Novel direct approach for placement of permanent transvenous pacing leads after Fontan procedure

Abstract

The need for transvenous pacing (patients who have exhausted epicardial options) after a Fontan-type operation has been recognized. Many novel strategies have been proposed, but currently, all of them require additional maneuvers or rerouting of the leads to the pacemaker pocket. In this report, we describe a novel direct approach to transvenous pacing after a Fontan-type operation from a standard, prepectoral approach.

Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management

“…In the atriopulmonary Fontan surgery which is almost abandoned today, both the entire right atrial appendage and coronary sinus ostium are available for placing atrial and left ventricular leads [[45], [46], [47], [48]]. In the intracardiac lateral tunnel Fontan surgery with creation of an intra-atrial baffle through a part of the right atrial wall to direct the inferior vena caval blood to the pulmonary circulation, the atrial wall can be used for atrial pacing and the baffle fenestrated for gaining a ventricular lead [17,41]. Another modification is extracardiac lateral tunnel surgery where a portion of the epicardium of the right atrium that forms a part of the wall of the baffle leading up to the pulmonary artery anastomosis is used for pacing [49,50].…”