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Single-Chamber and Dual-Chamber Pacemaker Devices in Adults with Moderate and Complex Congenital Heart Disease: A Single Tertiary Referral Center Experience

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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.

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No datasets were generated or analysed during the current study.

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Acknowledgements

Special thanks to the nursing staff of the Adult Congenital Heart Disease Unit, and specially to the head nurs,e Mrs. Assunta Carandente, for their essential contribution and support in maintaining a high-quality standard of care for our complex patients. Additionally, we express our gratitude to Dr. Gabriella Piccolo, Dr. Nadia Puzone, Dr. Cecilia Spinelli Barrile and Dr. Tiziana Varriale, the data manager and research assistants, for their efforts in data collection and analysis, as well as their support in remote control monitoring.

Funding

No funding was received for conducting this study.

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Author notes

  1. Giovanni Papaccioli and Fulvio La Rocca have contributed equally to the research.

Authors and Affiliations

  1. Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy

    Giovanni Papaccioli, Giovanni Domenico Ciriello, Anna Correra, Diego Colonna, Emanuele Romeo, Antonio Orlando, Nicola Grimaldi, Michela Palma & Berardo Sarubbi

  2. Cardiology Division, A. Cardarelli Hospital, Via Antonio Cardarelli, 80131, Naples, Italy

    Fulvio La Rocca

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  1. Giovanni Papaccioli
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  2. Fulvio La Rocca
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  3. Giovanni Domenico Ciriello
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Contributions

GP, FLR and BS contributed to write, review, and image editing. NG, AO and GDC contributed to data collection and review. AC, DC, ER and MP contributed to production of tables/figures and review. All authors approved the manuscript text.

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Correspondence to Giovanni Papaccioli.

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The authors have no financial or proprietary interests in any material discussed in this article.

Ethics Approval and Consent

The study received approval from the local ethics committee and conformed to the ethical guidelines of the 1975 Declaration of Helsinki and its later amendments. Informed consent was obtained from all patients or their guardians.

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Papaccioli, G., Rocca, F.L., Ciriello, G.D. et al. Single-Chamber and Dual-Chamber Pacemaker Devices in Adults with Moderate and Complex Congenital Heart Disease: A Single Tertiary Referral Center Experience. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03444-6

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