Abstract

The number of device implantation procedures has increased in adult patients with congenital heart disease (ACHD). Despite significant improvements in materials and implantation techniques, these patients are exposed to higher risk of device related complications than general population. Herein, we describe our single tertiary referral center experience on transvenous pacemaker (PM) implantation and follow-up in adult patients with moderate and complex congenital heart disease (CHD) as limited data are available on long-term outcome. We considered all adults with moderate and complex CHD aged more than 16 years who underwent transvenous single-chamber and dual-chamber PM implant for sinus node dysfunction or atrioventricular block between January 2013 to December 2022 at our Unit. Seventy-one ACHD patients were included in the study (mean age 38.6 ± 15.2 years, 64% with moderate CHD, 36% with complex CHD). Among 32 patients implanted with a dual chamber PM (DDD PM), 4 devices were reprogrammed in VDD mode, 3 in VVI and 2 in AAI mode during follow-up because of lead dysfunction or permanent atrial arrhythmia. In addition, 26 patients had a single chamber PM (AAI or VVI PM) and 13 patients had single-lead pacing system with a free-floating atrial electrode pair (VDD PM). Just one of 13 single-lead VDD PM was reprogrammed in VVI mode due to a low atrial sensing. In DDD PM group, 10 re-interventions were needed due to lead dysfunction (8 cases) and lead-related infective endocarditis (2 cases). Only 3 patients in the single-lead PM group developed lead dysfunction with 2 re-interventions needed, but no infective endocarditis was reported. The rate of long-term complications is high in moderate and complex ACHD with transvenous PM devices, and it is mainly lead-related. In our experience, the less leads implanted, the less complications will occur. Considering the heterogeneity of the ACHD population, transvenous single-chamber or dual-chamber PM device implantation should always be tailored on the single patient, balancing risks and benefits in this complex population.

中文翻译：

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患有中度和复杂先天性心脏病的成人的单腔和双腔起搏器装置：单一三级转诊中心的经验

摘要

患有先天性心脏病 (ACHD) 的成年患者的装置植入手术数量有所增加。尽管材料和植入技术有了显着改进，但这些患者比一般人群面临更高的设备相关并发症风险。在此，我们描述了我们的单一三级转诊中心对患有中度和复杂先天性心脏病 (CHD) 的成年患者进行经静脉起搏器 (PM) 植入和随访的经验，因为有关长期结果的数据有限。我们考虑了 2013 年 1 月至 2022 年 12 月期间在我们科室因窦房结功能障碍或房室传导阻滞接受经静脉单腔和双腔 PM 植入的所有年龄超过 16 岁的中度和复杂 CHD 成年人。该研究包括 71 名 ACHD 患者（平均年龄 38.6 ± 15.2 岁，64% 患有中度 CHD，36% 患有复杂 CHD）。在 32 名植入双室 PM (DDD PM) 的患者中，由于导线功能障碍或永久性房性心律失常，随访期间有 4 名设备被重新编程为 VDD 模式，3 名设备被重新编程为 VVI 模式，2 名设备被重新编程为 AAI 模式。此外，26 名患者采用单腔 PM（AAI 或 VVI PM），13 名患者采用带有自由浮动心房电极对（VDD PM）的单导联起搏系统。由于心房感测较低，13 个单引线 VDD PM 中只有一个被重新编程为 VVI 模式。 DDD PM组中，由于铅功能障碍（8例）和铅相关感染性心内膜炎（2例）需要重新干预10次。单导联 PM 组中只有 3 名患者出现导联功能障碍，需要 2 次重新干预，但没有报告感染性心内膜炎。使用经静脉 PM 装置的中度和复杂 ACHD 的长期并发症发生率较高，且主要与铅相关。根据我们的经验，植入的导线越少，发生的并发症就越少。考虑到 ACHD 人群的异质性，经静脉单腔或双腔 PM 装置植入应始终针对单个患者进行定制，平衡这一复杂人群的风险和收益。