Permanent Pacing in a Patient With Fontan Circulation: Use All You Have at Your Discretion

Area of Science:

• Cardiology
• Pediatric Cardiology
• Cardiac Electrophysiology

Background:

• Fontan circulation is a complex surgical palliation for single-ventricle congenital heart defects.
• Patients with Fontan circulation often require permanent pacemakers due to arrhythmias.
• Historically, epicardial pacemaker implantation has been the predominant method in this population.

Observation:

• Permanent pacemaker implantation in Fontan patients poses technical difficulties.
• The majority of Fontan patients receive surgically implanted epicardial pacemakers.
• Transvenous pacemaker implantation is a viable alternative.

Findings:

• Transvenous pacemaker implantation is technically feasible in patients with Fontan circulation.
• Successful transvenous implantation requires careful consideration of individual patient anatomy.
• Physicians must be aware of diverse anatomical variations and available pacing strategies.

Implications:

• Transvenous pacing offers a potentially less invasive option for pacemaker implantation in Fontan patients.
• Tailored approaches considering individual anatomy are crucial for successful pacemaker implantation.
• Enhanced understanding of transvenous feasibility may expand treatment options for Fontan patients requiring pacing.