Chronotropic incompetence is associated with poorer effort tolerance and worse mortality outcomes, not only in the general cardiac population but also in patients with congenital heart disease. When present in complex patients, pacing options may be limited by difficult pacing access, and an open surgical approach for epicardial lead placement may not always be desirable. We describe a case of symptomatic chronotropic incompetence in a patient with tricuspid atresia, valvar and subpulmonary stenosis, normally related great vessels, and a modified Blalock-Taussig shunt, awaiting cardiac transplantation, whom we palliated with a transvenous endocardial pacing strategy. This technique may provide an alternative pacing strategy for highly selected patients, where few other treatment options are available.
Adult Arrhythmias, Cardiac