Endocardial Pacing After Fontan‐Type Procedures

Abstract

Transvenous endocardial lead implantation avoids the problem of increasing capture thresholds typically observed with epicardial leads. Due to its high tensile strength and lumenless design, the isodiametric lead is expected to remain extractable for an extended period of time.

The Spectrum of Long-term Electrophysiologic Abnormalities in Patients with Univentricular Hearts

“…A transvenous pacemaker approach has been utilized in a small number of patients with good short‐term follow‐up 25–27 . The major concern for the transvenous approach is the potential for clots to form around the pacing lead.…”

Interventional Electrophysiology in Patients With Congenital Heart Disease

“…Transvenous ventricular pacing can sometimes be accomplished with a lead advanced into a ventricular branch off the coronary sinus in patients with the old variety of atriopulmonary Fontan anastomosis, but this option is not available for those with modern cavopulmonary connections. 95,96 The venous route to the atrium and ventricle in Mustard or Senning patients is likewise challenging. Transvenous leads need to be advanced through the atrial baffle before fixation in the modified right atrium and the anatomic left ventricle, and it is not uncommon to encounter tight obstruction along the upper limb of the baffle that requires dilation and stent placement before leads can be passed.…”

Transvenous approach to pacemaker lead implantation for sinus node dysfunction after extracardiac lateral tunnel Fontan conduit placement

“…A transvenous lead can spare the patient a repeat sternotomy or thoracotomy and the potential for pleural or pericardial effusions, perioperative bleeding, and prolonged hospital stays that are known to complicate the epicardial approach in this population 9, 10. However, as illustrated in this case series, the acute benefits of a TV lead must be balanced with the patient’s risk for venous thromboembolism and potential for nonadherence with anticoagulation regimens 11 .…”