Cardiac Implantable Electronic Devices in the Fontan Patient

Transcarotid implantation of a leadless pacemaker in a patient with Fontan circulation

“…The evidence for CRT in the Fontan population is limited and CRT implant may be very difficult to achieve. 12 Implantable cardioverter-defibrillator implant may be equally challenging 12 ; therefore, consideration of a subcutaneous device may be required.…”

Subcutaneous defibrillator use with unipolar pacemakers: Cautiously possible

“…Furthermore, when indicated, implantation is frequently limited by issues with venous access to a non-systemic ventricle [ 3 ]. The advent of the subcutaneous ICD (S-ICD) allows the easier insertion of an ICD which otherwise would have required a sternotomy or transvenous lead in a non-classical position [ 4 ]. However, the S-ICD remains a contraindication in patients with unipolar pacemakers due to concerns of over or under-sensing ventricular arrhythmia [ 5 , 6 ].…”