Pacemaker Lead Placement via Transmural Approach in an Adult With Palliated Single Ventricle Heart Disease

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Device Technology

Background:

• Palliated single ventricle patients often require epicardial pacemakers for dysrhythmia management.
• Repeated device hardware replacement is a significant challenge due to lead issues and device failure.
• 3-dimensional imaging offers potential for novel interventional approaches.

Purpose of the Study:

• To describe a novel endocardial pacemaker lead placement technique in a patient with extracardiac Fontan circulation.
• To evaluate the utility of 3D-printed models for procedural guidance in pacemaker implantation.
• To present an alternative strategy for managing pacemaker lead issues in single ventricle physiology.

Main Methods:

• A patient with extracardiac Fontan circulation underwent pacemaker lead implantation.
• A transmural approach was utilized for endocardial lead placement.
• A 3D-printed cardiac model was used for pre-procedural planning and guidance.

Main Results:

• Successful placement of an endocardial atrial pacemaker lead was achieved.
• The 3D-printed model facilitated procedural navigation and lead positioning.
• This approach potentially mitigates challenges associated with epicardial lead replacement.

Conclusions:

• Transmural, image-guided endocardial lead placement is a feasible alternative for pacemaker management in single ventricle patients.
• 3D-printed models enhance procedural accuracy and safety for complex cardiac interventions.
• This technique may reduce the need for repeated epicardial device hardware replacement.