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Extremely short setting of optimal sensed atrioventricular interval in patients after Fontan procedure with implanted dual-chamber pacemaker

Published online by Cambridge University Press:  11 September 2019

Aya Miyazaki Open the ORCID record for Aya Miyazaki [Opens in a new window] ,
Shin-ichiro Yoshimura ,
Hayato Matsutani ,
Makoto Miyake ,
Jun Negishi ,
Kazuo Yamanaka ,
Osamu Yamada ,
Hiraku Doi  and
Hideo Ohuchi
Aya Miyazaki*
Affiliation:
Congenial Heart Disease Center, Tenri Hospital, Tenri, Nara, Japan Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
Shin-ichiro Yoshimura
Affiliation:
Congenial Heart Disease Center, Tenri Hospital, Tenri, Nara, Japan
Hayato Matsutani
Affiliation:
Department of Clinical Laboratory, Tenri Hospital, Tenri, Nara, Japan
Makoto Miyake
Affiliation:
Congenial Heart Disease Center, Tenri Hospital, Tenri, Nara, Japan
Jun Negishi
Affiliation:
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
Kazuo Yamanaka
Affiliation:
Department of Cardiac Surgery, Tenri Hospital, Tenri, Nara, Japan
Osamu Yamada
Affiliation:
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
Hiraku Doi
Affiliation:
Congenial Heart Disease Center, Tenri Hospital, Tenri, Nara, Japan
Hideo Ohuchi
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center, Suita, Japan
*
Author for Correspondence: A. Miyazaki, MD, Congenital Heart Disease Center, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 631-8552, Japan. Tel: +81-743-63-5611; Fax: +81-743-62-1903; E-mail: [email protected]
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Abstract

Background:

Atrioventricular interval optimisation is important in patients with dual-chamber pacing, especially with heart failure. In patients with CHD, especially in those with Fontan circulation, the systemic atrial contraction is supposed to be more important than in patients without structural heart disease.

Methods:

We retrospectively evaluated two patients after Fontan procedure with dual-chamber pacemaker with a unique setting of optimal sensed atrioventricular interval.

Results:

The optimal sensed atrioventricular interval determined by echocardiogram was extremely short sensed atrioventricular interval at 25 and 30 ms in both cases; however, the actual P wave and ventricular pacing interval showed 180 and 140 ms, respectively. In both cases, the atrial epicardial leads were implanted on the opposite site of the origin of their own atrial rhythm. The time differences between sensed atrioventricular interval and actual P wave and ventricular pacing interval occurred because of the site of the epicardial atrial pacing leads and the intra-atrial conduction delay.

Conclusion:

We need to consider the origin of the atrial rhythm, the site of the epicardial atrial lead, and the atrial conduction delay by using electrocardiogram and X-ray when we set the optimal sensed atrioventricular interval in complicated CHD.

Keywords

CHDsensed atrioventricular intervaloptimal atrioventricular intervalepicardial pacing lead: Fontan operationintra-atrial conduction delay
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 11 , November 2019 , pp. 1375 - 1379
Copyright
© Cambridge University Press 2019 

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