Background: Patients with congenital heart disease and subsequent surgical corrections pose challenges for pacemaker lead placement due to abnormal venous anatomy, as well as myocardial scar.
Objective: We report of the use of 3D electroanatomic mapping at time of pacemaker placement from the device pocket due to limited venous access from interrupted IVC.
Results: A 36 year old female with a past medical history of left-sided isomerism with a common atrium status post surgical repair at 7 months old, as well as interrupted IVC, presented for pacemaker placement due to chronotropic incompetence from underlying sinus node dysfunction. Her left sided upper extremity veins demonstrated normal course and patency by pre-procedural CT imaging and venography. As difficulty in finding an adequate location for the right atrial lead was anticipated due to prior surgical scar, baseline voltage mapping of the right atrium was performed with a multipolar PENTARAY catheter (CARTO, Biosense Webster) through a 9F axillary sheath from the pocket venotomy site. Right atrial voltage map demonstrated normal voltage within the right atrial appendage. Merged fluoroscopy and electroanatomic data (CARTOUNIVU Module) facilitated easy and efficient right atrial lead placement with decreased radiation exposure (see figure). Adequate pacing and sensing were confirmed after lead placement.
Conclusion: While many individuals with congenital heart disease require CIEDs, issues often arise during implant with regards to access and lead placement. Utilization of 3D electroanatomic mapping at time of device implant from pocket access can facilitate safe and efficient lead placement.