Atrial pacing in Fontan patients: The effect of transvenous lead on clot burden

Complex Congenital Heart Disease in the Adult

“…Although placement of a transvenous atrial lead may be an option in classic or lateral tunnel Fontan, an epicardial pacing system is usually necessary in an extracardiac conduit because of a lack of direct communication with the right atrium. Unfortunately, the presence of an intravenous pacing lead can serve as a nidus for thrombus (49).…”

Use of an electroanatomic mapping system with high-density multipolar mapping catheters to guide transvenous atrial pacing lead implantation in a Fontan patient

“… 4 Patients with lateral tunnel or atriopulmonary variants of the Fontan operation have atrial tissue incorporated into the Fontan connection, and are candidates for a transvenous approach, though they must be carefully selected owing to potential increased risk of Fontan pathway thrombus. 5 Challenges with the transvenous approach include the use of ionizing radiation and difficulties related to identification of an adequate endocardial pacing site in the presence of significant scar within the Fontan pathway, both from surgery and from prior ablation attempts. 6 , 7 Electroanatomic mapping systems (EAM) are powerful tools that are widely available in electrophysiology laboratories.…”

Tempering the Storm of Arrhythmias in Adults With Congenital Heart Disease

“… 17 , 18 Vascular access limitations and lead‐related endocarditis and thromboembolism negatively impact transvenous pacing outcomes in the ACHD population. 19 Patient selection for primary prevention implantable cardioverter‐defibrillator placement remains challenging, and patients with ACHD are known to experience a substantial burden of implantable cardioverter‐defibrillator–related complications. 20 …”