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

Abstract

Introduction: No reports on atrial leadless pacing have been demonstrated in patients with the Fontan palliation. We present the case of a patient with a Lateral tunnel Fontan palliation with leadless pacing system for symptomatic bradycardia in the setting of sinus node dysfunction.

Methods: After internal review board approval, a retrospective case review was performed with follow-up of atrial leadless pacing in a patient with a Lateral tunnel Fontan.

Results: A 32-year-old male with a medical history of tricuspid atresia status post: Blalock-Taussig Shunt (BT) shunt, Glenn procedure, and Fontan surgery at 5 years of age presented with persistent atrial flutter and a history of symptomatic heart failure in the setting sick sinus syndrome with a dual chamber epicardial pacemaker procedure. After ablation of his intra-atrial re-entrant tachycardia he continued with symptomatic bradycardia in the setting of epicardial lead fracture. Implant values demonstrated an atrial threshold of 1 Volts (V) at 0.4 ms (ms), impedance at 820 ohms and sensing at < 1 mV. He was programmed AAIR (VVIR) 80-130 bpm, rate response of 2/7, and discharged on apixaban 5 mg twice a day. Follow-up at 4 months demonstrated no intracardiac thrombus, 98% atrial pacing, threshold of 0.75 V@0.15 ms, impedance of 590 ohms, and R-wave of 2.5 mV. The estimated device longevity was 17.2 years.

Conclusion: Atrial leadless pacing is feasible in the lateral tunnel Fontan. Larger patient population data sets are needed to assess safety of this type of pacing long-term.

Keywords: Fontan; atrial pacing; leadless pacemaker.