Systemic venous atrium stimulation in transvenous pacing aft
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Introduction:
The mustard operation (MO) was a well-established method to correct the transposition of the great arteries before being superseded, in the recent years, by anatomic repair, the so called arterial switch operation. The procedure employs a pericardial baffle to change the direction of the blood flow from the systemic venous return to the left ventricle and pulmonary venous return to the right ventricle.
Disturbances of rhythm and conduction in patients undergoing MO-have been the focus of many studies. Occasionally a permanent pacemaker is needed especially for patients with symptomatic sick sinus syndrome.
Usually one electrode is put in the apex of the anatomic left (subpulmonary) ventricle and the atrial lead is fixed into the left atrial appendage.
Nonetheless, if the the systemic venous atrium does not include the left atrial appendage it is impossible to screw the atrial lead into the left atrial appendage. In addition, it is questionable whether, positioning the electrode in the systemic venous atrium, sensing capabilities are inadequate as the neo-atrium consists partially of pericardial tissue and whether the electrode remains in the correct position.

We present the case of a young woman corrected with a Mustard procedure undergoing successful transvenous double chamber pacemaker implantation with the atrial lead placed in the systemic venous channel.

Case report:
A 32-year-old female was born with a transposition of the great arteries (TGA), a large defect of the ventricular septum and a persistent ductus. At six months old she had a MO which involved closure of the defect of the ventricular septum and ductus arteriosus.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176796/
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