What does this research mean for the field?

In patients with Fontan physiology, asynchronous ventricular pacing produces worse acute hemodynamics than dual-chamber or atrial pacing by increasing atrial and pulmonary pressures and reducing cardiac output and arterial pressure. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Evaluate the acute hemodynamic response to atrial, ventricular, and dual-chamber pacing modes in pediatric patients following the Fontan operation.

September 26, 2026Journal of the American College of CardiologyOpen Access

Acute Hemodynamic Effects of Pacing in Patients With Fontan Physiology

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Fontan physiology (n=21). Intervention: Asynchronous ventricular (VOO) pacing vs. Dual-chamber (DOO) and atrial (AOO) pacing. Primary outcome: Hemodynamic parameters including mean left atrial pressure, mean pulmonary artery pressure, mean arterial blood pressure, and indexed cardiac output.

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Key result

Asynchronous ventricular pacing worsens post-Fontan hemodynamics, driving higher LAP and lower cardiac output.

n=21

Why the study?

Bradycardia requiring pacing is common after the Fontan operation, but the optimal pacing mode for Fontan patients is unknown and critical due to potential hemodynamic deterioration.

Population

21 patients aged 2 to 18 years after Fontan operation in ICU

Comparison

Atrial, ventricular, and dual-chamber pacing modes

Design

Cross-over trial

Authors

BBBrent J. BarberUniversity of Arizona ABAnjan S. BatraChildren's Hospital of Orange County GBGrant H. BurchOregon Health & Science University

Discussion

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Implication

May inform acute pacing choices in Fontan patients; hypothesis-generating for randomized trials on long-term outcomes.

Key Points

Evaluate the acute hemodynamic response to atrial, ventricular, and dual-chamber pacing modes in pediatric patients following the Fontan operation.
Conducted a crossover trial of 21 intensive care patients (ages 2 to 18 years, median 4 years; 13 males) recovering from the Fontan operation.
Tested atrial (AOO), ventricular (VOO), and dual-chamber (DOO) pacing for 10 minutes each, separated by 10-minute rest intervals.
Measured mean left atrial pressure (LAP), mean pulmonary artery pressure (PAP), mean arterial blood pressure (MAP), and indexed cardiac output via Fick (Qs).
Asynchronous ventricular pacing (VOO) significantly worsened cardiac pressures compared to DOO and AOO modes, resulting in elevated LAP (9.4 vs 6.8 vs 5.4 mm Hg) and PAP (15.2 vs 13.5 vs 12.7 mm Hg).
Systemic perfusion deteriorated under VOO compared to DOO and AOO pacing, producing lower indexed cardiac output (3.0 vs 3.5 vs 3.9 l/min/m²) and reduced MAP (60.1 vs 66.5 vs 67.2 mm Hg).

Study Design

Type

RCT (n=21)

PICO

Population

21 pediatric patients (median age 4 years, 38% female) in the intensive care unit after a Fontan operation.

Intervention / Comparator

Asynchronous ventricular (VOO) pacing vs Dual-chamber (DOO) and atrial (AOO) pacing

Primary Outcome

Hemodynamic parameters including mean left atrial pressure, mean pulmonary artery pressure, mean arterial blood pressure, and indexed cardiac output

Cite This Study

Barber et al. (2005) conducted an RCT in Fontan physiology (n=21). Asynchronous ventricular (VOO) pacing vs. Dual-chamber (DOO) and atrial (AOO) pacing was evaluated on Hemodynamic parameters including mean left atrial pressure, mean pulmonary artery pressure, mean arterial blood pressure, and indexed cardiac output. Asynchronous ventricular pacing caused worse hemodynamics, including higher LAP (9.4 vs 6.8 DOO and 5.4 AOO) and lower cardiac output (3.0 vs 3.5 DOO and 3.9 AOO) in post-Fontan patients.

synapsesocial.com/papers/6ab8360f3ab6fc46e8e974ee https://doi.org/10.1016/j.jacc.2005.07.045

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Acute Hemodynamic Effects of Pacing in Patients With Fontan Physiology

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Cite This Study

Acute Hemodynamic Effects of Pacing in Patients With Fontan Physiology

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Cite This Study

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