Pediatric Cardiology

, Volume 39, Issue 7, pp 1476–1483 | Cite as

Longitudinal Outcomes of Epicardial and Endocardial Pacemaker Leads in the Adult Fontan Patient

  • Geoffrey D. Huntley
  • Abhishek J. Deshmukh
  • Carole A. Warnes
  • Suraj Kapa
  • Alexander C. Egbe
Original Article


Placement of an epicardial pacemaker system is often preferred over an endocardial system in patients who have undergone a Fontan operation, but data are limited on how these two systems perform over time in patients with Fontan palliation. We performed a retrospective review of adults with Fontan palliation who had pacemaker implantation and interrogation data at Mayo Clinic from 1994 to 2014. Lead parameters, pacing mode, and polarity were collected at the earliest device interrogation report. Clinic notes and device interrogation reports were reviewed at implantation, 6 months, and yearly after implantation to determine impedance, capture threshold (CT), and energy threshold (ET). There were 87 patients with 168 leads in the study cohort. The mean follow-up time was 7.7 years (6 months–19 years). There were 143 epicardial leads (57 atrial and 86 ventricular) and 25 endocardial leads (20 atrial and 5 ventricular). There was no difference in the baseline lead parameters between epicardial and endocardial leads for impedance (610 ± 259 versus 583 ± 156 Ω, p = 0.93), CT (2.0 ± 1.3 versus 1.8 ± 1.3 V, p = 0.28), or ET (7.1 ± 12.5 versus 6.8 ± 18.1 µJ, p = 0.29). Compared to endocardial leads, ventricular epicardial leads were associated with temporal decrease in impedance and increase in ET. Regarding clinical outcomes, epicardial leads had higher rates of failure but similar generator longevity in comparison to endocardial leads. Ventricular epicardial leads were associated with temporal decrease in impedance and increase in ET. Epicardial leads had a higher rate of failure but similar generator longevity compared to endocardial leads.


Fontan palliation Adult congenital heart disease Pacemaker Epicardial leads Transvenous leads Capture threshold 


Author Contributions

GDH contributed to concept/design, data analysis/interpretation, drafting article, and statistics. AJD contributed to concept/design and critical revision of article. CAW contributed to concept/design and approval of article. SK contributed to concept/design and critical revision of article. ACE contributed to concept/design, data interpretation, drafting article, and critical revision of article.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Geoffrey D. Huntley
    • 1
  • Abhishek J. Deshmukh
    • 2
  • Carole A. Warnes
    • 2
  • Suraj Kapa
    • 2
  • Alexander C. Egbe
    • 2
  1. 1.School of MedicineMayo ClinicRochesterUSA
  2. 2.Department of Cardiovascular DiseasesMayo ClinicRochesterUSA

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