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.