Why the study?
The Fontan procedure eliminates direct venous access to the ventricle and complicates implantable cardioverter-defibrillator placement.
Is a novel transvenous approach to ICD placement feasible in patients with atriopulmonary Fontan?
Is a novel transvenous approach to ICD placement feasible in patients with atriopulmonary Fontan?
A novel transvenous ICD implantation approach using the coronary sinus and right atrium offers a feasible alternative to epicardial leads in patients with atriopulmonary Fontan, avoiding the need for redo sternotomy.
May enable transvenous ICD placement in Fontan patients; leaves open need for safety and efficacy validation.
INTRODUCTION: The Fontan procedure, used to palliate univentricular physiology, eliminates direct venous access to the ventricle and complicates implantable cardioverter-defibrillator (ICD) placement. METHODS AND RESULTS: We describe two patients with Fontan palliation who underwent a novel transvenous approach to ICD placement. The approach uses a transvenous bipolar lead placed in a coronary sinus branch for ventricular sensing, and a defibrillation lead placed in the right atrium for atrial sensing and ventricular defibrillation. CONCLUSION: Transvenous ICD implantation is possible in some patients with an atriopulmonary Fontan. This approach avoids a redo sternotomy for epicardial leads and excludes the need for lead placement in the systemic circulation.
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Padanilam et al. (2021) studied this question.
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