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Percutaneous transhepatic dual chamber pacing in children with Fontan circulation
S S Adwani1, N Sreeram, J V DeGiovanni
1Department of Cardiology, Birmingham Children's Hospital NHS Trust, United Kingdom.
Insights
Dual chamber endocardial pacing was successfully achieved in two children with Fontan circulation using a transhepatic approach. This novel method offers a valuable alternative for patients lacking direct venous access for pacemaker implantation.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Congenital Heart Disease
Background:
- Permanent pacing is frequently necessary after the Fontan operation.
- Epicardial pacing is the conventional method due to limited systemic venous access to the ventricle.
Observation:
- Dual chamber endocardial pacing was performed via a transhepatic approach in two pediatric patients with Fontan circulation.
- The patients included a 7-year-old boy with complex single ventricle physiology and a 6-year-old girl with tricuspid atresia.
Findings:
- Successful endocardial pacemaker implantation was achieved using the transhepatic route.
- This approach bypasses the typical limitations of systemic venous access in Fontan patients.
Implications:
- The transhepatic approach represents a significant advancement for pacemaker implantation in Fontan patients.
- This technique may be crucial for patients with complex congenital heart defects and interrupted venous systems.
- It expands therapeutic options for managing bradyarrhythmias in this challenging population.
Abstract:
Permanent pacing is often required following the Fontan operation and is usually performed epicardially as there is no direct access to the ventricle from the systemic veins. Dual chamber endocardial pacing was achieved by the transhepatic approach in two children with Fontan circulation. The patients were a 7 year old boy with left atrial isomerism, single ventricle with pulmonary stenosis, interrupted inferior vena caval vein with azygous continuation, and direct drainage of the hepatic veins to the right sided atrium, and a 6 year old girl with tricuspid atresia. This approach to endocardial pacemaker implantation is potentially of considerable value in patients who do not have direct access to the ventricle from the systemic veins.