Extracardiac autologous pericardial tunnel Fontan allows implantation of an endocardial atrial lead for sinus node dysfunction.

Sinus node dysfunction is common after the Fontan procedure, and pacemaker implantation has been reported in 9.2% of Fontan patients. The two options for pacemaker implantation for sinus node dysfunction after the Fontan operation are epicardial lead placement, which allows for dual-chamber pacing, or transvenous atrial pacing. We report the first successful implantation of an endocardial atrial lead for sinus node dysfunction in a patient with an extracardiac lateral tunnel Fontan.