Introduction: Arrhythmia is detrimental to single-ventricle patients hemodynamic, so the control of atrial tachyarrhythmias (TA) strongly impacts on patients outcome. Surgical atrial ablation during extracardiac Fontan conversion (EFC) has been proven to reduce AT episodes. No study investigate the utility of remote monitoring (RM) of implantable cardiac devices in this particular population. AIM. To evaluate the clinical role of RM with pacemaker (PM) in single ventricle patients who underwent to EFC and surgical atrial ablation for hemodynamic instability and untreatable arrhythmias.
Methods: The population included patients who received an implantable PM after EFC with surgical atrial ablation. The remote device check was programmed every 3 months and all patients attended an out-patient visit every 6 months. Information on device-related events, hospitalizations and other clinical events were collected during remote checks and out-patient visits.
Results: A total of 11 patients were included in the study, male for 45.4%, with a mean age at PM implantation of 29.6±8.3 years. All patients presented incoercible AT before surgery. The PM stimulation was AAI for the 63.6% and DDD (complete AV block) for the 18.2%; the spontaneous rhythm was present in the 18.2% (backup VVI). During a mean follow of 7.2 years, the 90.9% (n=10) of the patients presented at least one episode of AT and 54.5% (n=6) had sustained AT episodes: in 2 cases AT were effectively treated with cardioversion, in other 2 cases AT episode was triggered by a clinical condition and spontaneously recovered in few hours, in one case the RM revealed asymptomatic paroxysmal atrial fibrillation and one case evolved in chronic atrial fibrillation. In 2 cases RM showed asymptomatic non sustained ventricular tachycardia. In 6 cases RM information led to change the antiarrhythmic therapy.
Conclusions: The RM proved to be extremely useful in the EFC population to recognize asymptomatic atrial and ventricular arrhythmias and to guide medical therapy.