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Wijesuriya N, De Vere F, Howell S, Mannakkara N, Bosco P, Frigiola A, Balaji S, Chubb H, Niederer SA, Rinaldi CA. Potential applications of ultrasound-based leadless endocardial pacing in adult congenital heart disease. Heart Rhythm 2024:S1547-5271(24)03296-X. [PMID: 39260666 DOI: 10.1016/j.hrthm.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/29/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024]
Affiliation(s)
- Nadeev Wijesuriya
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Felicity De Vere
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sandra Howell
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nilanka Mannakkara
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Paolo Bosco
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alessandra Frigiola
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Steven A Niederer
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; National Heart and Lunk Institute, Imperial College London, London, United Kingdom; Alan Turing Institute, London, United Kingdom
| | - Christopher A Rinaldi
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Goulden CJ, Khanra D, Llewellyn J, Rao A, Evans A, Ashrafi R. Novel approaches for leadless pacemaker implantation in the extra-cardiac Fontan cohort: Options to avoid leaded systems or epicardial pacing. J Cardiovasc Electrophysiol 2023; 34:2386-2392. [PMID: 37712334 DOI: 10.1111/jce.16072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Fontan surgery, a palliative procedure for single ventricle patients, often leads to the need for permanent pacing. Epicardial pacing has limitations, while transvenous pacing carries risks in the Fontan circulation. This case series introduces a novel approach of leadless pacemaker implantation in the extra-cardiac Fontan (ECF) cohort to overcome these limitations. METHODS The study includes four cases of leadless pacemaker (Micra™) implantation in patients with ECF. Procedures were performed under general anesthesia with guidance from trans-esophageal echocardiography. Various access routes were used, including trans-carotid and trans-fenestration approaches. Procedural details, parameters, and follow-up data were collected. RESULTS All leadless pacemaker implantations were successful, with satisfactory electrical parameters and stable pacing postprocedural outcomes during short-term follow-up. One patient required closure of their fenestration for symptomatic desaturation post procedurally. CONCLUSIONS Leadless pacemaker implantation via trans-carotid and trans-fenestration approaches appears to be a feasible back up option for pacing in Fontan patients where other options have been exhausted or there is a patient choice to avoid surgery. These techniques provide an option to avoid leaded systems or epicardial pacing, reducing the need for multiple thoracotomies and addressing challenges associated with surgical pacing leads. Further studies are needed to evaluate long-term outcomes and assess the broader application of leadless pacemakers in the Fontan population.
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Affiliation(s)
| | | | | | - Archana Rao
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Alison Evans
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Reza Ashrafi
- Liverpool Heart and Chest Hospital, Liverpool, UK
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Yamini‐Sharif A, Yaghoobian R, Ghaderian H, Moosavi N. Endocardial pacing in a single-ventricle patient with tricuspid atresia-a case report. Clin Case Rep 2023; 11:e7945. [PMID: 37744619 PMCID: PMC10514377 DOI: 10.1002/ccr3.7945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/24/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Key Clinical Message The use of endocardial pacing in patients with univentricular hearts and intracardiac shunts is limited, primarily due to the increased risk of thromboembolism. However, when accompanied by proper long-term anticoagulation therapy, it may be safer than epicardial interventions in selected patients at high risk for surgery. Abstract We report transvenous endocardial pacing through the atrial septal defect in a patient with tricuspid atresia, transposition of the great arteries, severe pulmonary hypertension, and complete heart block. This study is among the first reported cases using this pacing method in a patient with a univentricular heart and intracardiac shunt.
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Affiliation(s)
- Ahmad Yamini‐Sharif
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehranIran
| | - Ramin Yaghoobian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehranIran
| | - Homa Ghaderian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehranIran
| | - Najme‐Sadat Moosavi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehranIran
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Calvert P, Yeo C, Rao A, Neequaye S, Mayhew D, Ashrafi R. Transcarotid implantation of a leadless pacemaker in a patient with Fontan circulation. HeartRhythm Case Rep 2022; 9:53-58. [PMID: 36685685 PMCID: PMC9845646 DOI: 10.1016/j.hrcr.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Peter Calvert
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Cheng Yeo
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Archana Rao
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Simon Neequaye
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom,Liverpool University Hospitals Foundation Trust, Royal Liverpool Hospital, Liverpool, United Kingdom
| | - David Mayhew
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Reza Ashrafi
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom,Address reprint requests and correspondence: Dr Reza Ashrafi, Northwest Congenital Heart Disease Partnership, Liverpool Heart & Chest Hospital, Thomas Dr, Liverpool, England, UK L14 3PE.
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Mondésert B, Moore JP, Khairy P. Cardiac Implantable Electronic Devices in the Fontan Patient. Can J Cardiol 2022; 38:1048-1058. [PMID: 35588949 DOI: 10.1016/j.cjca.2022.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/22/2022] Open
Abstract
As a result of remarkable progress in operative techniques and cardiology care during childhood, Fontan patients continue to age and require team-based multidisciplinary expertise to manage complications encountered in adulthood. They face particular challenges in terms of altered hemodynamic stressors, cardiac and hepatic failure, and arrhythmias. Arrhythmias in Fontan patients are highly prevalent and associated with underlying anatomy, surgical technique, and postoperative sequelae. Diagnostic tools, treatments, and device strategies for arrhythmias in Fontan patients should be adapted to the specific anatomy, type of surgical repair, and clinical status. Great strides in our understanding of arrhythmia mechanisms, options and techniques to obtain access to relevant cardiac structures, and application of both old and new technologies have contributed to improving cardiac implantable electronic device (CIED) therapies for this unique population. In this state-of-the-art review, we discuss the various arrhythmias encountered in Fontan patients, their diagnosis, and options for treatment and prevention, with a focus on CIEDs. Throughout, access challenges particular to the Fontan circulation are considered. Recently developed technologies, such as the sub-cutaneous implantable cardioverter defibrillator carry the potential to be transformative but require awareness of Fontan-specific issues. Moreover, new leadless pacing technology represents a promising strategy that may soon become applicable to Fontan patients with sinus node dysfunction. CIEDs are essential tools in managing Fontan patients but the complex clinical scenarios that arise in this patient population are among the most challenging for the congenital electrophysiologist.
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Affiliation(s)
- Blandine Mondésert
- Adult Congenital Heart Disease Center, Montreal Heart Institute, Medicine Department, Université de Montréal, Montreal, Canada.
| | - Jeremy P Moore
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, CA; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, CA
| | - Paul Khairy
- Adult Congenital Heart Disease Center, Montreal Heart Institute, Medicine Department, Université de Montréal, Montreal, Canada
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Akazawa Y, Higaki T, Nagai T, Sasaki Y, Asagi Y, Moritani T, Inaba S, Nishiyama H, Eguchi M, Yamaguchi O. Transvenous pacing approach for atrioventricular block in fontan - Possibility of transvenous approach by electrophysiological assessment -. J Cardiol Cases 2022; 25:389-391. [DOI: 10.1016/j.jccase.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/15/2021] [Accepted: 01/07/2022] [Indexed: 10/18/2022] Open
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Driesen BW, Voskuil M, Grotenhuis HB. Current Treatment Options for the Failing Fontan Circulation. Curr Cardiol Rev 2022; 18:e060122200067. [PMID: 34994331 PMCID: PMC9893132 DOI: 10.2174/1573403x18666220106114518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 10/22/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
The Fontan operation was introduced in 1968. For congenital malformations, where biventricular repair is unsuitable, the Fontan procedure has provided a long-term palliation strategy with improved outcomes compared to the initially developed procedures. Despite these improvements, several complications merely due to a failing Fontan circulation, including myocardial dysfunction, arrhythmias, increased pulmonary vascular resistance, protein-losing enteropathy, hepatic dysfunction, plastic bronchitis, and thrombo-embolism, may occur, thereby limiting the life-expectancy in this patient cohort. This review provides an overview of the most common complications of Fontan circulation and the currently available treatment options.
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Affiliation(s)
- Bart W. Driesen
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Cardiology, Laurentius Ziekenhuis, Roermond, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Utrecht, The Netherlands
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Hoyt WJ, Moore JP, Shannon KM, Kannankeril PJ, Fish FA. Epicardial atrial pacing after the extracardiac Fontan operation: Feasibility of an entirely transvenous approach. J Cardiovasc Electrophysiol 2021; 33:128-133. [PMID: 34716972 DOI: 10.1111/jce.15285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022]
Abstract
This series describes an innovative technique for pacing in patients with sinus node dysfunction after extracardiac Fontan surgery. This transpulmonary approach to the left atrial epi-myocardium has been successfully applied to three patients at two centers and resulted in excellent acute and midterm pacing characteristics without known complications. The principal advantage of this procedure in comparison to prior iterations is the absence of pacing material within the pulmonary venous atrium, so that future systemic thromboembolism risk is minimized. The transpulmonary approach for permanent atrial pacing offers a novel solution to the unique challenges for patients after extracardiac Fontan operation.
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Affiliation(s)
- Walter J Hoyt
- Division of Pediatric Cardiology, Department of Pediatrics, Ochsner Health System, New Orleans, Louisiana, USA
| | - Jeremy P Moore
- Department of Pediatrics, Division of Pediatric Cardiology, UCLA Health System, Los Angeles, California, USA.,Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Health System, Los Angeles, California, USA.,Division of Cardiology, Department of Medicine, UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California, USA
| | - Kevin M Shannon
- Department of Pediatrics, Division of Pediatric Cardiology, UCLA Health System, Los Angeles, California, USA.,Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Health System, Los Angeles, California, USA.,Division of Cardiology, Department of Medicine, UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California, USA
| | - Prince J Kannankeril
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| | - Frank A Fish
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
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Bhyravavajhala S, Vanaparty B, Yerram S. Transvenous pacing through the pulmonary valve in a patient with cyanotic congenital heart disease after Glenn shunt - A case report. Indian Pacing Electrophysiol J 2021; 21:132-136. [PMID: 33429048 PMCID: PMC7952776 DOI: 10.1016/j.ipej.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 10/27/2022] Open
Abstract
Bradyarrhythmia requiring pacing is infrequently encountered in patients with complex cyanotic congenital heart disease. Even though epicardial pacing is the preferred mode, rarely, a need for endocardial lead implantation arises. Patients with cavopulmonary shunts limit access to the venous atria and ventricles, necessitating alternate methods of pacemaker implantation. We report transvenous endocardial lead implantation by an unconventional method in a patient with congenitally corrected transposition of great arteries after a bidirectional Glenn shunt.
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Affiliation(s)
| | - Bharathi Vanaparty
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Sreekanth Yerram
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India.
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