Pacing in adults with complex congenital heart disease: A narrative minireview

Abstract

Congenital heart disease (CHD) is a growing health care problem, as more pediatric patients survive to adulthood every year as the number of patients with complex conditions also increases. As more patients survive, there has been an increase in the need for pacemaker procedures. Historically, there has been a focus on epicardial pacing in the most complex groups. In this review, we examine the background epidemiology, existing evidence for pacing, extraction data in three of the most complex CHD groups- transposition of the great arteries with an atrial switch procedure, patients palliated with a Fontan procedure and univentricular hearts. In this expert narrative review, we have used a broad search strategy of PubMed supplemented with evidence where available from non-congenital cohorts. The evidence in these most complex cohorts can be limited to expert centre opinion, small numbers and mixed paediatric/adult data. We discuss below the available data, the limitations and the novel approaches available in centres to deal with the most complex conditions such as conduction system pacing and leadless pacing with promising results albeit in expert centres only. Whilst current applicability to a wider range of institutions is not yet suggested by the paper, this review hopefully illustrates potential options for consideration and research in the future.

Keywords: Pacing; Leadless pacemaker; Conduction system pacing; Congenital heart disease; Extraction; Baffle puncture

Core Tip: Newer technologies and techniques exist, such as leadless pacing and conduction system pacing, which can be used even in the most complex congenital heart disease cohorts to address needs where traditional techniques such as epicardial pacing are not possible. Long-term data is required to determine whether these techniques will translate into superior outcomes in the years ahead.