Fontan circulation is a surgically created heart pathway for children born with complex congenital heart disease and only one functioning ventricle.
The leadless pacemaker is placed inside the heart through a vein in the leg.
The recent breakthrough cases demonstrate that atrial leadless pacing is possible and can be implanted in the upper chamber of a patient’s heart — something that had never been done in someone with a lateral tunnel Fontan.
These procedures may offer a safer, more durable solution for patients who commonly experience slow heart rates, pauses or irregular heart rhythms following Fontan surgery. Instead of surgically replacing the leads with a traditional pacemaker, the UC Davis Health team implanted a leadless pacemaker,Abbott’s Aveir VR device, a capsule-sized device placed inside the heart through a vein in the leg. It eliminates the need for wires, which are typically placed through open heart surgeries. The leadless pacemaker is predicted to last for more than 17 years.
“These cases show that atrial leadless pacing can be performed safely within a lateral tunnel Fontan and extracardiac Fontan and may offer meaningful advantages for patients who have exhausted traditional pacing options,” said Cortez, lead author of the journal reports. “Given the high prevalence of sinus node dysfunction in single-ventricle patients and challenges with epicardial leads, this technology could be a much-needed alternative.”
Fontan patients often face limited pacing options due to altered cardiovascular anatomy, elevated risk of clotting and challenges after multiple prior surgeries. Leadless pacemaker systems, which are smaller in size, may reduce risks of complications.
“These cases expand what we believed possible for Fontan patients and gives hope for a better quality of life for single ventricle patients,” added Cortez, who has since successfully implanted leadless pacemakers in other Fontan patients.
