First Report on Atrial Leadless Pacing in a Lateral Tunnel Fontan Patient

Area of Science:

• Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• The Fontan procedure is a complex surgical palliation for single-ventricle congenital heart defects.
• Sinus node dysfunction and bradycardia can occur in Fontan patients, necessitating pacing.
• Leadless pacing offers a potential alternative to transvenous or epicardial pacing systems.

Purpose of the Study:

• To evaluate the feasibility and initial outcomes of atrial leadless pacing in a patient with a Lateral Tunnel Fontan palliation.
• To address symptomatic bradycardia in a Fontan patient with a history of epicardial lead issues.

Main Methods:

• Retrospective case review of a single patient with a Lateral Tunnel Fontan.
• Utilized an atrial leadless pacing system for bradycardia management.
• Monitored pacing parameters, sensing, impedance, and clinical status post-implantation.

Main Results:

• Successful implantation of an atrial leadless pacing system in a 32-year-old male with a history of complex congenital heart surgery.
• Achieved 98% atrial pacing at 4-month follow-up with stable and adequate pacing parameters.
• Demonstrated no intracardiac thrombus and estimated device longevity of over 17 years.

Conclusions:

• Atrial leadless pacing is a feasible option for managing symptomatic bradycardia in patients with a Lateral Tunnel Fontan.
• Long-term safety and efficacy require evaluation in larger patient cohorts.
• This case highlights a novel approach for pacing in complex Fontan physiology.