Leadless pacemaker implantation in a patient with complex congenital heart disease and limited vascular access.

Management of rhythm related issues might be particularly challenging in patients with congenital heart disease due to complex anatomy and restricted vascular access. The leadless technology appears a suitable and attractive alternative for this population. We describe a patient with single ventricle physiology who successfully underwent implantation of a leadless pacemaker.

Physical activity levels in adults with congenital heart disease.

BACKGROUND: Regular physical activity is associated with many health benefits in patients with cardiac disease. Advances in treatment have resulted in an increasing population of adults with congenital heart disease. Few data are available on physical activity levels and attitude to exercise in this group. DESIGN: Prospective, cross-sectional study of patients attending the adult congenital heart disease clinic in a supra-regional centre. METHODS: Physical activity assessed over 1 week using two accelerometers. The Actigraph was used to measure total activity volume and intensity and the Caltrac used to measure energy expenditure in physical activity. Patients completed a questionnaire to assess exercise self-efficacy. RESULTS: In all, 61 adults recruited (36 male; mean-age 31.7+/-10.9 years); divided into three groups according to New York Heart Association class [Group I (n=26; 14 male), Group II (n=18; 10 male), Group III (n=17; 11 male)]. Fourteen patients were overweight (body mass index 25-29.9) and seven obese (body mass index>30). Group 1 achieved similar activity levels to a sedentary reference population. Group II and III had significantly lower activity (55 and 40% of Group I). Most study patients failed to achieve UK national guidelines for physical activity (Groups I: 77%, II: 84%, III: 100%). Despite this, questionnaire responses suggested a willingness to participate in exercise in the majority of each group. CONCLUSIONS: Adults with congenital heart disease have a range of physical activity levels between normal and severely limited. Most patients showed a willingness to participate in exercise but were uncertain of the safety or benefit. Intervention to increase physical activity levels may be a low risk, low cost treatment strategy.