Introduction
Sinus node dysfunction and the need for atrial pacing is common in patients with Fontan palliation.1-3 Pacemaker implantation in patients with Fontan palliation is challenging as, with modern Fontan procedures, the venous circulation is directed to the pulmonary arteries with a conduit, bypassing the systemic atrium.2-5 This anatomy makes placement of a pacing lead via the typical venous routes nearly impossible. Epicardial leads are often placed at the time of the Fontan procedure to manage the sinus node dysfunction that is common in these patients. However, when the pacing lead(s) fail, the options to provide atrial rate support are very limited. We present a case report of a severed epicardial atrial lead that was salvaged using an IS-1 to IS-1 lead extender. The patient’s worsening failing Fontan physiology precluded him undergoing a fifth time re-do sternotomy for epicardial lead placement or a complex intravascular lead placement procedure. The aim of this case report is to show how lead extenders can be used to salvage severed pacemaker leads in patients that need pacing and in whom implantation of new leads is not promptly feasible due to anatomical limitations and/or clinical status.