Permanent transvenous left ventricular endocardial pacing in a patient with univentricular atrioventricular...

Area of Science:

• Cardiology
• Congenital Heart Disease
• Electrophysiology

Background:

• Chronotropic incompetence (CI) is linked to poor exercise capacity and mortality in cardiac patients, including those with congenital heart disease (CHD).
• Pacing in complex CHD patients can be challenging due to limited access and surgical risks.
• Limited therapeutic options exist for symptomatic CI in highly complex CHD cases.

Observation:

• A patient with complex CHD (tricuspid atresia, valvar/subpulmonary stenosis, Blalock-Taussig shunt) awaiting transplantation presented with symptomatic CI.
• Standard pacing approaches were considered difficult or undesirable.

Findings:

• A transvenous endocardial pacing strategy was successfully employed to manage symptomatic CI in this complex CHD patient.
• This approach provided effective palliation where other options were limited.

Implications:

• Transvenous endocardial pacing may serve as a viable alternative for select CHD patients with CI and limited pacing access.
• This case highlights a potential strategy to improve quality of life and manage symptoms in challenging CHD populations.
• Further investigation into this pacing technique for complex CHD is warranted.