Madalena Coutinho-Cruz et al. Guilherme Portugal Pedro Silva-Cunha Mário Martins-Oliveira
Case Report
A 29 year-old female patient with double inlet left ventricle, ventricle septal defect, malposition of the great arteries and subpulmonary obstacle, submitted to a modified Fontan procedure, at 9 years of age, presented with severely symptomatic brady-tachy syndrome (palpitations and syncope). Since venous access to the right ventricle was absent (due to the surgical redirection of venous blood flow from the right atrium to the pulmonary artery bypassing the ventricles) and the AV conduction was normal, it was decided to implant a permanent atrial pacemaker. A single active fixation lead was placed in the right atrial lateral wall, due to suboptimal pacing threshold in the atrial appendage. Due to concerns that either the progression of the conduction system disease or the effect of heart rate-slowing medication could lead to AV conduction disease, which would require an epicardial lead later on, a Sorin Reply 200 DR pulse generator with a plug in the ventricular port was used. The day after the procedure, the patient complained of palpitations. shows the ECG tracing performed.
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