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首页> 外文期刊>The American Journal of Cardiology >Effect of Ventricular Pacing on Morbidity in Adults After Fontan Repair
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Effect of Ventricular Pacing on Morbidity in Adults After Fontan Repair

机译：心室起搏对Fontan修复后成人发病率的影响

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Implantation of a permanent pacemaker is a negative prognostic marker in patients with Fontan palliation; however, data delineating outcomes in adult patients with pacemaker requirements are lacking. We hypothesize that high ventricular pacing burden is associated with adverse outcomes in adult Fontan patients. We performed a retrospective review comprising adult patients with history of Fontan repair. A high burden of ventricular pacing was defined as >= 40% pacing. Major adverse clinical events (MACE) were defined as all-cause mortality or need for advanced cardiac therapies (ventricular assist device or heart transplant). A total of 145 adult patients with Fontan were studied for a median of 3.1 years. Twenty (14%) patients had implanted pacemakers with >= 40% ventricular pacing. Twelve events occurred in those with >= 40% ventricular pacing (incidence 60.0%) versus 11 in those without (incidence 8.8%). In multivariable analysis, >= 40% ventricular-pacing (odds ratio 12.51, confidence interval [CI] 3.56 to 43.83, p = 40% ventricular pacing had nearly 8 times the risk of MACE compared with those with a lower ventricular pacing burden (hazard ratio 7.79, 95% CI 2.56 to 23.66, p <0.001), whereas patients with atrial-only or <40% ventricular pacing burden had a trend toward higher hazard of MACE compared with those without permanent pacemaker (hazard ratio 3.38, 95% CI 0.92 to 12.47, p = 0.07) that did not meet statistical significance. These findings suggest that high ventricular pacing burden contributes to poor outcomes in the adult Fontan patients and bear consideration when determining optimal treatment of tachyarrhythmias in this population. (C) 2020 Elsevier Inc. All rights reserved.
机译：永久起搏器的植入是Fontan Palliation患者的阴性预后标志物;然而，缺乏成人患者在成年患者中划定的数据缺乏。我们假设高室起搏负担与成人Fontan患者的不良结果有关。我们进行了回顾性审查，该审查包括成年患者的Fontan修复历史。室性起搏的高负担定义为> = 40％起搏。主要的不良临床活动（MACE）被定义为全导致的死亡率或需要晚期心脏疗法（心室辅助装置或心脏移植）。研究了145名成年患者的Fontan患者，为3.1岁的中位数进行了3.1岁。二十（14％）患者植入起搏器，= 40％的心室起搏。在没有（入射8.8％）的那些中有12个事件> = 40％的心室起搏（入射60.0％）与11。在多变量分析中，> = 40％的心室起搏（差距12.51，置信区间[CI] 3.56至43.83，P = 40％心室起搏与术士的风险近8倍，与患有较低的心室起搏负担（危险比率7.79,95％CI 2.56至23.66，P <0.001），而心房唯一或室内高温负担的患者与无永久性起搏器（危险比3.38,95％CI）相比，心房患者的危险性较高。 0.92至12.47，p = 0.07），不符合统计学意义。这些研究结果表明，高室起搏负担有助于成年式Fontan患者的差，并在确定该人群中的快速治疗Tachyarrhythmias时承担考虑。（c）2020 Elsevier Inc.保留所有权利。

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