Transvenous pacemaker implantation after the bidirectional Glenn operation for patients with complex congenital disease

Transvenous pacemaker implantation after the bidirectional Glenn operation for patients with... 1INTRODUCTIONThe population of children and adults with surgically palliated congenital heart disease (CHD) has enjoyed a tremendous increase in early and late survival, such that there are now an estimated 2.4 million such patients currently alive in the United States. These patients are often affected by both congenital and acquired abnormalities of the conduction system that require cardiac pacing. Patients with complex congenital anatomy are particularly likely to need pacing for the prevention of bradycardia, with over half of patients referred for pacing outside of the perioperative period. This may lead to a separate and otherwise unnecessary thoracotomy for pacemaker implantation.A particularly challenging situation arises for those patients that require pacing after the Glenn operation, where there is an absence of superior venous access to the heart. For such patients with established pacing indications, pacemaker implantation is typically performed surgically with epicardial leads tunneled to an abdominal generator. Unfortunately, limitations of this approach are numerous and include repeat thoracotomy, longer hospital stay, higher acute complication rate, and a shorter expected duration of lead survival relative to transvenous systems. An alternative strategy consisting of an inferior approach via the femoral or iliac veins has been described, but has not been http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Cardiovascular Electrophysiology Wiley

Transvenous pacemaker implantation after the bidirectional Glenn operation for patients with complex congenital disease

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
Journal compilation © 2018 Wiley Periodicals, Inc.
ISSN
1045-3873
eISSN
1540-8167
D.O.I.
10.1111/jce.13404
Publisher site
See Article on Publisher Site

Abstract

1INTRODUCTIONThe population of children and adults with surgically palliated congenital heart disease (CHD) has enjoyed a tremendous increase in early and late survival, such that there are now an estimated 2.4 million such patients currently alive in the United States. These patients are often affected by both congenital and acquired abnormalities of the conduction system that require cardiac pacing. Patients with complex congenital anatomy are particularly likely to need pacing for the prevention of bradycardia, with over half of patients referred for pacing outside of the perioperative period. This may lead to a separate and otherwise unnecessary thoracotomy for pacemaker implantation.A particularly challenging situation arises for those patients that require pacing after the Glenn operation, where there is an absence of superior venous access to the heart. For such patients with established pacing indications, pacemaker implantation is typically performed surgically with epicardial leads tunneled to an abdominal generator. Unfortunately, limitations of this approach are numerous and include repeat thoracotomy, longer hospital stay, higher acute complication rate, and a shorter expected duration of lead survival relative to transvenous systems. An alternative strategy consisting of an inferior approach via the femoral or iliac veins has been described, but has not been

Journal

Journal of Cardiovascular ElectrophysiologyWiley

Published: Jan 1, 2018

Keywords: ; ; ; ;

References

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