Salvage of an Epicardial Lead in a Pacemaker-Dependent Patient with
Fontan Palliation Using an IS-1 Extender.
We present a case report of severed epicardial atrial lead salvage using
an IS-1 lead extender. A 37-year-old male with single ventricle
physiology, Fontan palliation, sinus node dysfunction, recurrent atrial
tachycardias and atrial fibrillation resulting in failing Fontan
physiology presented with failure of the atrial pacing lead. The patient
was initially paced with an epicardial system that had to be removed due
to pocket infection, and the epicardial leads were cut and abandoned.
Given his significant sinus node dysfunction he required atrial pacing
to allow for rhythm control. The failing Fontan physiology of the
patient precluded him from undergoing surgery for epicardial lead
placement or a complex intravascular lead placement procedure (although
anatomically feasible). We considered the option of salvaging the
existing epicardial atrial leads to provide atrial pacing, allowing for
rhythm control and improvement of his failing Fontan physiology as a
bridge to a more permanent pacing solution. This case report is
important because it demonstrates how a lead extender can be used to
salvage a severed pacemaker lead. This may be useful for patients in
whom implantation of new leads is not promptly feasible due to patient
anatomy and/or clinical status.