Novel Technique of Dual Chamber Pacing Through Mini-thoracotomy and Transatrial Endocardial Active Fixation Lead Insertion for Epicardial Pacing Lead Malfunction

Epicardial pacing lead fixation is employed in patients with cavopulmonary anastamosis (Glenn shunts) when they need permanent pacing. Epicardial pacing in these patients may malfunction due to high pacing thresholds or diaphragmatic pacing. A novel technique of transatrial insertion of two endocardial screw-in pacing leads through right anterolateral minithoracotomy could achieve synchronous atrioventricular pacing in a patient with Ebsteins anomaly with symptomatic sinoatrial and atrioventricular nodal disease.