Transvenous Pacemaker Implantation 22 years after the Mustard Procedure

Abstract

We implanted a permanent transvenous pacemaker to a patient with d-transposition of the great arteries (TGA) 22 years after the Mustard procedure. The patient was a 23-year-old male who had undergone the Mustard procedure at one year of age. Although he was asymptomatic during regular follow-up at our outpatient clinic until the last visit 3 months earlier, advanced atrioventricular (AV) block with sporadic complete AV block was observed. He underwent transvenous pacemaker implantation after venography for confirmation of anatomical relationship of cardiac chambers and absence of venous stenosis. The ventricular lead was anchored at the left ventricular apex, and the atrial lead was anchored at left atrial roof to avoid phrenic nerve stimulation. Screw-in leads were selected for reliable fixation. A pacemaker with a more physiological rate response function with dual sensors was selected for the bradyarrythmia. The patient was able to resume his active daily life.

Keywords

• Atrial switch operation
• Advanced AV block
• Screw-in lead