Permanent pacing in patients with univentricular heart

Patients with one of several varieties of malformation designated as "unive ntricular hearts" may be especially challenging when permanent pacing is re quired. Our objective was to review our experience in this subset of patien ts that had undergone permanent pacing and thus determine the optimal appro ach. A retrospective chart review was done of 32 patients with some variety of "univentricular" malformation who had required permanent pacing at our institution. Although technically challenging, permanent pacing in this gro up of patients can be successful through several approaches. The various ap proaches, as well as consideration of the differences that exist between pa tients undergoing septation and those undergoing a Fontan procedure are dis cussed. Although long-term permanent pacing is possible in this group of pa tients, before pacing begins, a thorough understanding of the anatomy and p rior surgical procedures is necessary. Use of a combined atrial transvenous and ventricular epicardial pacing system may work well for some patients. With the development of newer and more reliable coronary sinus leads, dual chamber transvenous pacing with ventricular stimulation via the coronary si nus could become the approach of choice in some patients with "univentricul ar hearts."