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Endocardial pacing in a single-ventricle patient with tricuspid atresia-a case report
Ahmad Yamini-Sharif1, Ramin Yaghoobian1, Homa Ghaderian1
1Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences Tehran Iran.
Insights
Transvenous endocardial pacing may be a viable option for patients with univentricular hearts and intracardiac shunts when combined with anticoagulation. This approach could offer a safer alternative to epicardial interventions in high-risk surgical candidates.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Electrophysiology
Background:
- Endocardial pacing in univentricular hearts with intracardiac shunts presents challenges due to thromboembolism risk.
- Epicardial interventions carry significant surgical risks for these complex patients.
Observation:
- A case of transvenous endocardial pacing through an atrial septal defect is presented.
- The patient had tricuspid atresia, transposition of the great arteries, severe pulmonary hypertension, and complete heart block.
Findings:
- This represents one of the first reported instances of transvenous endocardial pacing in a univentricular heart with an intracardiac shunt.
- Successful pacing was achieved via the atrial septal defect.
Implications:
- Transvenous endocardial pacing, with appropriate anticoagulation, may be a safer alternative to epicardial pacing in select high-risk patients.
- This technique expands pacing options for complex congenital heart disease patients.
- Further research is warranted to establish long-term safety and efficacy.
Key Clinical Message:
The use of endocardial pacing in patients with univentricular hearts and intracardiac shunts is limited, primarily due to the increased risk of thromboembolism. However, when accompanied by proper long-term anticoagulation therapy, it may be safer than epicardial interventions in selected patients at high risk for surgery.
Abstract:
We report transvenous endocardial pacing through the atrial septal defect in a patient with tricuspid atresia, transposition of the great arteries, severe pulmonary hypertension, and complete heart block. This study is among the first reported cases using this pacing method in a patient with a univentricular heart and intracardiac shunt.
