australia Cardiac arrhythmia Arrhythmias Cardiac Transplantation Child Preschool Propensity score matching cardiovascular system Cardiology Heart Transplantation Female Cardiology and Cardiovascular Medicine business Follow-Up Studies New Zealand |
| Zdroj: | International Journal of Cardiology. 282:33-37 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2019.01.088 |
| Popis: | The need for permanent pacing has been identified as a predictor of poor outcomes in the late survivors of Fontan surgery. However, it is not clear if the need for a pacemaker is a surrogate marker of a declining Fontan state, or if pacing is deleterious to the Fontan circulation.We sought to compare the long-term outcomes of propensity-matched Fontan patients with and without a permanent pacemaker.Patients who have survived Fontan completion with a documented history of cardiac arrhythmia were identified from the Australia and New Zealand Fontan Registry. Pacemaker insertion details, cardiac function and electrophysiological data were obtained for the patients with a permanent pacemaker. Survival analysis was performed with propensity score matching to compare late survival and outcomes in patients with versus without a pacemaker.There was a total of 310 patients with a history of cardiac arrhythmia, of which 126 (41%) had a permanent pacemaker. After propensity-score matching, 99 pairs were generated (n = 198). Patients with a permanent pacemaker had a higher risk of death (HR 3.32 95% CI 1.60-6.90, p = 0.001) and death or transplantation (HR 3.55 95% CI 1.87-6.73, p 0.001). Patients who were only paced atrially were not at a significantly increased risk of death or transplantation. However, patients who were ventricular paced50% of the time were much more likely to encounter late death or transplantation (HR 3.82 95% CI 1.64-8.95, p = 0.002).Having a permanent pacemaker and needing ventricular pacing is likely associated with an increased risk of death and transplantation in patients with a Fontan circulation. |
| Databáze: | OpenAIRE |
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