title: Long-term outcomes of cardiac pacing in adults with congenital heart disease.
abstract: OBJECTIVE
  The purpose of this retrospective study was to define long-term outcomes after pacemaker therapy in adults with congenital heart disease (CHD).
  
  
  BACKGROUND
  Adults with CHD represent a unique and expanding population. Many will require pacemaker or implantable defibrillator therapy, with a lifelong need for re-intervention and follow-up. They pose technical and management challenges not encountered in other groups receiving pacing, and the complication and re-intervention rates specific to this population are not well-defined.
  
  
  METHODS
  We reviewed outcomes of 168 adults with CHD, 89 females, mean age 40 years, in whom a pacemaker or anti-tachycardia device was implanted.
  
  
  RESULTS
  Mean age at implant was 28 years with mean pacing duration 11 years at follow-up (range, 0.5 to 38.0). Seventy-two (42%) received initial dual-chamber devices and remained in this mode, while 23 (14%) went from ventricular to dual-chamber pacing in follow-up. Initial mode of pacing did not have a significant effect on subsequent atrial arrhythmia. Patients receiving an initial epicardial system were younger than those paced endocardially (17 +/- 12 years vs. 35 +/- 16 years, p < 0.001) and more likely to undergo re-intervention (p = 0.019). Difficulty with vascular access was encountered in 25 patients (15%), while 45 (27%) experienced lead-related complications. No significant predictors of lead complications were identified.
  
  
  CONCLUSIONS
  Lead complications were not significantly different for epicardial versus endocardial, nor physiologic versus ventricular pacing, but a trend toward improved lead survival in patients receiving endocardial leads at first implant was observed. Adults with CHD remain at risk for atrial arrhythmias regardless of pacing mode.
authors.affiliation: Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Walker
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Siu
authors.forename: Shane
authors.initials: S
authors.lastname: Woods
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Cameron
authors.forename: Gary D
authors.initials: GD
authors.lastname: Webb
authors.forename: Louise
authors.initials: L
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017147:Defibrillators, Implantable; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome