Trans-Fontan baffle placement of an endocardial systemic ventricular pacing lead

Introduction Patients with single-ventricle physiology palliated to a Fontan can be at risk for high-grade atrioventricular block, necessitating permanent pacemaker placement. Historically, epicardial leads have been used for these patients given the concern for clot formation within the Fontan pathway or systemic ventricle. However, epicardial pacing systems are fraught with issues, including higher pacing thresholds and increased risk for lead failure. Given this, transvenous leads are being used more routinely for atrial pacing, with some case reports even reporting atrial leads within the pulmonary venous atrium. This is the first report of a transvenous ventricular lead in a Fontan patient.