We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Transpulmonary Atrial Pacing: An Approach to Transvenous Pacemaker Implantation After Extracardiac Conduit Fontan Surgery.
- Authors
MOORE, JEREMY P.; SHANNON, KEVIN M.
- Abstract
Transpulmonary Atrial Pacing Introduction Patients with prior extracardiac (EC) conduit Fontan surgery are considered ineligible for transvenous atrial pacemaker implantation due to lack of venous access to the atrial myocardium. A new technique for atrial lead placement in the setting of this surgical anatomy is proposed. Methods and Results A 30-year-old female with prior EC Fontan surgery, incessant supraventricular tachycardia, sinus node dysfunction, and multi-organ failure was admitted to our hospital. After placement of a transvenous lead in the left pulmonary artery (LPA) for temporary pacing with ensuing clinical improvement, the patient was taken back to the catheterization laboratory for definitive treatment. After ablation of the supraventricular tachycardia and 3D mapping of the common atrium, a puncture through the LPA and into the left-sided atrium was performed. A transvenous lead was then attached to the base of the left-sided appendage where excellent pacing and sensing characteristics were observed. Follow-up transesophageal echocardiography revealed stable lead placement and absence of pericardial effusion. The patient was discharged to home several days later on warfarin therapy. Conclusions Transpulmonary access to the left-sided atrium for patients with prior EC Fontan surgery is a feasible strategy for transvenous atrial pacing. Lead placement in this location is associated with excellent pacing characteristics and involves a limited segment of lead within the pulmonary venous atrium. The approach is technically straightforward and avoids the need for surgical pacemaker placement.
- Subjects
SUPRAVENTRICULAR tachycardia; CARDIAC pacemakers; CATHETER ablation; CONGENITAL heart disease; ECHOCARDIOGRAPHY; ELECTROCARDIOGRAPHY; ELECTRODES; ARTIFICIAL implants; WARFARIN; THERAPEUTICS
- Publication
Journal of Cardiovascular Electrophysiology, 2014, Vol 25, Issue 9, p1028
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.12447