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. 2024 Jul 20;10(10):752–756. doi: 10.1016/j.hrcr.2024.07.016

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© 2024 Heart Rhythm Society. Published by Elsevier Inc.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Case 3 with adult congenital heart disease after unsuccessful atrial lead implantation with the stylet-based system. A: Unsuccessful AAI system with a stylet-based implantation. White arrow: Tined lead in the free wall of the right atrium. B: VVI system with left ventricular (LV) lead fixed to the anterior interventricular vein (AIV). White arrow: LV lead. C: Preimplantation voltage mapping of the RA chamber (right anterior oblique [RAO], anteroposterior [AP], and left anterior oblique [LAO]). Low-voltage area: <0.5 mV of bipolar voltage, scar: <0.01 mV. D: High IAS implantation with the S5 (LAO). White arrow: 3830 lead. E: Final fixation of the high IAS with the S4 (RAO, AP, LAO). White arrow: 3830 lead.