Benefits of Chronic Atrial Pacing in Fontan Physiology with Sinus Node Dysfunction and Preserved Ejection Fraction: Novel Therapeutic Approach for Failing Fontan

Figures

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  Fig. 1. Case presentation. The left figure shows hemodynamics before pacemaker implantation (PMI), whereas the right figure shows the changes in hemodynamics during atrial pacing (AP) and cardiac catheterization. As the heart rate (HR) increased from baseline of 51 bpm to 60, 70, and 80 bpm via AP, the ventricular end-diastolic pressure (EDP) and central venous pressure (CVP) decreased, particularly EDP. Additionally, ventricular contractility (dP/dt) and cardiac index (CI) increased. Red arrows indicate EDP at each HR during AP. EDVI ventricular volume index, EF ventricular ejection fraction, LVP left ventricular pressure, LVSP left ventricular systolic pressure, PAP pulmonary artery pressure, PCW pulmonary artery wedge pressure

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  Fig. 2. Changes in hemodynamics during AP in a cardiac catheterization study (acute test). The increase in HR induced via AP resulted in a decrease in ventricular EDP (a) and CVP (b), whereas the CI increased (d). Additionally, a decrease in EDP was accompanied by a reduction in CVP (c). The colors in each graph represent the same case. Some data, except for CVP, were not available during the pacing study. CVP central venous pressure, CI cardiac index, EDP ventricular end-diastolic pressure

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  Fig. 3. Changes in hemodynamics 1 year after PMI (chronic test). One year after PMI, CVP (a), ventricular EDP (b), end-diastolic volume index (EDVI) (c), brain natriuretic peptide (BNP) (d), renal resistive index (RRI) (e), and ejection fraction (EF) (f) all decreased. The colors in each graph correspond to the same case shown in Fig. 2. The RRI value was not obtained in one patient (blue). CVP central venous pressure, EDP ventricular end-diastolic pressure, EDVI ventricular volume index, BNP brain natriuretic peptide, RRI renal resistive index, EF ventricular ejection fraction

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  Fig. 4. The relationship between EDP and EDVI before and 1 year after PMI (a), and the changes in CVP before PMI, during the acute test, and 1 year and beyond after PMI (b). The EDP–EDVI relationship before PMI (closed circle) shifted to a position equivalent to that of a successful Fontan (gray square) 1 year after PMI (open circle). Each plot indicates the corresponding median value with interquartile range (a). In the acute test, as well as at 1 year and beyond, CVP was lower than that before PMI in all cases (b). The colors in each graph correspond to the same case shown in Figs. 2 and 3. CVP central venous pressure, EDP ventricular end-diastolic pressure, EDVI ventricular volume index, HR heart rate