Outcome of patients with functional single ventricular heart after pacemaker implantation: What makes it poor, and what can we do?

Yoshihiko Kodama, Ayako Kuraoka, Yuichi Ishikawa, Makoto Nakamura, Hiroya Ushinohama, Koichi Sagawa, Shintaro Umemoto, Toru Hashimoto, Ichiro Sakamoto, Kisho Ohtani, Tomomi Ide, Hiroyuki Tsutsui, Shiro Ishikawa

研究成果: ジャーナルへの寄稿学術誌査読

15 被引用数 (Scopus)

抄録

Background: Pacemaker implantation in patients with single ventricle is associated with poor outcomes. Objective: The purpose of this study was to determine the reasons for the poor outcomes of pacemaker implantation. Methods: We performed a retrospective chart review of patients with single ventricle who had undergone permanent pacemaker implantation. Patients were categorized into 3 groups based on the site of pacing and the proportion of ventricular pacing (VP) as follows: (1) atrial pacing group with atrial pacing only (n = 11); (2) low VP group with low daily VP proportion (<50%; n = 12); and (3) high VP group with high daily VP proportion (≥50%; n = 15). Pacing leads were placed at the epicardium in all patients. Results: No patients in the atrial pacing or low VP groups died, whereas the survival rate in the high VP group was 58.9% and 39.3% at 10 and 20 years, respectively, after pacemaker implantation. Among the post-Fontan patients, plasma brain natriuretic peptide (BNP) levels significantly increased with the proportion of VP: 11.7, 20.3, and 28.4 pg/mL in the atrial pacing, low VP, and high VP groups, respectively (P = 0.04). In the high VP group, the plasma BNP level was significantly lower in patients with an apical pacing lead than in those with a nonapical pacing lead (27.0 pg/mL vs 82.8 pg/mL, respectively; P = .03). Conclusion: A higher proportion of VP was associated with poor outcome and higher plasma BNP levels, probably due to ventricular dyssynchrony. In epicardial ventricular pacing, apical pacing is better to avoid the increase in ventricular stress and plasma BNP level.

本文言語英語
ページ(範囲)1870-1874
ページ数5
ジャーナルHeart Rhythm
16
12
DOI
出版ステータス出版済み - 12月 2019

!!!All Science Journal Classification (ASJC) codes

  • 循環器および心血管医学
  • 生理学(医学)

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