Key result
Prolonged paced QRS duration is linked to death, transplant, and Fontan failure in paced patients.
Why the study?
Permanent pacemaker implantation is a risk factor for morbidity and mortality after Fontan operation, but factors associated with outcomes in these patients required investigation.
Does a longer paced QRS duration predict poor outcomes in Fontan patients with permanent pacemakers?
Cohort (n=32)
No
Does a longer paced QRS duration predict poor outcomes in Fontan patients with permanent pacemakers?
Absolute Event Rate: 153.1% vs 127.7%
p-value: p=0.044
A prolonged paced QRS duration (≥153 ms) is associated with poor outcomes in Fontan patients with permanent pacemakers, suggesting its potential as a prognostic marker.
May support closer monitoring in Fontan patients needing PPM; leaves open causal factors and optimal strategies.
BACKGROUND: Permanent pacemaker (PPM) implantation has been identified as a risk factor for morbidity and mortality after Fontan operation. This study investigated the factors associated with outcomes in patients with Fontan physiology who underwent PPM implantation. METHODS AND RESULTS: We retrospectively reviewed 508 patients who underwent Fontan surgery at Asan Medical Center between September 1992 and August 2022. Of these patients, 37 (7.3%) received PPM implantation. Five patients were excluded, leaving 32 patients, of whom 11 were categorized into the poor outcome group. Poor outcomes comprised death, heart transplantation, and "Fontan failure". Clinical, Fontan procedure-related, and PPM-related factors were compared between the poor and good outcome groups. Ventricular morphology, Fontan procedure-associated factors, pacing mode, high ventricular pacing rate, and time from first arrhythmia to PPM implantation did not differ significantly between the 2 groups. However, the poor outcome group exhibited a significantly longer mean paced QRS duration (P=0.044). Receiver operating characteristic curve analysis revealed a paced QRS duration cut-off value of 153 ms with an area under the curve of 0.73 (P=0.035). CONCLUSIONS: A longer paced QRS duration was associated with poor outcomes, indicating its potential to predict adverse outcomes among Fontan patients.
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Shin et al. (2024) conducted a cohort in Fontan physiology requiring permanent pacemaker implantation (n=32). Poor clinical outcome (death, heart transplantation, or Fontan failure) vs. Good clinical outcome was evaluated on Mean paced QRS duration (ms) (p=0.044). A prolonged paced QRS duration was significantly associated with poor outcomes, including death, heart transplantation, and Fontan failure, among Fontan patients with permanent pacemakers.
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