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.