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

O’Leary, Edward T.; Alexander, Mark E.; Fynn‐Thompson, Francis; Mah, Douglas Y.

doi:10.1016/j.hrcr.2016.07.006

Cited by 14 publications

(13 citation statements)

References 11 publications

(15 reference statements)

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“…Atrial leads can be delivered epicardially with surgical approaches or, in select cases of intracardiac conduits, transvenously with complex interventions that involve puncture of the Fontan conduit 2–5 . Case reports are available that describe transvenous lead implantation in patients with extracardiac Fontan conduits 4,5,9,10 . Any attempt for transvenous lead delivery in patients with Fontan palliation requires an experienced operator with an in‐depth understanding of the patient′s anatomy and the details of previous surgeries.…”

Section: Discussionmentioning

confidence: 99%

Salvage of an epicardial lead in a pacemaker‐dependent patient with Fontan palliation using an IS‐1 extender

Aronis

Mettler

Love

et al. 2020

Cardiovasc electrophysiol

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We present a case report of severed epicardial atrial lead salvage using an IS‐1 lead extender. A 37‐year‐old male with single ventricle physiology, Fontan palliation, sinus node dysfunction, recurrent atrial tachycardias, and atrial fibrillation resulting in failing Fontan physiology presented with failure of the atrial pacing lead. The patient was initially paced with an epicardial system that had to be removed due to pocket infection, and the epicardial leads were cut and abandoned. Given his significant sinus node dysfunction he required atrial pacing to allow for rhythm control. The failing Fontan physiology of the patient precluded him from undergoing surgery for epicardial lead placement or a complex intravascular lead placement procedure (although anatomically feasible). We considered the option of salvaging the existing epicardial atrial leads to provide atrial pacing, allowing for rhythm control and improvement of his failing Fontan physiology as a bridge to a more permanent pacing solution. This case report is important because it demonstrates how a lead extender can be used to salvage a severed pacemaker lead. This may be useful for patients in whom implantation of new leads is not promptly feasible due to patient anatomy and/or clinical status.

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Section: Discussionmentioning

confidence: 99%

Salvage of an epicardial lead in a pacemaker‐dependent patient with Fontan palliation using an IS‐1 extender

Aronis

Mettler

Love

et al. 2020

Cardiovasc electrophysiol

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“…A growing need for transvenous pacing options has been identified in univentricular hearts palliated with a Fontan-type operation. [ 2 3 4 5 6 7 8 9 ] When the Fontan palliation involves an ICLT, transvenous atrial pacing using atrial tissue in the lateral tunnel is now well established. [ 2 ] In this population (ICLT Fontan), if the coronary sinus drains into the Fontan pathway, ventricular pacing through the coronary sinus can be achieved.…”

Section: Discussionmentioning

confidence: 99%

“…When epicardial pacing options are exhausted, transvenous atrial and/or ventricular pacing strategies become necessary and have been described both after ICLT and TCPC. [ 2 3 4 5 6 7 8 9 ] We report a 1-year follow-up of a novel approach for the placement of transvenous leads from a typical left prepectoral pocket without requiring any additional manipulations described in the previous reports.…”

Section: Introductionmentioning

confidence: 94%

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

et al. 2018

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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.

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“…5 We hypothesised that this technology may facilitate the identification of atrial tissue with satisfactory sensing and pacing thresholds within a patient's Fontan baffle where limited mobility and diffuse scar is present. 6 Here we report a case of a patient with a Fontan palliation for complex cyanotic CHD in whom epicardial pacing was thought to carry an excessive risk due to exuberant scarring around the heart noted during prior surgeries who underwent electroanatomic voltage mapping and real-time 3-dimensional anatomic mapping to guide a transvenous single chamber lead placement within their Fontan baffle.…”

mentioning

confidence: 99%

“…11 The risk of thrombosis is believed to be higher in the presence of pacing leads within the baffle requiring initiation of anticoagulation therapy. 6 This becomes particularly important when the transvenous pacing approach is utilised for a fenestrated Fontan which has the additional risk of an embolic stroke as the baffle "pops off" into the pulmonary venous atrium. Hence, it is paramount to weigh these risks against the potential benefit of avoiding a repeat sternotomy.…”

mentioning

confidence: 99%

Voltage mapping to guide pacemaker placement in patients with CHD

2019

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Transvenous pacemaker implantation for sinus node dysfunction in patients with Fontan palliation presents the difficulty of finding suitable pacing tissue and the potential of causing vascular obstruction in a low-flow circuit. We describe a patient who underwent electro-anatomic voltage mapping to guide a transvenous single chamber lead within her Fontan baffle. This highlights the use of advanced mapping technologies for pacemaker implantation in complex cyanotic heart disease.

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

Cited by 14 publications

References 11 publications

Salvage of an epicardial lead in a pacemaker‐dependent patient with Fontan palliation using an IS‐1 extender

Salvage of an epicardial lead in a pacemaker‐dependent patient with Fontan palliation using an IS‐1 extender

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

Voltage mapping to guide pacemaker placement in patients with CHD

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