{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:40:12Z","timestamp":1791214812604,"version":"4.1.0"},"reference-count":12,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T00:00:00Z","timestamp":1694736000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fontan surgery, a palliative procedure for single ventricle patients, often leads to the need for permanent pacing. Epicardial pacing has limitations, while transvenous pacing carries risks in the Fontan circulation. This case series introduces a novel approach of leadless pacemaker implantation in the extra\u2010cardiac Fontan (ECF) cohort to overcome these limitations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study includes four cases of leadless pacemaker (Micra\u2122) implantation in patients with ECF. Procedures were performed under general anesthesia with guidance from trans\u2010esophageal echocardiography. Various access routes were used, including trans\u2010carotid and trans\u2010fenestration approaches. Procedural details, parameters, and follow\u2010up data were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All leadless pacemaker implantations were successful, with satisfactory electrical parameters and stable pacing postprocedural outcomes during short\u2010term follow\u2010up. One patient required closure of their fenestration for symptomatic desaturation post procedurally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Leadless pacemaker implantation via trans\u2010carotid and trans\u2010fenestration approaches appears to be a feasible back up option for pacing in Fontan patients where other options have been exhausted or there is a patient choice to avoid surgery. These techniques provide an option to avoid leaded systems or epicardial pacing, reducing the need for multiple thoracotomies and addressing challenges associated with surgical pacing leads. Further studies are needed to evaluate long\u2010term outcomes and assess the broader application of leadless pacemakers in the Fontan population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16072","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T08:45:53Z","timestamp":1694767553000},"page":"2386-2392","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Novel approaches for leadless pacemaker implantation in the extra\u2010cardiac Fontan cohort: Options to avoid leaded systems or epicardial pacing"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6052-6413","authenticated-orcid":false,"given":"Christopher J.","family":"Goulden","sequence":"first","affiliation":[{"name":"Liverpool Heart and Chest Hospital Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dibbendhu","family":"Khanra","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Llewellyn","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archana","family":"Rao","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Evans","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Ashrafi","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.07.065"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2003.00079.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2009.02365.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2020.03.019"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(02)03677-9"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2008.151985"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-017-0266-2"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ipej.2018.11.013"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jccase.2022.01.010"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2021.2621"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab767"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.14352"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.16072","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T03:45:22Z","timestamp":1700279122000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.16072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,15]]},"references-count":12,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1111\/jce.16072"],"URL":"https:\/\/doi.org\/10.1111\/jce.16072","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,15]]},"assertion":[{"value":"2022-11-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}