Epicardial atrial pacing after the extracardiac Fontan operation: Feasibility of an entirely transvenous approach

Abstract

This series describes an innovative technique for pacing in patients with sinus node dysfunction after extracardiac Fontan surgery. This transpulmonary approach to the left atrial epi-myocardium has been successfully applied to three patients at two centers and resulted in excellent acute and midterm pacing characteristics without known complications. The principal advantage of this procedure in comparison to prior iterations is the absence of pacing material within the pulmonary venous atrium, so that future systemic thromboembolism risk is minimized. The transpulmonary approach for permanent atrial pacing offers a novel solution to the unique challenges for patients after extracardiac Fontan operation.

Fontan Junctional Rhythm—Innocent Bystander or Silent Killer?

“…Unfortunately, the extracardiac Fontan is currently favored by most cardiac surgeons . AP in this situation, therefore, requires either thoracotomy or other innovative approaches reported by a few centers . Endocardial pacing can also promote thrombus formation around the lead with embolization to the lungs or the systemic circulation .…”

Treatment of arrhythmia disorders in the adult with congenital heart disease: A lesion-specific review

“…It involves accessing the venous system and advancing to the left pulmonary artery through the extracardiac Fontan. Then, the pulmonary artery is punctured inferiorly, and the lead tip is left in the intrapericardial space on the epicardial surface of the left atrium [41]. This technique is not routine and currently, most patients with an extracardiac Fontan circuit receive epicardial leads.…”