Introduction
Fontan circulation critically depend on pulmonary resistances and atrial
pressure. [1] It has been observed that during sinus rhythm blood
predominantly flow during atrial relaxation. Furthermore loss of
atrioventricular synchrony may lead to phasic increase of atrial
pressure which is transmitted to the Fontana circuit. [2] Heart
rhythm optimization is recognized as a pivotal component of the follow
up in this group of patients, while the impact of even self limited
period of junctional rhythm is less defined, particularly wether the
heart rate trend is acceptable.
We describe two cases of acute heart failure, after fenestrated total
cavo-pulmonary connection (TCPC) which resolved after 48 h of atrial
pacing. We demonstrated acute changes of Fontan flow pattern during the
two modality of pacing that strictly correlated with the clinical
status.