Trans-aortic His bundle ablation with permanent ventricular pacing via the coronary sinus in L-transposition of great arteries with classic Fontan procedure.

We report findings in a patient with 1-transposition of great arteries with single ventricle and classic Fontan procedure who required both His bundle ablation for palliation of refractory atrial tachycardia and placement of a transvenous dual-chamber atrio-ventricular permanent pacemaker for hemodynamic support. A method for retrograde trans-aortic His bundle ablation in this congenital anomaly and subsequent placement of permanent dual chamber pacemaker using the right atrium and coronary sinus as an access to the ventricle is described.